In today’s fast-paced world, the conversation around mental health has taken center stage in workplace wellness initiatives. As employers strive to create a more supportive and resilient workforce, integrating mental health resources into employee benefits and absence strategies has never been more critical.

According to the National Institute of Mental Health, nearly 1 in 5 U.S. adults live with a mental illness1. That number rises significantly among working-age adults, especially in high-stress professions or environments lacking psychological safety and support. This increased prevalence of mental illness leads to more time away from work, reduced ability to perform while present, and an increase disability claims incidence rates.

The Insurance Impact: Disability & Mental Health Claims

From a disability insurance standpoint, behavioral health-related disability claims are a major concern for Benefits and HR teams across the country. Mental health conditions like anxiety, depression, PTSD, and burnout are now among the leading causes of short term and long term disabilities.

A significant area of concern and recent discussion pertains to the common inclusion of a 24-month lifetime limitation for mental health-related claims in long term disability (LTD) policies. The consequence of this provision is that an employee whose disability stems from a mental health condition becomes ineligible for continued LTD benefits after a lifetime combined 24 months, even if they continue to meet the plan’s definition of disability. These limitations stand in contrast to individuals experiencing other types of disability, who are not subjected to an equivalent restriction. While the rationale for such limitations includes mitigating plan risk exposure by capping the duration and encouraging a return to work before prolonged disengagement, these provisions undeniably create a disparity in the treatment of individuals with different types of disabilities. Furthermore, they are frequently perceived as being at odds with the array of mental health initiatives that employers are increasingly implementing to address the escalating incidence of mental health issues within their workforce.

Tools to Help: Leveraging Absence and Benefits Strategy

Employers have the opportunity and, some would argue, the responsibility to take a proactive role in supporting mental health. Integrating meaningful mental health resources into leave and benefits programs is no longer optional. It is a critical business imperative. Leading organizations are stepping up to close the gap in several ways.

1. Employee Assistance Programs (EAPs) and Virtual Behavioral Health Programs

EAPs are often an underutilized resource, despite their potential to have a real, immediate impact. EAPs are employer-sponsored programs that are designed to help support employees’ health habits and well-being. Some common examples include counseling, substance abuse support, financial guidance, and legal advice. By actively promoting EAPs and embedding access points and reminders to employees throughout the leave process, employers can help support an employee’s mental health challenges.

To further assist employees with mental health concerns, employers can offer virtual Behavioral Health programs. These programs can significantly enhance employee mental health by expanding access to care and offering convenient and confidential support from anywhere. This accessibility helps overcome traditional barriers like stigma, travel, and scheduling conflicts, enabling earlier intervention and consistent engagement with mental health services. Ultimately, these programs empower employees to manage their well-being proactively, leading to improved overall health and productivity.

2. Financial Wellness Resources

Financial stress significantly impacts mental health. When employees grapple with issues like debt, budgeting difficulties, or unexpected expenses, they often experience heightened anxiety, reduced focus, and even physical symptoms2. This direct link underscores the importance of addressing financial well-being as a component of overall mental health support.

Employers can play a crucial role by offering financial counseling, whether through specialized vendors or as part of a broader EAP. This type of support helps employees navigate their financial challenges, which in turn can alleviate the associated mental burden. When an employee takes leave for mental health reasons, integrating recovery resources with financial guidance can create a more holistic approach, promoting greater well-being and facilitating a smoother return to work.

3. Integrated Absence Management Programs

Forward-looking integrated absence management programs take a holistic view of why an employee may be absent from work, coordinating federal protections such as the Family Medical Leave Act (FMLA) and the Americans with Disabilities Act (ADA), state leave programs, and employer-specific offerings. Taking an integrated approach not only streamlines compliance, but also allows for early intervention and triage, ensuring that mental health needs are identified and addressed as part of the overall leave experience.

