Paid Family Leave {Agent / Broker Highlights}

OUR TECHNOLOGY IS YOUR FUTURE

New York State

PAID FAMILY LEAVE {AGENT / BROKER HIGHLIGHTS}

PFL EFFECTIVE DATE 01/01/18 PFL BENEFITS DATE 01/01/18 CARRIER STATUS DATE 07/01/17 HIGHLIGHTS UPDATE 06/09/17 POWERED BY

NY STATE DISABILITY & PAID FAMILY LEAVE SERVICES NY-PFL BULLETIN 06/09/17 516.482.2696 / www.LiDAC.com New York State Paid Family Leave {AGENT / BROKER HIGHLIGHTS}

TABLE OF CONTENTS

SERIES DESCRIPTION PAGE I Introduction 1 II Conditions for Paid Family Leave 2 III Eligibility 3 IV Schedule of Benefits 4 V Rates & Contributions 5 VI Employ-ER Considerations 7 VII Employ-EE Considerations 12 VIII Agent / Broker Value Proposition 16 IX Insurance Providers / Carriers Services 17 X General Administration & Service (Coming Soon) TBD

IMPORTANT The following information is provided for illustrative purposes only highlighting some of the criteria as may be applicable to the Paid Family Leave Law, effective January 1st. 2018. LiDAC and its representatives make no representations as to the complete applicable benefits, durations, rates, terms and conditions as may be required under the NY Paid Family Law, which remains subject to New York State review, approval and release on behalf of eligible covered employers and / or insurance companies / providers, who are subject to the NYPFL law.

For additional information and / or assistance on The New York Paid Family Leave and / or The NY Statutory DBL, please contact a LiDAC representative @ 516-482-2696 or [email protected].

NY STATE DISABILITY & PAID FAMILY LEAVE SERVICES NY-PFL BULLETIN 06/09/17 516.482.2696 / www.LiDAC.com New York State Paid Family Leave {AGENT / BROKER HIGHLIGHTS}

INTRODUCTION SERIES I Governor Cuomo signed into law a significant addition to the New York Statutory Disability (DBL) Law offering a comprehensive Paid Family Leave policy for eligible employees working for a covered employer in the State of New York. Effective January 1st 2018, eligible employees will have the ability to take time in providing for the necessary care for their eligible family members, while ensuring a level of economic security.

LiDAC.com provides licensed Brokers and Agents immediate access to The NY DBL & PFL Exchange. Using your Online Portal select from a host of preferred insurance carriers & vendors to obtain proposals, bind coverage and generate your clients’ New York-DBL and PFL policy, Forms and Admin kit all online in minutes. (Register Now or call 516-482-2696)

WHAT IS PAID FAMILY LEAVE? Starting January 1, 2018, the New York State Paid Family Leave Program will provide New York State employees job-protected, paid leave to bond with a new child, care for an eligible family member with a serious health condition or to assist family members when someone is called to active military service. New York State Paid Family Leave will be released in phases over the next four (4) years. Employees will be eligible for paid time off to care for a new child or sick family member. New York State has adopted the richest Paid Family Leave in the United States effective, January 1st 2018.

FAMILY MEDICAL LEAVE ACT (FMLA) VS. NY PAID FAMILY LEAVE (PFL) Family Medical Leave Act (FMLA), provides for unpaid family leave, while offering job security during a period of an approved eligible employee family medically related leave. • FMLA offers up to 12 weeks of unpaid time off for families to welcome a new child or care for ill family members. • FMLA affects all employees at businesses larger than 50 employees within a 75-mile radius. • FMLA does not provide a monetary benefit whereas PFL does. Alternatively, Paid Family Leave (PFL) covers all eligible employees of businesses in the State of New York with more than one employee. • PFL will provide a portion of an employee’s Average Weekly Wage (AWW) during the time of their leave for up to 12 weeks, once the entire plan is fully implemented in 2021. POWERED BY

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CONDITIONS FOR PAID FAMILY LEAVE SERIES II Under Paid Family Leave (PFL), employees may be eligible to participate in providing care for such conditions as may be related to physical or psychological care for a family member. In addition, bonding with the employee’s child during the first twelve months following the child’s birth, or the first 12 months after the placement of a child for adoption or foster care or for a qualified military service as defined by the FMLA.

