Paid Family Leave Benefit (New York State only)

The Plan provides a paid family leave benefit that complies with New York State’s paid family leave law. This benefit is only available to active members who are eligible for paid family leave under this law.

Benefits are payable to eligible active members who may need to take time off to:

• Bond with a newborn, adopted, or fostered child
• Care for a close relative with a serious health condition
• Assist loved ones when a family member is deployed abroad on active military service

What you need to do

• For more information, visit this website to obtain a claim form.
• Speak with your employer if you’re planning to request leave. In most cases, you need to provide 30 days’ advance notice before taking a leave. Your employer must also complete a portion of the claim form.
• Submit the claim form with required documentation to:
  Ullico Claims Service Center
  PO Box 49
  Bloomfield, CT 06002
  888-855-4261
  (or fax forms to 860-769-6986)