The Bigger Picture: Prevention and Culture

Prevention remains the most cost-effective approach. Employers can have an impact by building a workplace culture where mental health is normalized and where resources are visible and accessible. Communication is also key. In addition to formal programs and benefits, employers can provide employees with education and resources such as Alera Group’s Mental Health Awareness Toolkit, which provides employers with email templates, campaigns, and more to help support employee wellbeing and keep their colleagues informed about what resources they have.

Employers that prioritize mental well-being as part of their overall strategy are seeing positive results across the board. These include shorter claim durations, higher employee engagement, and reduced turnover. Mental health challenges are not going away, and the workplace plays a key role in both creating and addressing these issues. By utilizing tools like EAPs, virtual Behavioral Health programs, financial counseling, and integrated absence programs, employers can reduce the long-term costs and disruptions of behavioral health-related absence, while helping their employees lead healthier lives.

1National Institute of Mental Health (NIMH), “Mental Illness,” 2023. https://www.nimh.nih.gov/health/statistics/mental-illness
2Debrosky, “Why Are Mental Health Disability Claims Denied More Often? Insights from Mark DeBofsky on Main & Wall” 2024. https://www.debofsky.com/articles/denied-mental-health-disability-claims/#:~:text=Most%20long%2Dterm%20disability%20policies,which%20creates%20an%20unfair%20distinction.
3American Psychological Association (APA), “Stress in America: The State of Our Nation,” 2023. https://www.apa.org/news/press/releases/stress

AARP estimates that there are over 53 million caregivers across the United States1. This equates to roughly 1 in 6 employees providing unpaid care to family members or friends. While caring for loved ones can be deeply fulfilling, it also leads to increased stress, reduced productivity, and higher absenteeism. The ripple effect extends beyond the family unit, as colleagues and employers are also impacted.

To attract and retain top talent, employers have started to reprioritize caregiving benefits. Historically, organizations recognized a gap in child and adult care services, and have responded by offering onsite or nearby care centers along with backup care services to boost presenteeism. While these solutions addressed the immediate logistical challenge of caregiving, they often overlooked the emotional burden on caregiving employees.

Recently, forward-thinking employers have adopted a more holistic approach to caregiving, resulting in a more satisfied and engaged workforce. Caregiving benefits commonly fall into five categories: time off, financial support, referral services, care centers, and emotional support.

Time Off: This includes enhanced policies for parental or family leave and flexible work arrangements like hybrid or remote work, which allow employees to better manage their caregiving responsibilities. Employers may provide additional leaves on top of federal or stated mandated requirements.

Financial Support: Employers may offer stipends, dependent care assistance plans, subsidized child or backup care, or financial incentives linked to broader employee benefits, such as Health Savings Accounts or maternity care programs.

Referral Services: For employers with limited budgets, services such as care navigation, employee assistance programs (EAPs), and educational resources can offer significant support.

Care Centers: Larger employers with a geographically concentrated workforce may continue to offer onsite childcare centers or partner with external providers for backup child and adult care. This is particularly vital in regions with long childcare waitlists, an issue worsened by the COVID-19 pandemic when many in-home daycare providers did not reopen2.

Emotional Support: Perhaps the most critical, this category includes coaching, support groups, and integration with mental health services. While much attention is given to the transition into parenthood, fewer resources exist for employees who must care for aging parents with declining health, a role that can be devastating and isolating without proper support.

Though the return on investment (ROI) for caregiving benefits can be difficult to quantify, many employers find it results in reduced turnover, increased employee satisfaction, and fewer unplanned absences. This may also be an important benefit when working to recruit new employees. A phased approach that begins with lower cost options, builds awareness, and later expands the benefit offerings can be an effective strategy for organizations beginning this journey.

While caregiving support is advisable for all employers, it becomes essential when employee loyalty and work-life balance are core aspects of your company culture. Additionally, caregiving benefits can be a valuable negotiation point in union discussions, particularly when retention is a shared concern, and the workforce includes those in the “sandwich generation”—employees caring for both young children and aging parents3.

The easiest and fastest way to show you are a caring employer is simple. Care for your caregivers.