PATERNITY AND CARE OF A MILITARY SERVICE MATERNITY LEAVE FAMILY MEMBER Eligible Employees may be covered Individuals who may be expecting a Under the new PFL law, covered to provide care and assistance to child and / or fostering or adopting individuals may be eligible to take family members under the military a child, may be able to take time for the necessary time to provide provisions in the federal Family care of their child, while being eligible care for a loved one with a serious Medical Leave Act. to receive up to 8 weeks of Paid Family health condition. Family members Leave in 2018. may include a child, parent, parent- in-law, grandchild, grandparent, spouse, or domestic partner.

NEW YORK STATE DISABILITY & PAID FAMILY LEAVE Employees in the State of New York may be eligible for Statutory Short-term Disability Insurance (DBL) which provides short-term coverage for employees based on qualifying events, like off-the-job injuries, illness, or pregnancy, and offers up to 26 weeks of paid disability benefits in a consecutive 52 week period. Paid Family Leave (PFL) has been incorporated into the New York State Disability Benefits Law (DBL) provisions, effective January 1st 2018 and may be subject, but not limited to the following:

• PFL will be included under an employer’s New York State DBL policy. • DBL and PFL benefits cannot be collected at the same time. • NY DBL and NY PFL combined duration may not exceed a maximum period of 26-weeks during any 52 consecutive calendar weeks.

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ELIGIBILITY SERIES III

LiDAC.com WHO IS ELIGIBLE? Representatives are Effective January 1, 2018, employees in the State of New York may be eligible, prepared to assist you if they meet certain criteria: and your clients in • Employees who work for private sector employers with at least 1 employee (not counting the owner). reviewing the details for • Employers in the public-sector that may choose to participate through collective bargaining. implementation of your • Full-time employees regularly scheduled to work 20 or more hours per week for at least New York State Paid 26 consecutive work weeks preceding the first full day when family leave begins. Family Leave Program. • Part-time employees regularly scheduled to work less than 20 hours per week will become CALL NOW! eligible to take family leave after 175 days of scheduled employment. 516-482-2696 or [email protected] Any eligible individual that has a qualifying leave event (birth, adoption, foster care, care of family member during a military leave or qualifying medical issue) commencing with date on or after January 1st, 2018, as well as births and adoptions within the last 12 months — even those in 2017.

WHO IS NOT ELIGIBLE? Employees may not be eligible for coverage under the New York State PFL due to one or more of the following criteria: • Any employee already receiving total disability (the coverage an injured worker may receive during his or her recovery) benefits. • Employees on administrative leave. • Employees who work for an exempt employer. • Employees who are excluded from coverage under Article 9 of the Disability Benefits Law (DBL) and the Paid Family Leave Benefits Law (PFL).

HOW MUCH DOES IT PAY? • January 1, 2018; up to 8 weeks of paid leave of the employee’s average weekly wage capped at a maximum of 50% of NYS Average Weekly Wage (average weekly wage in 2016 was $1,305.92). • January 1, 2019; up to 10 weeks of paid leave of the employee’s average weekly wage capped at a maximum of 55% of NYS Average Weekly Wage. • January 1, 2020; up to 10 weeks of paid leave of the employee’s average weekly wage capped at a maximum of 60% of NYS Average Weekly Wage. • January 1, 2021; and thereafter; up to 12 weeks of paid leave of the employee’s average weekly wage capped at a maximum of 67% of NYS Average Weekly Wage.

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SCHEDULE OF BENEFITS SERIES IV

NEW YORK PAID FAMILY LEAVE SUMMARY OF BENEFITS

CALENDAR WEEKS AVAILABLE MAX % OF MAXIMUM (AWW) NYS YEAR BENEFIT PERIOD EMPLOYEE SALARY WEEKLY BENEFIT (EST *) AWW (EST *)

01/01/18 8 50% $653 $1,305.92 01/01/19 10 55% $718* $1,305.92* 01/01/20 10 60% $784* $1,305.92* 01/01/21 12 67% $874* $1,305.92* * Pending AWW Changes WORKERS’ COMPENSATION LAW § 2(16) The maximum Paid Family Leave benefit is subject to a percent of the employee salary to a maximum of the NYS Average Weekly Wage (NYSAWW). The 2016 AWW used for this calculation is $1,305.92. The AWW is updated annually on / or about March 31st for review. NYSAWW is the average weekly wage paid in New York State during the previous calendar year as reported by the Commissioner of Labor to the Superintendent of Financial Services on March 31 each year.

