N.Y. Comp. Codes R. & Regs. Tit. 12 §§ 380-7.7

Current through Register Vol. 46, No. 45, November 2, 2024

Section 380-7.7 - Coverage

(a) On January 1, 2018, and continuing thereafter, every disability benefits policy effective on that date that satisfies the employer's obligation to provide disability benefits coverage under article 9 of the Workers' Compensation Law, and that is not subject to any exemption under the law, shall also include paid family leave coverage in the disability benefits policy.

(b) Every carrier that provides statutory disability benefits policies in New York State shall also offer paid family leave coverage.

(c) Each employee covered by his or her employer's statutory disability benefits policy on January 1, 2018, who is not subject to any exemption under the law, shall on that date be provided paid family leave coverage by the same carrier regardless of whether his or her employer has updated their policy or has paid additional premiums to include paid family leave coverage in their disability benefits coverage.

(d) In order to deny a claim based on cancellation of paid family leave coverage, the cancellation must have been made effective by the carrier notifying the board of such cancellation.

(e) Employers who purchase disability benefits insurance coverage from the State Insurance Fund or a private carrier shall purchase paid family leave coverage from the same carrier and waive the option of self-insuring for paid family leave coverage purposes.

(f) A carrier that disputes that it provided paid family leave coverage for an employer, must make payments to the employee during the family leave period or pendency of the dispute, whichever is shorter. Such payments are subject to reimbursement by the employer, special fund for disability benefits, or another insurance carrier identified during dispute resolution.

(g) A carrier who elects to discontinue offering coverage to employers for disability and paid family leave benefits must provide to the chair, or the chair's designee, a copy of the written notification of proposed discontinuance of coverage as required by the Department of Financial Services by:

(1) the later of July 1, 2017, or within 60 days of the date the Superintendent of Financial Services publishes the community rate for premiums for family leave benefits coverage for the policy benefit period beginning on January 1, 2018, if discontinuing coverage for calendar year 2018; or

(2) at least 90 days prior to the date of discontinuance of such coverage if discontinuing coverage on or after January 1, 2018.

(h) A carrier who discontinues offering all coverage for disability and family leave benefits may re-enter the market upon approval of the Superintendent of Financial Services and the chair.

(i) A carrier who provides a disability benefits policy together with a rider for paid family leave benefits shall calculate the premium payment as a total amount for both the disability benefits policy and paid family leave rider. When a partial payment of the premium is received by the carrier, the amount must be applied to both the policy and the rider, and any cancellation resulting from unpaid premiums will apply to both the disability benefits policy and the paid family leave benefits rider.

(j) An employer will be required to refund to its employees any contribution collected for paid family leave and disability benefits coverage that corresponds to any policy coverage period cancelled by the insurance carrier.

N.Y. Comp. Codes R. & Regs. Tit. 12 §§ 380-7.7

Adopted New York State Register July 19, 2017/Volume XXXIX, Issue 29, eff. 7/19/2017