Basic Eligibility for Your Employees

Your employee may be eligible for DI if they:

• Have a qualifying illness or injury.
• Have elective surgery.
• Are pregnant.
• Are recovering from childbirth.
• Are a resident for a limited period in an alcoholic recovery home or drug-free residential facility that is licensed and certified by the state in which the facility is located.

DI benefits can be paid only after your employees meet the following requirements:

• They can’t do their usual work for at least eight consecutive days.
• They are employed or looking for work at the time they become disabled.
• They lost wages because of their disability or, if unemployed, have been looking for work.
• They earned at least $300 that had State Disability Insurance (SDI) deductions withheld during their base period.
• They are under the care and treatment of a licensed health professional or an accredited religious practitioner during the first eight days of their disability. (The beginning date of a claim can be adjusted to meet this requirement.) They must remain under care and treatment to continue getting benefits.
• A licensed health professional must complete the medical certification of their disability.
  
  • A nurse practitioner can certify to a disability within his/her scope of practice. However, he/she must perform a physical examination and collaborate with a licensed physician or surgeon.
  • A licensed midwife, nurse-midwife, or nurse practitioner may complete the medical certification for disabilities related to normal pregnancy or childbirth.
  • If your employee is under the care of an accredited religious practitioner, they may download and print the Claim for Disability Insurance Benefits-Religious Practitioner’s Certificate (DE 2502) (PDF).

Note: Citizenship and immigration status do not affect eligibility.

An independent medical examination to determine the individual’s initial or continuing eligibility may be required.

Your employee may apply for benefits even if they are not sure they are eligible. They will be notified if we find they are not eligible for all or part of a period claimed. Your employee might not be eligible for DI benefits if they:

• Are claiming or receiving Unemployment Insurance or Paid Family Leave benefits.
• Became disabled while committing a crime resulting in a felony conviction.
• Are in jail, prison, recovery home, or any other place because they were convicted of a crime.
• Are receiving workers’ compensation benefits at a weekly rate equal to or greater than the DI rate.
• Fail to have an independent medical examination when requested to do so.
• Are in an alcoholic recovery home or drug-free residential facility that is not licensed and certified by the state in which the facility is located.

Employees covered by DI are also covered for PFL. If a Voluntary Plan insurer provides your company’s DI coverage, then it must also provide PFL coverage.

An employee may submit a claim for PFL insurance benefits for the following reasons:

• To care for a seriously ill child, parent, parent-in-law, grandparent, grandchild, sibling, spouse, or registered domestic partner.
• To bond with a new child entering the family through birth, adoption, or foster care placement of the child with the employee or the employee’s spouse or registered domestic partner.
• To participate in a qualifying event because of the military deployment of their spouse, registered domestic partner, parent, or child to a foreign country.

To qualify for PFL benefits, your employee must meet the following requirements:

• They can’t do their regular or customary work due to their need for family leave.
• They are employed or actively looking for work at the time their family leave begins.
• They lost wages because of their need to take family leave.
• They earned at least $300 from which State Disability Insurance (SDI) deductions were withheld during their base period.
• They must complete and submit their claim form no earlier than the first day their family leave begins, but no later than 41 days after their family leave begins or they may lose benefits.
• They must provide all supplemental documentation required for bonding, care, or military assist claims.
• They must provide a medical certificate on their care claim for the seriously ill family member. The certificate must be completed by the care recipient's licensed health professional.
  
  • A nurse practitioner or physician assistant may certify to the need for care within their scope of practice; however, they must perform a physical examination and collaborate with a physician or surgeon.
  • If your employee's care recipient is under the care of an accredited religious practitioner, they may download and print the Claim for Disability Insurance Benefits-Religious Practitioner's Certificate (DE 2502) (PDF).

Note: Citizenship and immigration status do not affect eligibility.

A serious health condition is defined as:

• An illness, injury, or physical or mental condition that requires inpatient care in a hospital, hospice, or residential medical care facility.
• Continuing treatment in connection with inpatient care; or continuing treatment by a licensed health professional.

Cosmetic treatments and common illnesses like the cold, earaches, upset stomach, and headaches (other than migraine) are examples of conditions that do not meet the definition of a serious health condition for purposes of PFL benefits.

Employers with employees working in San Francisco: You may be required to supplement employee wages under the San Francisco Paid Parental Leave for Bonding with New Child Ordinance. For more information, view the Paid Parental Leave Ordinance

Your employee may not be eligible for PFL benefits if they:

• Receive Disability Insurance, Unemployment Insurance, or workers’ compensation.
• Are not working or looking for work at the time they begin their family leave.
• Have not lost wages.
• Are in custody due to conviction of a crime.
• Cannot provide certification by the treating licensed health professional that they are needed for care.