BENEFIT CALCULATION EXAMPLE: In 2018, an employee who makes $1,000 a week would receive a benefit of $500 a week (50% of $1,000). Another employee who makes $2,000 a week would receive a benefit of approximately $653, because this employee is capped at 50% of the New York State’s Average Weekly Wage (NYSAWW) —currently $1,305.92, which results in a benefit amount of $653 weekly.

PAID TIME OFF (PTO) / VACATION Paid Family Leave may coordinate with qualified employee vacation benefits. • PFL allows additional options for eligible employees who may have accrued Paid Time Off (PTO) with their employer to either; > Combine PTO days with PFL, while earning their full salary for part of their leave or; > Electing to keep their vacation time, while earning the salary percentage covered under the PFL law. > Employers may elect to require employees who are using PFL to use their accrued vacation time instead of PFL.

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PFL RATES & CONTRIBUTIONS SERIES V The New York State Department of Financial Services (DFS) have published their final regulations, and rate factor for the calculations of the employee contributions and premiums for PFL benefits. Effective January 1, 2018 all covered employers will be required to withhold contributions on behalf of employees based on their meeting the eligibility criteria full or part-time status.

THE RATE FACTOR The rate factor used for employee PFL weekly contributions will be 0.126% of an employee’s weekly wage up to and not to exceed 50% of the New York State average weekly wage (AWW).

NYS AVERAGE WEEKLY WAGE (AWW) NYSAWW is the average weekly wage paid in New York State during the previous calendar year as reported by the Commissioner of Labor to the Superintendent of Financial Services on March 31 each year. • The AWW for calendar year ending 2016 to be used in calculation of the PFL employee contributions, effective January 1st 2018 is $1,305.92 *

MAXIMUM WEEKLY CONTRIBUTION The maximum weekly contribution rate for Paid Family Leave is 0.126% of the employee’s weekly wage which is capped at the NYS Average Weekly Wage currently $1,305.92

HOW TO CALCULATE CONTRIBUTIONS? • EMPLOYEE EARNING MAXIMUM WEEKLY: .126% x $1,305.92 (Employee Weekly Wage) = $1.65 (Employee Weekly Contribution) • EMPLOYEE EARNING: $1,000 WEEKLY: .126% x $1,000.00 (Employee Weekly Wage) = $1.26 (Employee Weekly Contribution) • EMPLOYEE EARNING: $500 WEEKLY: .126% x $500.00 (Employee Weekly Wage) = $0.63 (Employee Weekly Contribution) Note: Employee contributions as shown are not based on or subject to any other rate factors i.e. age, gender, industry, or location.

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PFL RATES & CONTRIBUTIONS-Cont'd SERIES V

MAXIMUM WEEKLY BENEFIT The maximum weekly benefit for an employee Paid Family Leave for 2018 is capped at 50% of the NYS AWW ($1,305.92) or $652.96.

EMPLOYER GROUPS The Employee PFL rate factor, benefit and contributions are currently the same for all covered employer groups regardless of the number of employees, which is subject to review and change by NYS Workers’ Compensation Board and Department of Financial Services. PAYROLL DEDUCTION INSURANCE CARRIERS In collecting employee contributions through The Employee PFL rate factor, benefit, limits and contributions payroll deductions, the employer shall act as are the same for each of participating insurance carriers the agent of his or her employees and shall underwriting New York Paid Family Leave. use the contributions only to provide disability and family leave benefits as required.

CONTRIBUTIONS / DEDUCTIONS • In no event may the employee’s annual contribution for family leave exceed his or her per capita share of the actual annual premium charged for the same year and must be determined consistent with the principle that employees should pay the total costs of family leave premium. • A covered employer may deduct employee contributions prior to the effective date of the policy and prior to an employee’s eligibility for Paid Family Leave. • A covered employer may be responsible for payment of premium prior to collection of all employee contributions for a policy year. Under these circumstances, the covered employer may collect employee contributions after the premium payment in order to cover the cost of the Paid Family Leave coverage. • A covered employer shall use his or her employees’ contributions to provide PFL benefits to employees andshall promptly return to employees any surplus in employee contributions that exceed the annual premium. • A covered employer may continue to deduct the employee contributions set forth in Workers’ Compensation Law section 209 when an employee is receiving benefits pursuant to Workers’ Compensation Law section 204.

