Insurance 2017 EDD Disability Insurance Branch Administration Branch Policy Accountability amp Compliance Branch Public Affairs Branch Tax Branch Unemployment Insurance ID: 755221
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California State Disability Insurance
2017Slide2
EDD
Disability
Insurance
Branch
Administration
Branch
Policy
Accountability
& ComplianceBranch
PublicAffairs Branch
TaxBranch
Unemployment InsuranceBranch
WorkforceServicesBranch
Information
Technology
BranchSlide3
State
Disability
Insurance
Disability
Insurance
Paid Family
LeaveSlide4
State Disability Insurance
Vision The State Disability Insurance program is a
model of excellence, innovation, and integrity.Slide5
State Disability Insurance
Mission We provide California’s eligible workers with timely benefits and deliver quality service to all our customers.Slide6
What is SDI?
State Disability Insurance (SDI) is a partial, short-term, wage-replacement insurance plan for California workers.Slide7
Workers Covered by Two Benefits
Disability Insurance (DI) provides partial wage replacement benefits for up to 52 weeks per claim.
Paid Family Leave (PFL) provides partial wage replacement benefits for up to six weeks within a 12-month period.Slide8
Disability Insurance
Which States Have It?
Hawaii - DI
New Jersey – DI, PFL
New York - DI
Rhode Island – DI, PFL
The Commonwealth of Puerto Rico -DI
California is one of six U.S. locations with State Disability Insurance.Slide9
Key Points of SDI
Covers approximately 18.1
million California workers. Replacement of approximately 55% of an employee’s income.
Requires
qualifying wages
in the base
period and attachment to the labor market when the DI or PFL claim begins.Slide10
More Key Points of SDI
Requires a seven day, non-payable waiting period.Provides benefits starting on the 8th
day.Must file a timely claim (no later than 49 days).
Can apply
without regard to length of
employment.
Does not provide entitlement to leave or job protection.Slide11
Can a Claimant work Part- Time?
Must be working less than their normal, regular and customary hours.The reduction of work hours must be a direct result of the disability or family leave claim.
Must have a loss of wages.Slide12
How is SDI Funded?
Employees pay into SDI through state-mandated payroll deductions. 2017 withholding rate of 0.9%
2017 taxable wage limit = $110,9022017 maximum yearly employee
contribution = $998.12Slide13
Weekly Benefit Amounts (WBA)
1946
2017
Minimum Weekly Benefit Amount
$10
$50
Maximum Weekly Benefit Amount
$20
$1,173
A base period of 12 months is used for calculating the maximum and weekly benefit amounts.Slide14
Base
Period for WBA
$11,180
$11,180
$15,657
$12,249
$12,249
CED
6/1/16
1/15-3/15 4/15-6/15 7/15-9/15 10/15-12/15 1/16-3/16 4/16-6/16
(QTR 1) (QTR 2) (QTR 3) (QTR 4) (QTR 5) (QTR 6)
Base Period QuartersWBA = Weekly Benefit Amounts
CED
= Claim Effective
DateSlide15
State Disability Insurance Data
State Fiscal
Year 2015/16 Slide16
SDI - Employer Responsibilities
Post
EDD Notice to Employees (DE 1857A). Slide17
SDI - Employer Responsibilities
Provide
SDI brochures to new hires or employees who may need to file a claim: DE
2515 for
DI
DE
2511 for PFLSlide18
SDI - Employer Responsibilities
Complete and return the
Notice to Employer
(
DE
2503/2503F)
within two working days.Slide19
Key Points of Disability Insurance
Provides benefits for employees who cannot work due to a non-work-related illness or injury.
Includes: Elective surgery, alcoholism, drug addiction treatment and recovery, pregnancy, childbirth or other related conditions.Slide20
More Key Points of
Disability Insurance Employees must be
unable to perform their regular or customary work.Employees must be
under the care of a
physician/practitioner.
Certification must be from the treating physician/practitioner of the illness, injury, or disability.Slide21
Key
Points Paid Family LeavePaid Family Leave (PFL) is a component of State Disability Insurance (SDI) and applies to all employees covered by SDI.
PFL benefits are payable at the same rate as DI.
Payments are limited to six weeks over a consecutive 12-month period for bonding or caregiving needs.
Mothers transitioning from DI maternity leave to PFL for bonding benefits do
not
serve a second seven day waiting period.Employers may require employees to use up to two weeks of vacation before receiving PFL benefits.Slide22
Two Basic PFL Claim Types
Bonding
Requires written proof of the new child such as birth certificate, adoption papers, or foster care placement document.
Must
be claimed within 12 months of the child entering into family
.