1AARP. (2020). Caregiving in the U.S. https://www.aarp.org/ppi/info-2020/caregiving-in-the-united-states.html
2Center for American Progress. (2021). The Child Care Crisis Causes Job Disruptions for More Than 2 Million Parents Each Year. https://www.americanprogress.org/article/child-care-crisis-causes-job-disruptions-2-million-parents-year/
3Pew Research Center. (2013). The Sandwich Generation: Rising Financial Burdens for Middle-Aged Americans. https://www.pewresearch.org/social-trends/2013/01/30/the-sandwich-generation/

Substance use disorder (SUD) is often discussed in relation to student health and wellness across colleges and universities. Just as important, but sometimes overlooked, are faculty, administrators, and staff who may be silently struggling with substance use or supporting loved ones who are.

When schedules are demanding and support systems may be limited, institutions can better support their workforce by offering comprehensive and stigma-free solutions related to SUD and recovery.

Understanding Substance Use Disorder

Substance use disorder is a chronic condition affecting millions of Americans.  It’s often characterized by the compulsive use of substances such as alcohol, prescription medication, or illicit drugs despite harmful consequences, with impacts felt across all socioeconomic, professional, and educational backgrounds.

According to the National Survey on Drug Use and Health, about one in eleven full-time workers struggles with SUD, and nearly 12 percent of U.S. adults live with someone in recovery. ¹

Why It Matters

Workplace cultures that reward overworking, multitasking, and perfectionism may add to the pressure.  In education specifically, faculty and staff may silently manage stress or avoid disclosing personal struggles out of fear for their careers or a desire to prioritize student health. Since academic institutions influence the broader community, unaddressed employee struggles can impact student experience, productivity, and retention.

Supporting recovery is more than a wellness initiative, it is a cultural responsibility and a strategic investment in employee wellbeing.

What Recovery-Supportive Workplaces Can Offer

Limitless options exist in supporting employees with substance use disorders or those who are caregivers for family and friends with similar challenges.  The most common is to provide programs that focus on this area, but perhaps even more important is to foster a culture that allows employees to take advantage of these programs and feel supported. 

Programs that should be considered include, but not be limited to, the following:

Employee Assistance Programs (EAPs)

EAPs can provide free counseling, treatment referrals, and crisis support. Promoting awareness and confidentiality is essential to building trust in these services.

Recovery-Focused Benefits Platforms

Some employers partner with vendors to provide treatment matching, sobriety coaching, medication-assisted treatment, and caregiver resources.

Flexible Leave Policies

Non-punitive leave for treatment and recovery can make it easier for employees to seek help. Review existing policies to ensure they support behavioral health needs.

Caregiver Support

Employees supporting a loved one through addiction need resources, too. Solutions that offer navigation support, stress management, and mental health care can ease the burden.

Training for Managers and HR

Educating leadership on how to recognize signs of SUD and refer employees to resources ensures the first response is supportive, not disciplinary.

Campus Recovery Communities

Some colleges have launched employee recovery groups or partnered with local organizations like AA or NA to provide safe, supportive spaces.

Breaking the Stigma

Regardless of the programs implemented, the culture within your organization can directly impact success.  Stigma remains one of the greatest barriers to seeking help. Misconceptions that SUD is a moral failing rather than a health condition prevent many from accessing support. This is especially true in academia, where self-sufficiency and achievement are often prioritized.

Using person-first language—such as “person with a substance use disorder” instead of “addict”—can help humanize and normalize these experiences. Institutions that model this language in policy and communication help shift the culture.

If this bias exists, it likely extends beyond SUD to all mental health or substance use concerns. Therefore, adopting a culture that actively works to break the stigma will help all employees.

1Substance Abuse and Mental Health Services Administration. 2022 National Survey on Drug Use and Health (NSDUH).
2SAMHSA National Helpline: https://www.samhsa.gov/find-help/national-helpline
3Shatterproof Treatment Atlas: https://treatmentatlas.org

Rapidly emerging technologies are now guiding patients through the complexities of the healthcare system and helping them receive care that best fits their individual needs. Artificial intelligence (AI) is being used to bridge gaps in healthcare access by supporting patient navigation, ensuring patients understand their options and are directed to the most appropriate providers, care settings, and treatment paths. Although many tools are working behind the scenes, the benefits to patients and providers are vast, but must be carefully monitored to avoid inadvertent consequences. 