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EMPLOY-ER SERIES VI Considerations

COVERED EMPLOYERS New York State has and will continue to provide additional information and details to employers in order for them to review, prepare and implement Paid Family Leave on behalf of their covered employees on or before its effective date of January 1st, 2018, subject to the following considerations.

• Employers will be covered in accordance with the number of their eligible employees as follows: A. Groups 49 Lives or less B. Groups 50 to 499 Lives C. Groups 500 plus Lives • Employers subject to the New York State Statutory Disability Law (DBL) are equally mandated to provide their eligible employees Paid Family Leave (PFL). • Employers covering employees in the private sector with at least 1 employee (not counting the owner). • Employers in the public-sector that may elect to choose their participation under the Paid Family Leave, while being excluded from New York State Disability. • Partners, members of an LLP, Sole proprietors, or other self-employed individuals may elect to be covered under Paid Family Leave (PFL). • Paid Family Leave (PFL) coverage may be offered to out-of-state employees covered by a New York State employer, subject to the underwriting carrier’s considerations and approval. • Employers failing to collect employee paid family leave contributions will be liable for payments of Paid Family Leave benefits, and will waive their right to collect employee contributions for the period in which contributions went uncollected. • Employers will be required to collect the cost of premiums through employee contributions paid through payroll deductions on behalf of all eligible covered employees. • Employers are required to post a notice of coverage on behalf of their employees in their place of business in accordance with New York State guidelines.

• Employers may terminate health insurance coverage for employees who are more than 30 days late in paying their share of the premium • Employers must mail a notice to those employees at least 15 days before their health insurance coverage is to be terminated

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EMPLOY-ER SERIES VI Considerations-Cont’d

HEALTH INSURANCE • Employers will be required to continue and maintain health coverage on behalf of any eligible employee while using their PFL benefit. • The Affordable Care Act rules apply to employer groups with under and over 50 employees. Employers may obtain additional information from their health care advisor on their health plan and PFL benefits. • Employers will be billed by their insurance providers in accordance with rates determined by NY State guidelines, subject to the billing frequency available through insurance providers based on the number of eligible employees for each employer.

FAMILY LEAVE WAIVER

Employers must provide employees the option to file a waiver to exempt them from making contributions for PFL. This occurs when an employee’s regular employment schedule is 20 hours or more per week, but they will work less than 26 consecutive weeks or their regular employment schedule is less than 20 hours per week and they will work less than 175 days in a 52 consecutive week period.

• Employers may make deductions from the pay of employees, who choose not to file such a waiver. • If an employer hires an employee who (i) is ineligible for PFL benefits and (ii) enters into a waiver, the waiver shall be deemed revoked within eight weeks of change to the employee’s schedule that requires an employee continue working for 26 weeks or 175 days in a 52 consecutive week period. • After the employer notifies the employee that his or her waiver has been revoked, the employer should begin immediately taking contributions from the employee and shall make contributions for PFL coverage, including any retroactive amounts due from the employee’s date of hire. • The covered employer shall keep a copy of the fully executed waiver on file to be produced at the request of the Chair, for as long as the employee remains in employment with the covered employer.

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EMPLOY-ER SERIES VI Considerations-Cont’d CONTRIBUTIONS • Employers may elect to subsidize and share the cost or a portion of the cost required for the PFL premiums on behalf of their eligible covered employees. • Employers may be responsible for payment of premium prior to collection of all employee contributions for a policy year. > Under these circumstances, the covered employer may collect employee contributions after the premium payment in order to cover the cost of the Paid Family Leave coverage. • A covered employer shall use his or her employees’ contributions to provide PFL benefits to employees and shall promptly return to employees any surplus in employee contributions that exceed the annual premium. • 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.

Employers are permitted, but not required, to collect the weekly employee contribution on July 1, 2017 for paid family leave coverage beginning on January 1, 2018. • Employers may deduct employee contributions prior to the effective date of the policy and prior to an employee’s eligibility for Paid Family Leave.