Child must be under 18 years of age.Slide23
Two Basic PFL Claim Types
Care
To care for seriously ill child, parent, parent-in-law, grandparent, grandchild, sibling, spouse, or registered domestic partner.
Requires physician/practitioner certification of a serious illness and a need for care.
Requires the signature of the person receiving care or
their
authorized representative.Slide24
Differences Between DI and PFL
Disability Insurance
Paid Family Leave
Up to 52 weeks per claim
Up to six weeks per 12-months
Employee’s personal illness, injury, or disability
Caring for a seriously ill family member or to bond with a new child
Not required to use vacation benefits
Employers may require employees to use up to two weeks of vacation
Vacation pay is not in conflict with DIVacation pay conflicts with PFL when employer requires employee to use
Benefits are not reportable to IRS (unless in lieu of UI)Benefits are reportable to IRSSlide25
SDI – Fraud Prevention
To deter fraud, please respond immediately to the Notice to Employer if you are not the employer shown or if the claimant:
Is not your employee.Has quit their job.Is receiving
wages.
Has not
stopped or has started back to work.
Is known to be working for another employer.Has filed for workers’ compensation or is believed to be planning to do so.Is using a Social Security number incorrectly.Is working under another name.Slide26
To Report Fraud
To report Disability Insurance, Paid Family Leave or Unemployment Insurance fraud:Call the EDD Fraud Tip Hotline
at1-800-229-6297To report Payroll fraud:
Submit
an online Fraud Reporting Form at
www.edd.ca.gov
Call 1-800-528-1783Email ueo@edd.ca.govFax 1-916-227-2772Slide27
What is SDI Online?
SDI Online:Is an online claim filing system.
Allows online submission of SDI claims and other claim documents by claimants, physicians/practitioners, employers, and voluntary plan administrators.
Provides the
best method to
file a DI or PFL claim and for employers and physician/practitioners to submit their
paperwork.Is the faster and easier alternative to filing by mail.Slide28
SDI Online - Security
Claimants can securely submit:Disability Insurance (DI) claims.Paid Family Leave (PFL) claims.
Required documentation related to their claim.Physicians/Practitioners and physician/practitioner representatives can:
View a patient’s initial claim for benefits
Submit DI and PFL claim certifications.
View claim certification history. Slide29
SDI Online - Convenience
Employers, designated representatives, and Voluntary Plan Administrators canuse an SDI Online account to:File the
Notice to Employer of Disability Insurance Claim Filed (DE 2503)File the Disability Insurance Eligibility – Workers’ Compensation (DE 2578A)
File the
Employer’s Statement of Job Duties
(DE 2546PE)
Update contact information.Slide30
SDI Online - Benefits
Benefits of SDI Online:Improved access to services, claim status, and payment history.
Reduced claim processing time.Improved detection and management of fraud and abuse.Reduced paperwork and postage costs.
Health Insurance Portability and Accountability Act
compliant
.Slide31
SDI Online Access
Visit www.edd.ca.gov/disability to register or login.Slide32
SDI Online Access
Select Register for SDI Online to register for an SDI Online account. Existing users may
go directly to the Log in to SDI Online.Slide33
SDI Online Access
Select
Employers to view tips, FAQs, videos, and tutorials.Slide34
SDI Online Access
SDI Online page showing available Employer tips, FAQs and tutorials.Slide35
Paper Claim Form - DI
DE 2501, Optical Character Recognition (OCR)
form for Disability Insurance which can be scanned and interfaces with the SDI Online system. Part
A
(pages 1-4):
Claimant’s
StatementPart B (pages 5-7): Physician/Practitioner’s CertificationSlide36
Paper Claim Form - PFL
DE 2501F, Optical Character Recognition (
OCR)form for Paid Family Leave
Part A
(page 1):
Claimant’s StatementSlide37
Paper Claim Form - PFL
Page 2:Care Recipient’s AuthorizationSlide38
Paper Claim Form - PFL
Parts B and C (page 3):Bonding Certification (B)
and Statement of Care Recipient (C)Slide39
Paper Claim Form - PFL
Part D (page 4):Doctor’s CertificationSlide40
SDI Contact Information
State Employee
Disability Insurance 866-352-7675Paid Family Leave 877-945-4747Non-Industrial Disability Insurance 866-758-9768
Disability
Insurance
English 800-480-3287
Español 866-658-8846Paid Family LeaveEnglish 877-238-4373Español 877-379-3819Slide41
SDI
Contact Information
SDI Online Services Help Desk
855-342-3645
For Employers Only:Slide42
Visit
www.edd.ca.gov/disability
for more information about State Disability Insurance and SDI Online.DIBOutreach@edd.ca.gov
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Questions?Slide44