CO PFML Webinar – What to expect when working with Guardian - FAQs

Benefits for Colorado’s paid family and medical leave (CO PFML) program begin on 1/1/24. If you are planning to have Guardian administer your private plan, or are considering making Guardian your carrier, please see below for some frequently asked questions on what you can expect when working with Guardian.

Is this coverage mandatory?

Yes, CO PFML is mandatory for most employers with at least one employee working in Colorado.

Do employers need to enroll in a private plan?

A private plan is an alternative to the state-administered program; it is not required. However, there are benefits to a private plan. For example, if your disability or Family and Medical Leave Act (FMLA) are also administered by Guardian, we will coordinate the claims processes across the programs.

If an employer has fewer than 10 employees in Colorado, do they still need to offer CO PFML? And if so, can Guardian provide them with a private plan option?

Yes, CO PFML is applicable to most employers with at least one employee working in the state. At this time, Guardian's private CO PFML offering is only available to employers with 10 or more employees.

Is it possible for my company to switch to a private plan even though we selected the state plan and the 10/31/23 deadline has passed?

Yes, employers may choose to move to a private plan after 10/31/23. The effective date of the private plan cannot be earlier than 60 days from the date of private plan application.

What happens if an employer has submitted an opt-out request before the deadline of 10/31/23, and the state doesn't accept it until after the deadline? Does the employer still get their refund?

Guardian’s understanding is that, in this scenario, the employer will still be eligible for the refund as long as the application is not denied.

How do employers handle employee leaves that are initiated in 2023, but extend into 2024? How does CO PFML work in the transition process?

If an employee meets the eligibility requirements for CO PFML and they are out for a covered reason, they would be eligible for benefits beginning 1/1/24. Claims can be filed as of 1/1/24.

Is it true that if a Colorado-based employee has a baby in 2023, they can take 12 weeks of baby bonding time in 2024?

Yes, if an employee has a baby in 2023 and they are eligible for CO PFML benefits, they can take bonding leave in 2024, as long as the leave is completed within 12 months of the child’s birth or addition to their family.

Has the Colorado Family and Medical Leave Insurance Program (FAMLI) released any online calculators for these benefits?

Yes, you can view the calculator here: https://famli.colorado.gov/individuals-and-families/premium-and-benefits-calculator

Can CO PFML claims be initiated more than 30 days before an expected leave?

An employee is required to give their employer a 30 -day notice for any foreseeable leave event. However, that does not necessarily mean that an employee should file their PFML claim with Guardian 30 days in advance. When a leave event is not foreseeable, an employee should provide their employer with notice of the leave as soon as practicable.

Guardian encourages employees to submit their claims as close to the date they are planning to take their leave as possible (e.g. within two weeks of the actual leave). CO PFML claims that are submitted to Guardian too far in advance of an upcoming covered leave event will require that much of the information be reverified when the actual leave date occurs.

However, claims for CO PFML cannot be initiated before 1/1/24.

Outside of Colorado, does Guardian offer private plans in other states?

Yes. In addition to Colorado, Guardian has private plan offerings for mandated PFML in New York, Hawaii, New Jersey, Massachusetts, Connecticut, and Oregon.

If an employer has a short-term disability (STD) plan with Guardian along with CO PFML, what will that claim process look like?

When both plans are in place with Guardian, when an employee files a claim for one benefit, Guardian will initiate a claim for both plans. Information collected (from the employee, employer, and providers) will be used to make determinations on and manage both claims. The STD plan benefit will be offset by benefits due/paid against the CO PFML plan.

Do employers need to have CO PFML insurance, or can they manage this themselves, in-house?

There is an opportunity for employers to apply for a self-funded private plan exemption from the state. You can learn more about this process on the FAMLI website. Employers may also choose to remain in the state-administered program.

Do employers still have to pay contributions to FAMLI in 2023 if they've successfully opted out?

Once an employer’s private plan application is approved by FAMLI for 1/1/24, they will no longer be required to remit contributions to the state.

How will Guardian's premium due amounts be calculated?

As an employer’s private CO PFML policy with Guardian is self-administered, they will receive a premium report worksheet to fill out with the number of employees as well as their wages for the period. They will then multiply the total wages for the period by the rate provided on the worksheet. The calculated amount will be what is owed for the policy period.

Do employers need to have a life or disability product with Guardian to have Guardian administer their CO PFML private plan?

While life and/or disability insurance isn’t a requirement, Guardian does require one additional non-state paid leave line of coverage (either already in force or added) alongside the CO PFML coverage.

How often must CO PFML private plan exemptions be renewed with the state?

Private plans are approved for an eight-year period. Employers must comply with FAMLI’s private plan maintenance requirements, including completion of annual attestations about the private plan and the annual maintenance fee.

Can you explain the reimbursement of CO PFML premium contributions collected in 2023 in more detail? Does Guardian’s policy expressly allow collection of contributions from employees in 2023?

If an employer has collected premium contributions from its employees in 2023, and FAMLI later reimburses the employer for premiums remitted in 2023, the employer must reimburse its employees for any premium contributions collected, unless the terms of the approved private plan allow the employer to collect premiums from employees in 2023. In that case, the employer need not reimburse employees for premium contributions collected. Guardian’s insured policy does not expressly allow or even address employer contributions prior to the effective date of the policy and Guardian does not collect premiums in advance of a policy taking effect. So, employers must reimburse employees for any premium contributions collected.

How can an employer verify wages of a previous employer? 

Guardian will request this information from the claimant to confirm previous employer wages.

Will reporting show the progress of the employee in their leave, such as what they will be paid? 

Yes, copies of letters, Explanation of Benefit (EOB) statements, and other claim details are available through Guardian Anytime.

Further, when a claim determination is made, a phone call is made to the employee providing claim details and next steps and expectations. Then, an approval letter is mailed to the employee. 

If the employer pays 100% of the CO PFML premium, will the employee have tax liability for the coverage and/or benefit?

Yes, Guardian treats PFML benefits the same as disability benefits, also called “third party sick pay,” for which there is longstanding guidance under federal tax law. If an employer contributes a share of the premium pre-tax, a portion of the employee’s paid medical leave (PML) benefit will be taxable at the same percentage. PML is reported on Form W-2, and applicable FICA taxes are withheld from benefit payments.