EMPLOYEE INFORMATION & GUIDE • If a covered employer maintains written guidance for employees concerning employee benefits or leave rights, such as in an employee handbook, information concerning leave under PFL and employee obligations under PFL shall be included in the handbook or other written guidance. • If a covered employer does not have written policies, manuals, or handbooks describing employee benefits and leave provisions the employer shall provide written guidance to each of his or her employees concerning all of the employee's rights and obligations under PFL, including information on how to file a claim for Paid Family Leave. • Employers are required to sign their business up for PFL insurance as part of their DBL (Statutory Short-Term Disability) coverage (if they are self-insured they can get stand-alone PFL insurance). • Employers with employees returning from PFL are required to provide their employees with the same or comparable position without loss of benefits that they would have accrued otherwise. • An employer that fails to provide Paid Family Leave under the PFL will be subject to a fine of up to .5% of the employer’s weekly payroll, plus an additional sum of not more than $500.

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EMPLOY-ER SERIES VI Considerations-Cont’d

VACATION PAID TIME OFF Employers may offer eligible employees an option to apply accrued vacation time or charge all or part of their leave to PFL, enabling the employee to elect to receive their full salary in lieu of the percentage provided by PFL benefits alone. • When an Employer offers, and the eligible employee exercises an option to charge all or part of his or her family leave time to unused accruals or other paid time off and receive full salary, > The employer may request reimbursement out of any family leave benefits due or to become due by filing its claim for reimbursement with the carrier prior to the carrier’s payment of such family leave benefits. > The actual reimbursement amount may be computed after family leave is complete.

EMPLOYER PFL PREPARATION The new PFL benefit will require employers and their insurance advisor to work together to ensure that they take the appropriate steps to increase awareness and education for their employees. As well employers will need to review their internal administrative process to accommodate changes in maintaining eligibility, payroll contributions, billing, policy documents and informational bulletins on behalf of their employees. Employers must follow all federal and state laws for notices provided to sensory-impaired individuals. Employers may consider the deductions for the funding of contributions July 1st 2017, in advance of the effective date January 1st 2018. • Employers should review their current protocols and or procedures with respect to their leave policies, and the submission of disability claims to determine any changes that may be needed or desired to administer the Paid Family Leave benefits. • Employers should start preparing for these new requirements by reviewing and revising current policies and practices and creating new comprehensive policies to ensure full compliance with the law’s requirements, including the leave of absence and job reinstatement provisions.

EMPLOYEE COMMUNICATION Employers must be aware that the proposed regulations require employers to display or post a notice in plain view where all employees and applicants can readily see it with information about PFL, including on how to file a complaint. • If many of the employers’ employees do not read and write in English, the notice also must be in a language in which the employees can read and write.

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EMPLOY-ER SERIES VI Considerations-Cont’d

NY STATE DISABILITY NON-COMPLIANCE REVIEW An employer who has had New York State employment with one or more employees on each of at least 30 days in any calendar year shall be a "covered employer" subject to the Disability Benefits Law after the expiration of four weeks following the 30th day of such employment. • A "covered employer" under the law is required to provide for the payment of Disability Benefits to all eligible employees, which includes full-time and part-time employees. • If an employer fails to obtain and maintain NYDBL for all eligible employees, it may result in non-compliance with NYDBL law. • In the event of loss of coverage, an employer may be subject to fines and / or penalties, subject to the Workers Compensation Board review.

Avoid Non-Compliance and Loss of Coverage, Contact LiDAC for Assistance 516-482-2696

• Eligible Full-time employees working 20 hours a week or more may be eligible for PFL after 26 consecutive weeks of employment. • Eligible Part-time employees working less than 20 hours a week may be eligible to PFL after 175 days of regular employment.

DOCUMENTATION Employer should contact their insurance advisor to review the selection of their current NY DBL insurance carrier to confirm that they will continue to offer coverage. As well, your insurance advisor will work with the insurance carrier to obtain the necessary PFL documentation that will include but may not be limited to: • Policy Contract Rider • Claim Forms • Certificates of Insurance • Billing Invoices • Posting Notice POWERED BY

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EMPLOY-EE SERIES VII Considerations Eligible Employees covered by an employer in the State of New York may be eligible for Paid Family Leave (PFL) commencing January 1st, 2018 with the following considerations: • Employees will realize enhanced benefits commencing in 2018 with schedule changes through 2021, which will include increasing the maximum percentage of covered wages and the duration period. • Paid Family Leave (PFL) claims will be completed, verified and reviewed in accordance with the applicable new PFL claim form and submitted to the underwriting carrier for processing and approval.