Patient Data Management

Electronic health records (EHRs) store vast amounts of information, much of which is unstructured. Natural language processing (NLP), a subset of AI, can interpret and extract meaningful insights from these notes, making them useful for predicting diagnoses and delivering individualized care recommendations. This significantly improves data accessibility, especially when extracting information from scanned documents, which have long posed challenges. It also contributes to cost reduction and enhanced care quality. The ability to mine patient data will allow providers to more quickly assess care and make recommendations, sometimes based on systematic analysis.

Automated Communication

AI-powered chatbots and virtual health assistants are transforming communication in healthcare, enabling instantaneous, 24/7 interactions that improve patient engagement. These tools can respond to routine inquiries, offer care options, provide health advice, and remind patients about appointments or medications. This kind of around-the-clock support enhances convenience and personalization, making healthcare navigation more user-friendly and patient-centric.

Provider Matching and Scheduling

AI-driven scheduling platforms and algorithms help patients identify and access the most appropriate healthcare services while also improving operational efficiency for providers. These tools match patients with in-network providers based on personalized criteria such as location, insurance, and specialty. AI and machine learning applications can find appointment slots that meet patient needs, factoring in provider availability and urgency of care. One powerful feature is real-time adaptability, which enables appointment reallocation to accommodate urgent cases with minimal disruption. The result is reduced wait times, better resource allocation, greater transparency, and improved patient satisfaction.

AI Detection

AI is highly effective in identifying patterns and correlations to aid in the prediction and diagnosis of diseases. Several case studies highlight AI’s growing role in early detection and risk prediction for conditions such as cancer, diabetes, and heart disease, as well as other chronic illnesses. As machine learning and NLP algorithms are exposed to more data, their accuracy and reliability continue to improve. Early identification helps shape the course of treatment and enables timely intervention. Another cutting-edge advancement is symptom analysis and virtual triage, where patients can conduct self-assessments and receive guidance on when and where to seek care. This empowers patients with accessible information and helps reduce unnecessary visits to the emergency room.

The Future of AI-Powered Care Navigation

The use of AI in healthcare navigation will continue evolving and further revolutionize the patient experience. One major trend is the movement toward highly personalized care, with AI tailoring guidance to each patient’s unique needs. Future developments may include enhanced AI features in medical imaging for diagnostics and greater integration with wearable health monitoring technologies. While AI-powered navigation tools have already made significant progress, there remains vast potential to further streamline the patient journey and break down access barriers. This will ensure timely, effective, and patient-centered care.

Source: Maleki Varnosfaderani, S., & Forouzanfar, M. (2024). The Role of AI in Hospitals and Clinics: Transforming Healthcare in the 21st Century. Bioengineering (Basel, Switzerland), 11(4), 337. https://doi.org/10.3390/bioengineering11040337

CAs focus continues to grow on mental wellbeing and diversity, the concept of neurodiversity has garnered increasing attention. Neurodiversity refers to the range and variation in how human brains function, and includes conditions such as autism, ADHD, Tourette’s, dyslexia, dyspraxia, social anxiety disorders, and more. Recognizing and supporting these differences can foster inclusivity, innovation, and personal wellbeing. Cognitive wellness tools are playing a crucial role for employers looking to help all employees thrive.

Neurodiversity challenges the idea of a single “normal” brain type. It highlights that neurological differences are not deficits, but rather variations in processing, communication, and learning. While the potential benefits of hiring a diverse workforce are high, reports estimate that the unemployment rate in the U.S. for neurodivergent individuals is between 30% and 40%.[1] Embracing neurodiversity promotes equity in education, work, and healthcare by acknowledging the unique strengths and needs of each person. In addition, neurodivergent individuals may be highly skilled, more productive, and exhibit different strengths than neurotypical individuals, such as attention to detail or direct communication skills.

