What is a Caregiver Leave?
In the state of New Jersey, Family Leave Insurance Benefits can partially replace your wages when you have to stop working to care for a loved one with a serious physical or mental health condition, including COVID-19, or to handle certain matters related to domestic or sexual violence.
A qualifying family member is defined by New Jersey as one of the following: parents, spouse, children of any age, parents-in-law, siblings, grandparents, grandchildren, domestic partners, chosen family, any other individuals related by blood and any other individuals with whom you consider to be family.
How do I receive state benefits from the state of New Jersey while caring for a loved one?
Family Leave Insurance provides New Jersey workers cash benefits to care for a seriously ill or injured family member. In order to have a valid claim for Family Leave Insurance, you need to have paid into the program through your employment and meet minimum gross earnings requirements. Family Leave Insurance is available to most New Jersey workers.
Family Caregivers do not need to take their leave all at once. You can claim Family Leave Insurance to provide care in one consecutive 12-week period, or on a day-by-day basis to suit your needs. However, the manner in which you choose to claim your leave will determine the duration of leave that you are entitled to.
What is a Medical Provider Certification?
A health care provider must certify your family member's condition and that your family member needs your care. Under FMLA, an employer is allowed to require that an employee submit a timely, complete, and sufficient medical certification to support a request for leave due to a serious health condition.
This information is filled out by the recipient of care (your loved one’s) medical provider who is attesting to the caregiver leave. For official government information regarding the Medical Provider Certification, please see here. Medical providers are health care professionals that can certify leave. These include: doctors, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, nurse practitioners, nurse-midwives, clinical social workers and physician assistants.
How do I fill out my Claim for Paid Family Leave Benefits?
While Cocoon cannot handle the facilitation of your caregiver leave claim, we are here for you to provide guidance and answer any questions you may have. Please refer to the step by step guide on how to file your claim online via www.myLeaveBenefits.nj.gov.
Step 1 - Profile Information:
You will need to provider your SSN, name and date of birth
Step 2 - Personal Information:
The information (name and date of birth) for your user logon profile will be displayed
You will be asked to select your gender
You will be asked to select your ethnicity
You will be asked to select your highest level of education
You will be asked to provide your main occupation
You will be asked to select if you are a resident of the United States
If “Yes”, you will provide your home address
You will be asked to select if your mailing address if the same as home address
Step 3 - Citizenship and Contact Information:
You will be asked to select if you are a citizen or national of the United States
You will be asked to provide your phone number
You will be asked to provide and confirm your email address
Step 4 - Profile Verification:
Confirm your personal and contact information displayed are correct - Select “Yes”
Step 5A - Leave Information (Intermittent):
Family Leave Information: Select the date you want your family leave to begin
This date should be the date you had stop working to care for your loved one and should match you leave start date in your Cocoon Dashboard
Last day worked: Select the last day worked
This date should be the previous business day worked prior to you leave start date
Intermittent Family Leave: Is a non-continuous leave (see this resource to learn more about intermittent leaves)
If you are taking family leave on an intermittent basis you will select “Yes”
You will provide the specific days or weeks that you actually missed work within the Employment Information section of the application
Bonding/Caring: You will be asked to select if you are taking this family leave to bond with a child or care for a loved one
Select “Caring”
Step 5B - Leave Information (Continuous):
Family Leave Information: Select the date you want your family leave to begin
This date should be the date you had stop working to care for your loved one and should match you leave start date in your Cocoon Dashboard
Last day worked: Select the last day worked
This date should be the previous business day worked prior to you leave start date
Intermittent Family Leave: Is a non-continuous leave (see this resource to learn more about intermittent leaves)
If you are not taking family leave on an intermittent basis you will select “No”
Claim your maximum entitlement now?
Select “Yes” if you plan to take the entire 12 weeks now
Select “No” if you are taking less than the entire 12 weeks now
Select the date you want your benefit payments to end. The date should match the leave end date in your Cocoon Dashboard
Bonding/Caring: You will be asked to select if you are taking this family leave to bond with a child or care for a loved one
Select “Caring”
Step 6 - Recipient Information:
Enter the name of the loved one you’re taking this leave to care for
Enter the date of birth of the loved one you’re taking this leave to care for
Enter the address of the loved one you’re taking this leave to care for
Enter the SSN of the loved one you’re taking this leave to care for
Enter the phone number of the loved one you’re taking this leave to care for
Select the category that the loved one you’re taking this leave to care for falls under
Step 7 - Other Benefits:
Unemployment Insurance Benefits: Select “No” unless applicable
Employer or Union Disability Benefits: Select “No” unless applicable
Social Security Benefits: Select “No” unless applicable
Worker’s Compensation Benefits: Select “No” unless applicable
Step 8 - Payment Information:
Benefits Withheld For Federal Taxes: Select “No”
Step 9 - Review Leave Info:
Family Leave Information Correct?: Select “Yes”
Step 10 - Employment Information:
Select “Add Employer”
Employer Details: You will want to provide your employers legal name. This can be found from the State of New Jersey Secretary of State website
You will enter the Cocoon office address: 548 Market Street #68975, San Francisco CA 94104 - This allows Cocoon to handle any action required for your claim on behalf of your employer
Enter your employers phone number
Classified as an “educational institution”?: Select “No”
Step 11 - Span of Employment:
Select the through dates for which you have worked for your employer (ex: hire date to present)
Stopped work due to: Select “On Approved Leave”
Separation permanent?: “Select “No”
Provide your work location
Provide department, section, division or unit you work for
Union member?: Select “No”
Step 12 - Work Schedule:
Select “Full time” or “Part time” as applicable for your regular work schedule
Provide the hours worked for each day worked of your regular work schedule
Select “schedule varies” as applicable
Step 13 - PTO, Pension:
Paid Time Off/Earnings: Select “No”
Pension: Select “No”
Step 14A - Intermittent:
Intermittent Leave: You will once again be asked if you are taking family leave intermittently
If you are not taking family leave on an intermittent basis you will select “No”
Step 14B - Intermittent: Detailed Leave Schedule:
Intermittent Leave: You will once again be asked if you are taking family leave intermittently
If you are taking family leave on an intermittent basis you will select “Yes”
Provide the dates of each occurrence for which you missed work due to caring for your loved one (you are allotted enough space to enter up to 10)
Step 15 - Review Employer Information:
Confirm the information displayed for employer is correct - Select “Yes”
Step 16 - Certification:
Agree to declarations, terms and conditions: Select “Yes”
Step 17 - Obtain medical certification:
After you complete your portion of the online application, you will be prompted to download and print the Medical Certificate (M01) form to take to your medical provider. This form includes instructions and a unique Online Form ID number so your medical provider can complete the medical certificate online.
If you receive a denial notice before the medical certificate is submitted online, your medical provider will need to print out and complete a medical statement (Part C of the application) and fax it to 609-984-4138.
How to submit your claim
There are 2 options for you to submit this form. Choose only one, as sending multiple copies will delay processing. If you filed your claim online, do not also submit a paper application.
Division of Temporary Disability & Family Leave Insurance
P.O. Box 387, Trenton, NJ 08625-0387
Fax: 609-984-4138
After submitting your claim
If you are eligible for Family Leave Insurance benefits but do not initially claim all 12 weeks of leave when filing, the State of New Jersey will send you a request for continued claim certification (form FL-3). Use this form if you need to claim benefits for additional periods of leave. Complete and return the form promptly to ensure uninterrupted benefits.
You can find more information and check your claim status at www.myLeaveBenefits.nj.gov
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