EMPLOYEE PFL NOTIFICATION Employees are required to advise employers with a 30-day notice of their request to use PFL benefits, if the qualifying event is foreseeable. If not foreseeable, the employee shall advise the employer as soon as practicable, usual, and customary notice requirements applicable to such leave. • When the need for family leave is foreseeable and an employee fails to give 30 days advance notice, the employer or the carrier may file a partial denial of the family leave claim for a period of up to 30 days from the date notice is provided. • An employer may require an employee to comply with the employer’s usual and customary notice and procedural requirements for requesting leave, absent of unusual circumstances. Where an employee does not comply with the employer’s usual notice and procedural requirements, and no unusual circumstances justify the failure to comply, PFL may be delayed or denied.

JOB PROTECTION & DISCRIMINATION • Eligible Employees will have job protection while taking extended time away from work. • Eligible Employees will be protected against discrimination for taking extended time away from work.

• Eligible Employees for PFL may include an undocumented workers whose immigration status has no impact on their eligibility for benefits. • Eligible Employees may be covered under PFL benefits to care of an eligible relative living outside New York, subject to them providing medical certification.

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EMPLOY-EE SERIES VII Considerations-Cont’d EMPLOYEE VACATION / PAID TIME OFF Eligible Employees have the ability to elect an option to apply accrued vacation time to all or part of their leave for PFL. This enables them to receive their full salary in lieu of the percentage provided by PFL benefits alone. • Eligible Employees won’t be able to collect both vacation pay and PFL benefits simultaneously. • Eligible Employees who are not working and collecting Workers’ Compensation Benefits may not be eligible to receive Paid Family Leave.

PFL CONDITIONS Eligible Employees may be covered by PFL in the result of qualifying events such as: paid maternity leave to recover from having a child, bonding with infant or adopted children, caring for a seriously ill family member, or spending time with a family member on a qualifying military leave.

FAMILY MEMBER Eligible Employees cannot use (PFL) benefits for their own disability or qualifying military service. It may only be used for the care of family members that include:

• Spouse • Domestic partner • Child • Parent • Parent in-law • Grandparent • Grandchild

CARE OF FAMILY MEMBER Employees may be eligible to take the necessary time to provide care for a loved one with a serious health condition • Serious Health Conditions may include an illness, injury, impairment or physical or mental condition that involves:

> Inpatient care in a hospital, hospice or residential health care facility; or > Continuing treatment or continuing supervision by a health care provider.

MATERNITY LEAVE PFL only begins after birth and is not available for prenatal conditions: • If an eligible employee’s child was born or adopted or placed by foster care before January 1, 2018, the employee may take paid family leave on or after January 1, 2018, during the first 12 months after the child’s birth or placement.

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EMPLOY-EE SERIES VII Considerations-Cont’d MILITARY SERVICE Eligible Employees may be covered to provide care and assistance to family members under the military provisions in the federal Family Medical Leave Act. • This entails of when a spouse, child, domestic partner or parent of the employee is on active duty or has been notified of an impending call or order of active duty.

EMPLOYEE AVERAGE WEEKLY WAGE Employee’s average weekly wage shall be calculated using the average weekly wage of the employee’s previous 8 weeks of employment or portion thereof that the employee was in such employment with the same employer that is collecting the employee’s contribution. • In the case of a self-employed person, the average weekly wage for such person shall be the greater of the person’s self-employment income for the previous full calendar year divided by 52 weeks, or the statewide average weekly wage.

EMPLOYEES COVERED BY MULTIPLE EMPLOYERS An employee with multiple covered employers is not required to take paid family leave from each covered employer during a single period of family leave. • An employee with multiple covered employers may not take Paid Family Leave for a single qualifying event from different covered employers at separate intervals, but must take family leave from all covered employers during the same family leave period.

MARRIED COUPLES Eligible married employees working for independent employers may be eligible to take benefits separately under the PFL law. However, if you and your spouse work for the same employer, they can deny Paid Family Leave to more than one employee at the same time to care for the same family leave recipient, or to bond with a child.

