Principal Life's GP62713 packet handles paid family leave to care for a covered service member, and qualifying exigency leave, under Principal's private plans in Colorado, Connecticut and Massachusetts. A one-page Health Care Provider Medical Certification documents the service member's condition, whether it is connected to military service, and how many days a week care is needed.
The employee completes the Employee Statement and the employer the Employer Statement; for covered service member leave, the service member's health care provider completes and signs the medical certification on page 6. Exigency leave needs no provider page.
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Paid Family Leave Health Care Provider Medical Certification for Care for a Covered Service Member
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Not Principal. The provider page states that the patient is responsible for obtaining a complete form without expense to Principal. Any charge for completing the certification is therefore between the practice and the patient or employee.
No. Exigency leave relates to a family member's active duty and is supported by documents like active-duty orders or a commanding officer's letter of impending activation. Only covered service member leave needs the provider's medical certification on page 6.
Principal uses this packet for paid family leave military caregiver claims in Colorado, Connecticut and Massachusetts under its private or equivalent plans. The same packet's employee and employer statements also serve qualifying exigency claims, which need no provider certification.