To address this gap, various tools—often referred to as cognitive wellness tools—have emerged. Cognitive wellness focuses on supporting brain health and functionality through personalized strategies. For neurodivergent individuals, this may include tools that assist with executive function, focus, emotional regulation, and sensory processing. Investing in cognitive wellness has been shown to reduce burnout and improve productivity—not just for neurodivergent individuals, but for all employees.

There are a variety of tools available:

  1. Digital Apps: Tools like MindMeister, Todoist, and Calm help with organization, mindfulness, and task management.
  2. Assistive Technology: Speech-to-text software, noise-canceling headphones, and screen readers enhance accessibility.
  3. Therapeutic Supports: Cognitive Behavioral Therapy (CBT) adapted for neurodivergence, occupational therapy, and coaching foster self-understanding and practical skills.
  4. Workplace & Educational Tools: Flexible work arrangements, sensory-friendly environments, and universal design principles empower success in diverse settings.

In addition, employers must comply with laws such as the Americans with Disabilities Act (ADA), which may extend to certain neurodivergent conditions, including autism or ADHD. This means that employers may be required to engage in the interactive process to ensure employees and prospective employees are provided with fair opportunities to succeed. Possible accommodations include:

Supporting neurodiversity through cognitive wellness tools is more than just a trend—it’s a necessary evolution. By integrating technology, therapy, and systemic accommodations, we can empower neurodivergent individuals to thrive and contribute their full potential in the workplace.

1 https://imagine.jhu.edu/blog/2022/10/05/neurodivergence-at-a-glance/

Medical stop-loss coverage protects organizations that self-insure their health plans from catastrophic medical and prescription drug claims. It has long been a valuable tool for small- and medium-sized employers seeking to limit their financial exposure to unexpected, high-cost claims. However, as healthcare and insurance dynamics shift, even large employers are increasingly turning to stop-loss coverage, particularly through captive insurance models.

1. Hardening Markets and Rising Premiums

Insurance markets have been hardening, with factors such as the lingering effects of the COVID-19 pandemic, economic uncertainty, and climate-related disasters (e.g., California wildfires, Hurricane Milton, etc) driving up premiums. Providers face higher operational costs due to regulatory changes and rising healthcare utilization, pushing insurers to reassess risks and raise prices. For self-insured employers, these market shifts result in increased reinsurance costs and reduced flexibility.

Captive medical stop-loss programs offer protection from these rising premiums by allowing employers to control claims funding and reserves. Captives offer a more customized solution compared to traditional insurers, enabling companies to mitigate costs while maintaining financial stability.

2. Volatile Claims and High Costs

Healthcare claims have become more unpredictable, especially with the rise of costly specialty treatments such as gene therapies and cancer drugs. This unpredictability can make it difficult for employers to forecast healthcare costs. A well-structured medical stop-loss program smooths out this volatility, helping employers manage cash flow by transferring risk to a captive. This approach allows for more predictable healthcare spending, similar to a fixed-premium model, despite the fluctuating nature of claims.

3. Rising Healthcare Costs

Healthcare costs continue to rise sharply, projected to increase by 8% annually due to higher care utilization and rising specialty medication costs. Traditional cost-shifting methods like high-deductible plans are no longer sufficient. Medical stop-loss coverage through captives offers a long-term solution by allowing employers to establish formal reserves and fund future high-cost years. This enables them to take a proactive approach to managing healthcare costs while improving benefits offerings.

4. Enhanced Control and Transparency

Captive stop-loss programs give employers more control over plan design and claims management. With greater access to data, employers can make informed decisions about cost drivers and health management initiatives. They can also secure better rebates on pharmacy benefits, reducing overall spending. Employers using captives as a purchasing platform to carve out pharmacy benefits, see overall Rx spend decrease, often saving 15-30% on net pharmacy claims. Captives provide the flexibility to tailor coverage to an employer’s unique needs, aligning with broader financial and risk management strategies.