INDEPENDENT CONTRACTOR Individuals who are not regularly scheduled to work for a covered employer in the State of New York or who are an independent contractor will not have Paid Family Leave benefits, unless they purchase coverage for themselves.

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EMPLOY-EE SERIES VII Considerations-Cont’d COLLECTIVELY BARGAIN EMPLOYEES If employees of a covered employer are entitled to receive family leave benefits under a collective bargaining agreement, the employer shall be relieved of providing family leave benefits under Article 9 of the Workers' Compensation Law.

FAMILY LEAVE WAIVER Employees have the option to file a waiver to exempt them from making contributions for PFL. • If an employee is hired who (i) is ineligible for PFL benefits and (ii) enters into a waiver, the entered waiver shall be deemed revoked within eight weeks of a change to the employee’s schedule that requires the employee to continue working for 26 weeks or 175 days in a year based on weekly hours worked.

PFL BENEFIT LIMITATIONS Employee’s request for PFL benefits may be denied by the carrier for the following reasons: • Employee may not collect benefits for short-term disability required by New York State law and PFL concurrently. • Employee who is also eligible for disability benefits may receive only a combined amount of 26 weeks of disability benefits and PFL benefits in a 52-consecutive calendar week period. • Employee has not been employed with employer for a sufficient amount of time to be eligible for benefits. • Employee is not an employee of the employer, or an Employee of a covered employer. • The family member that the employee is seeking leave to care for is not a covered family member under subdivision (20) of section 201 of the Workers’ Compensation Law; or • Employee amount of leave requested exceeds the statutory maximum benefit period for family leave or disability benefits under Article 9 of the Workers’ Compensation Law.

Other situations in which PFL benefits may not be payable include when the employee is: • Receiving total disability payments pursuant to a claim for workers’ compensation, volunteer firefighters’ benefits, or volunteer ambulance workers’ benefits; • Not employed or is on administrative leave from his or her employment; • Collecting sick pay or paid time off from the employer;

• Works at least part of that day with pay for the employer or for any other employer; and using the same period of family leave to care for the same family member in question. • In addition, unless otherwise expressly permitted by the employer, leave available under the FMLA runs concurrently with PFL. For a subsequent, unrelated disability, an employee may seek benefits up to the maximum number of available weeks permitted.

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AGENT / BROKER SERIES VIII Value Proposition

Agents / Brokers value proposition will be expanded to include their involvement in the process of the introduction, implementation and education of Paid Family Leave benefits on behalf of their group employer clients. • Agents / Brokers may have the opportunity to provide their clients a comprehensive introduction, review and understanding of the new Paid Family Leave Benefits. • Agents / Brokers may provide assistance in the selection of insurance providers and implementation of the PFL program on behalf of their clients.

BROKER VALUE PROPOSITION Agent / Broker Services will include detailed information related to the specific considerations involved in the eligibility, benefits, heath conditions, contributions, premium payments and selection of the insurance carrier best suited to underwrite, administer and service their NY State Paid Family Leave (PFL) and Disability Benefits (DBL). Live Webinar / More information Call 516-482-2696 or [email protected]

BROKER SERVICES • Agents / Brokers may offer alternative funding arrangements to underwrite and manage the PFL program based on the demographics and number of employees included in their clients group. • Agents / Brokers may assist their clients in maintaining compliance with the New York State (DBL) and Paid Family Leave (PFL) law. > This will include but is not limited to ensuring the timely and accurate payment of insurance premiums, submission of state disability and PFL claims and coordination of any and all communication as may be required by and between the client and their insurance provider.

• Agents / Broker may be involved in the prospective underwriting The Paid Family Leave (PFL) details and review, evaluation and decisions as to the continued selection regulations may continue to be updated. and administration of the insurance provider. LiDAC remains committed to providing • Agents / Broker may assist their client in communication of timely and comprehensive information as any updates and or changes as may be passed by the State of made available by the State of New York New York governing the PFL eligibility, benefits, durations, rates and our industry insurance providers. and contributions.

