No. Coverage will cease when employment is terminated. However, termination of this policy will not affect any claim which was approved by us prior to termination, even if the start date of the leave is after the date this policy has terminated.

The qualifying reasons for OR PFML include all of the following reasons:

OR PFL:

• Family leave: To bond with a new child within the first 12 months after birth, adoption, or foster placement.
• Family leave: To care for a family member experiencing a serious health condition.

Family Violence:

• Safe leave: For survivors of sexual assault, domestic violence, harassment, or stalking to obtain legal or law enforcement assistance, seek medical treatment or recover from injuries, obtain counseling or support services, or relocate or take other steps to secure the health and safety of themselves or their dependent child.

OR PML:

• Medical leave: For an employee’s own serious health condition. Additional leave (limited to two weeks) due to a complication of pregnancy.

Family member means the following:

• A covered individual’s spouse or domestic partner;
• A child of the covered individual or covered individual’s spouse or domestic partner;
• A parent of the covered individual or covered individual’s spouse or domestic partner;
• A sibling or stepsibling of the covered individual or covered individual’s spouse or domestic partner;
• A grandparent of the covered individual or covered individual’s spouse or domestic partner;
• A grandchild of the covered individual or covered individual’s spouse or domestic partner; or
• Any individual related by blood or affinity whose close association with the covered individual is the equivalent of a family relationship.

The Taxable Wage Base for contributions is capped at 1% of the Social Security maximum wage base beginning 1/1/24.

$1,307.17. The State Average Weekly Wage is used to calculate the minimum and maximum benefit. The State Average Weekly Wage is effective from July 2024 to July 2025. The State Average Weekly Wage is subject to change annually.

The benefit year means a period of 52 consecutive weeks beginning on the Sunday immediately preceding the day that Family, Medical, or Safe Leave commences for the covered individual, except that the benefit year shall be 53 weeks if a 52-week benefit year would result in an overlap of any Calendar Quarter of the Base Year of a previously filed valid claim for benefits. A covered individual may only have one valid benefit year at a time.

No. There is no relapse period for leaves under this plan.

Yes, under Symetra’s insured plan, if the Policyholder requests reimbursement for a payment prior to making an advance benefit payment, we will send the Policyholder any PFML benefits due, or that become due for their advance payment of Family or Medical Leave benefits.

Yes. Leave is allowed on an intermittent or reduced leave schedule. Intermittent leave is leave taken in separate periods of time due to a single qualifying purpose, rather than for one consecutive period of time. Covered individuals can take paid leave in increments equal to one workday or one workweek. Examples of intermittent leave include:

• Leave taken on an occasional basis for medical appointments.
• Leave taken several days at a time spread over a period of months.

The minimum designated time period for approved intermittent leave cannot be in increments less than one workday. A covered individual who takes leave in workday increments shall be paid a prorated benefit amount based on the number of workdays of leave taken in the workweek.

• Intermittent or reduced leave for bonding requires employer agreement with the schedule.
• Intermittent or reduced leave for a serious health condition (whether the covered individual’s or family member’s) is allowed if medically necessary.
• Intermittent or reduced leave is allowed, as needed, for qualifying exigencies or family violence.

A covered individual who takes leave in workday increments shall be paid a prorated benefit amount based on the number of workdays of leave taken in the workweek.

The benefit amount paid for a workday is calculated by dividing the covered individual’s Weekly Benefit Amount by the average number of workdays that the covered individual would typically work in their workweek. The total benefit amount paid for leave taken in increments is calculated by multiplying the benefit amount paid for a workday by the number of workdays of leave taken for the workweek, rounded to the nearest whole cent, and not to exceed the Weekly Benefit Amount. Intermittent leave means the same as “nonconsecutive leave,” as used in the OR PFML statute and regulations.

Yes, however, the following conditions apply:

• A covered individual must work 90 days before taking leave to ensure reinstatement to the same or an equivalent position.
• Employers with less than 25 employees are permitted to restore the covered individual to a different position with equal benefits and pay.

Accrued paid leave benefits may be taken with OR PFML and will not reduce the OR PFML Weekly Benefit Amount.

An employer cannot require a covered individual to take accrued paid leave prior to accessing OR PFML benefits.

• Oregon’s private plan must be filed with and approved in advance by the department. Symetra can help you with any questions you may have on the exemption process and provide you with the documentation you need to complete the filing.
• It is an employer responsibility to file an equivalent plan exemption application with the department and provide any supporting documentation required to obtain and maintain approval of the private plan exemption.
• A copy of this equivalent plan policy must be submitted in France Online for the department to approve an equivalent plan.
• The approval of an equivalent plan does not exempt an employer from any program-related obligations, such as reporting requirements.
• The exemption application must be filed with the department every year for the first three years, or sooner if a substantive amendment is approved for this policy. After three years, an exemption reapplication is only required for substantive amendments.
• Amendments of previously approved plans are effective on the first day of the calendar quarter immediately following the date of approval of the amendment by the department.
• For non-substantive amendments, a reapplication fee is not required but a revised equivalent plan must be submitted to the department at the time the amendment becomes effective.
• The private plan must be equal to or better than the state plan, with no greater burden or hardship to the employee. The employee cannot be required to pay more for the private plan than they would have paid under the state plan, and the employer is required for any excess.
• An insured plan must be issued through an insurer like Symetra that has an approved OR PFML insurance policy filed with the Oregon Division of Insurance.
• A self-funded private plan’s exemption filing with the Authority also requires a surety bond that runs to the state.

Please click the following link Frances Online (oregon.gov) to apply for a private plan. The following resources may also be of use:

FRANCES ONLINE:

How to guide (PDF)

State of Oregon: Modernization - Frances Online Help

It is the employer’s responsibility to notify Symetra of all employees eligible for coverage. Employer’s must also notify Symetra if an employee’s eligibility for coverage ends, or if there are changes in an employee’s coverage amounts. The employer must provide accurate census and wage information on all covered employees to Symetra on or before the policy effective date and each anniversary of the policy effective date. The employer is also responsible for filing the Quarterly Tax Report and Aggregate Financial Information to The Department. We will provide the Annual Aggregate Benefit Usage Report to The Department.

The report shall include, but is not limited to, the following:

• Number of application for benefits received during the year and the qualifying purpose;
• Number of application for benefits approved during the year, the qualifying purpose, and total amount of leave; and
• Number of applications for benefits denied during the year and the qualifying purpose and the number of appeals made on denials and the outcome of the appeals.

The employer must, for a period of six years from the policy effective date, retain the following:

• Oregon quarterly tax reports and other reports referenced in the PFML statute and regulations;
• Information and records relating to the equivalent plan policy, including:
  • Any amendments to the policy;
  • Financial information regarding the administrative cost, maintenance, and claim documentation of the policy; and
  • Copies of any written notice(s) provided to employees about the policy, as required by the Department.
• Employee applications for benefits with the current status of pending, approved, or denied along with the reason for denial, if applicable, as well as any employer records regarding such leave; and
• Information regarding any disputes and appeals.

These records must be provided to The Department for review upon request, with advance reasonable notice to the employer. The Department may request to review the records at any time.