A Multi-Layered Protection Strategy

In a volatile healthcare environment, captive medical stop-loss coverage offers employers a customizable, multi-layered approach to risk management. It enables organizations to not only manage current challenges but also shape a sustainable future for their healthcare benefits.

As spring unfolded, the 2025 Disability Management Employer Coalition (DMEC) Compliance Conference brought together absence management professionals from across the nation to explore emerging trends, compliance strategies, and innovative solutions in the world of leave management. Held in Columbus, Ohio, this year’s conference offered in-depth sessions on pressing issues, including compliance, mental health accommodations, technological advancements, and diversity in the workplace. Here’s a look at some of the key topics that were discussed:

1) Navigating Complex Compliance Challenges

With the ever-changing landscape of leave and accommodation laws, staying compliant remains a top priority for employers. This year’s conference offered valuable insights into managing the intersection of federal and state regulations. Experts shared practical advice on how to avoid common mistakes and streamline compliance efforts across diverse workforces. Here are some noteworthy sessions:

This session offered a deep dive into upcoming changes to the Department of Labor’s regulations and what HR teams need to do to stay ahead of the curve.

Speakers unpacked the complexities of these intersecting laws and shared strategies for managing situations where they overlap.

Our team was joined by a regulator, attorney, carrier, and employer to outline the different use cases and provide audience members with a framework for making a decision about whether they should file a private plan or stay with the state.

2) Mental Health Support

Mental health remains a cornerstone of today’s workplace benefits, and the conference didn’t shy away from tackling this critical issue. Sessions focused on creating a supportive environment for employees experiencing mental health challenges. These discussions provided actionable strategies for maintaining compliance while prioritizing employee well-being:

Experts explored best practices for managing mental health claims, with a focus on the unique complexities of psychological disabilities in the workplace.

This session helped employers navigate the delicate balance of offering accommodations while staying compliant with ADA and FMLA guidelines.

A deep dive into how mental health conditions are handled under Long-Term Disability (LTD) policies and the ongoing challenge of achieving true mental health parity in benefits.

3) Innovations in Leave and Accommodation Management

Technology continues to transform the way employers manage leave and disability claims. This year’s conference highlighted cutting-edge tools and strategies, including the use of artificial intelligence (AI) to streamline compliance processes, as well as other technologies to support for disability management. These sessions explored how employers can leverage technology and data-driven insights to improve leave management and drive better outcomes:

This session explored how AI is reshaping leave management, helping employers automate compliance and improve accuracy in decision-making.

One of the most forward-thinking sessions, this presentation discussed the growing role of psychedelic-assisted therapies in managing mental health conditions in the workplace.

Participants learned about five new tools designed to optimize Return-to-Work (RTW) and Stay-at-Work (SAW) programs, improving the experience for both employers and employees.

The 2025 DMEC Compliance Conference provided a comprehensive overview of the challenges and opportunities facing HR and absence management professionals today. From navigating complex compliance requirements to embracing new technologies and supporting employee mental health, the conference highlighted the evolving nature of leave and accommodation management. With valuable insights and actionable strategies, attendees left the conference better equipped to address the needs of their diverse workforces while staying compliant with an ever-changing legal landscape. We’re already looking forward to what next year’s conference will bring!

In a recent article on Captive.com, spotlighting the CICA session, “Employee Benefits and Medical Stop-Loss: A Partnership between HR, Finance, Risk, and Markets,” our SVP, Prabal Lakhanpal explains the legal process of setting up a captive and results employers can expect. You can find the full article here.

There was a flurry of activity at the federal level that involved state and local paid family and medical leave (PFML) programs in the days leading up to President Trump’s inauguration. Both the Department of Labor (DOL) and the Internal Revenue Service (IRS) provided additional guidance and clarification, which is summarized in this Alert.