NY STATE DISABILITY & PAID FAMILY LEAVE SERVICES NY-PFL BULLETIN 06/09/17 16 516.482.2696 / www.LiDAC.com New York State Paid Family Leave {AGENT / BROKER HIGHLIGHTS}

INSURANCE PROVIDERS / CARRIERS SERIES IX Services CARRIER MARKET PARTICIPATION Insurance carriers currently participating in underwriting New York State Statutory Disability (DBL) are required to declare the earlier of not later than July 1 of this year – or within 30 days of the PFL rates being released by the state, if they will continue to underwrite DBL coverage. • Insurance carriers that make such declaration are required to offer Family Paid Leave (PFL), otherwise they must exit the NY State Disability (DBL) market. Further details may be available: DFS 11 NYCRR 363, Section 363.6 (k) (1)

CARRIER CONSIDERATIONS Each insurance carrier participating in New York State Statutory (DBL) business must consider all of the underwriting, administrative and service requirements in order to provide Paid Family Leave Benefits. • In order to administer PFL claims insurance carriers will be required to review, verify and approve that an employee’s request for Paid Family Leave is valid and or medically justified. • Insurance health care providers offering out-of-state or out-of-country coverage must have a valid license where they practice. • In the event of these instances it will also require a review and certification that an employee's request for Paid Family Leave is valid and or medically justified.

Insurance Carriers will be required at significant cost to make necessary and timely adjustments to their systems, while training their sales, service and claims staff as well as address premium billing and collection changes that include but are not limited to: • Documentation, reports and NY State mandated forms related to Paid Family Leave must be added to the current NYS DBL policy contracts.

• All insurance health care providers will be required to provide their license number with a description of their medical specialty and written documentation to the employee related to the state or country where they are licensed. • All insurance health care providers based in United States must provide the ICD 10 primary and secondary codes detailing the diagnosis of a serious health condition. • All Non-United States based insurance health care providers may be permitted to provide a diagnosis description determined to be sufficient in accordance with New York State Guidelines. • These changes in addition to their current market share may weighted greatly in their decision to withdraw from offering NYDBL and PFL commencing in 2018. POWERED BY

NY STATE DISABILITY & PAID FAMILY LEAVE SERVICES NY-PFL BULLETIN 06/09/17 17 516.482.2696 / www.LiDAC.com New York State Paid Family Leave {AGENT / BROKER HIGHLIGHTS}

INSURANCE PROVIDERS / CARRIERS SERIES IX Services-Cont'd CONTINUITY OF COVERAGE Effective January 1st, 2018 all insurance carriers underwriting New York’s statutory disability must assume the coverage in offering Paid Family Leave (PFL). • Any carrier that fails to offer the Paid Family Leave (PFL) will no longer underwrite any New York DBL coverage. • The insurance carrier underwriting the DBL must also underwrite the PFL, which may not be underwritten separately under another carrier’s policy. • Insurance carriers are currently preparing the required PFL policy rider to be added to the NY DBL policy.

CARRIERS & EXISTING CLIENTS In the event that any of the current NY DBL insurance carriers fail to declare that they wish to continue to underwrite the NY DBL together with the PFL benefits, they must advise their existing policyholders of their decision. Policyholders will be required to find an appropriate insurance company to replace their coverage on or before December 31st, 2017.

CARRIERS PFL CLAIMS Once the carrier receives a completed request for paid family leave with the necessary certification as identified in Subpart 380-4 of this Part, the carrier must pay the claim or deny the claim within 18 days • In the event that an employee makes a claim for Paid Family Leave upon an uninsured employer and is entitled to such benefits, the Special Fund for Disability Benefits shall make payment of the benefits to the employee. • The Special Fund for Disability Benefits will attempt to seek reimbursement from the uninsured employer of any benefit payments made on behalf of the uninsured employer. If the Special Fund for Disability Benefits seeks reimbursement of such payments from the uninsured employer, the employer cannot seek contributions from its employees to pay the required reimbursement.

The above information provides a brief summary of guidelines related to recent updates as may be available from the State of New York under the Paid Family Leave Act. This is not intended to offer specific details, terms and / or conditions as it relates to the final passage of the law and or proposed changes as may be pending. You may request a copy of the NYS PFL law for additional information as may be required. Looking for more information, please contact our sales and service office New York Statutory Disability Services 516-482-2696 or [email protected]

NY STATE DISABILITY & PAID FAMILY LEAVE SERVICES NY-PFL BULLETIN 06/09/17 18 516.482.2696 / www.LiDAC.com New York State PAID FAMILY LEAVE

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1010 Northern Blvd, Suite 324 Great Neck, NY 11021 516.482.2696 / www.LiDAC.com