I. DOL Opinion Letter Clarifies Interaction of FMLA and State of Local PFML Programs

As the paid leave landscape has evolved, employers have struggled with how to reconcile compliance with the Family and Medical Leave Act (FMLA) with that of state or local paid family and medical leave (PFML) programs. While running FMLA, PFML, and other leaves concurrently has been a common and often recommended practice, understanding specific rules that apply in these scenarios has long been a concern for employers. The Department of Labor, in recently issued DOL Opinion Letter FMLA2025-1-A, finally addresses the interplay between the FMLA and state or local PFML programs when an employee’s absence qualifies for both.

The core issue explored in the opinion letter is how the FMLA’s “substitution” rule operates in these concurrent leave scenarios, particularly regarding the use of PFML and whether the same principles as those that apply to disability plans and workers’ compensation benefits apply to PFML. The substitution rule generally allows an employee to elect, or an employer to require that an employee, substitute accrued employer-provided paid leave (including vacation, PTO, or sick leave) while also falling under the protections of unpaid FMLA leave, which means that the employee can elect to have, or an employer can require, that the employer-provided paid leave run concurrently with FMLA leave. Employers have long been uncertain how to apply the rule when state or local PFML benefits are also involved.

The opinion letter clarifies that the FMLA substitution rule does not apply when employees receive benefits under a state or local PFML program, just as it does not when the employee is receiving paid disability or workers’ compensation benefits. This clarification means employees can choose, or be required by their employer, to use their state or local PFML concurrently with FMLA leave. The DOL emphasizes that this coordination is permissible even if the state or local law does not explicitly address the interaction with FMLA and offers employers a clearer framework for managing these often complex leave situations.

Another key takeaway from the opinion letter is that using state PFML concurrently with FMLA leave does not diminish the employee’s protections under FMLA. The FMLA’s 12 weeks of leave remain protected, regardless of whether the employee receives state or local PFML benefits during that time, thereby ensuring that employees receive the full federal protection of the FMLA while also accessing state or local benefits.

Additionally, the DOL’s guidance touches upon the implications of PFML providing partial income replacement. If an employer offers employer-provided accrued paid leave benefits in addition to state or local PFML, the opinion letter suggests that these employer-provided benefits can also be used concurrently with FMLA leave to “top off” the PFML benefit.

This opinion letter is significant because it provides much-needed clarity in an area where confusion often arises. The increasing prevalence of state and local PFML programs necessitates clear guidance on how these laws interact with the FMLA. By addressing the substitution rule in this context, the DOL helps employers navigate the complexities of concurrent leave and ensures employees understand their rights and options.

Ultimately, FMLA2025-1-1 aims to streamline the administration of FMLA leave when state or local PFML is involved, promoting a more consistent and predictable approach for both employers and employees. It reinforces the principle that the FMLA provides a baseline of protection, which can be supplemented by state benefits, without diminishing the federal entitlement.

Next Steps for Employers:

Employers should carefully review DOL Opinion Letter FMLA202-1-A and ensure that their current policies and procedures are consistent with the new guidance.

II. Navigating the Tax Implications of State PFML Programs

    The rise of state-level PFML programs has brought a wave of tax-related questions from employers, employees, and other stakeholders. Previously, state guidance on PFML taxation was often vague, leaving many to seek expert advice. However, the IRS issued Revenue Ruling 2025-4, providing much-needed clarity on these complex issues.

    Federal Tax Implications:
    State Tax Implications:

    State tax treatment of PFML contributions and benefits varies. Employers must consult the specific laws, rules, regulations, and guidance for each state program to ensure compliance.

    PFML Contribution Requirements:

    In 2025, state PFML programs have varying requirements for employee and employer contributions when the employer participates in the state plan. Exceptions may apply based on employer size or private plan offerings. Consult the specific state program details for accurate contribution requirements.

    Next Steps for Employers:

    Employers should carefully review Revenue Ruling 2025-4 and any related state guidance. During the 2025 transition period, adjustments to taxation practices may be necessary. This may include updating employee handbooks, policies, FAQs, payroll systems, and other relevant resources. Proactive compliance is crucial, as employers are generally responsible for the correct administration of these programs.

    For further questions or assistance regarding either the DOL Opinion Letter or the IRS Revenue Ruling, please contact Spring.