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New York - Compensation & Benefit Legislation

NEW YORK - AASHOWME

Demonstrates www.BenefitsReview.com™ site. Illustrates insurance carriers' coverages within the State.

 

NEW YORK - ADOPTED CHILD HEALTH CARE MANDATE

OBRA 1993 (Federal) requires group health plans to honor medical and child support orders. Also, plans must treat adopted children like biological children covered by the plan, and plans are precluded from applying pre-existing condition exclusions to an adopted child where no such exclusion applies to a newborn biological child. Health plans that covered the cost of pediatric vaccines as of May 1, 1993, and fail to continue that level of coverage, will be subject to an excise tax penalty applicable to plans that fail to meet the health care continuation coverage requirements under OBRA 1993.

 

Mandatory coverage of birth of adopted children is included in state's newborn health care mandate.

 

Preventive care for children: Mandatory to age 19.

 

(New York Insurance Law Sections 3221(k)(5)(A), 3221(l)(8)(A), 3221(l)(8)(B), 4235(f)(1), 4235(f)(2); New York Public Health Law Section 2803-n)

 

NEW YORK - ALCOHOLISM & DRUG ABUSE

Employer option.

 

Minimum yearly inpatient coverage: 7 days detoxification; 30 days rehabilitation.

 

Minimum yearly outpatient coverage: 60 visits.

 

Minimum lifetime coverage: no statutory requirements.

 

(New York Insurance Law Sections 3221 (I)(6)(A), 3221 (I)(6)(B), 3221 (l)(7).

 

NEW YORK - CAFETERIA PLAN TAX LAWS

State income tax, unemployment insurance tax on salary reduction: State Unemployment Insurance law has no specific provisions relating to cafeteria plan benefits, but employer contributions toward health and group-term life insurance are not taxable, even if provided under a cafeteria plan. Employer contributions toward other cafeteria plan benefits and all employee salary reductions are Unemployment Insurance taxable.

 

NEW YORK - CONTINUATION OF COVERAGE CONVERSIONS

Events Triggering Continuation of Coverage:

 

NEW YORK - COORDINATION OF BENEFITS

Requires use of the birthday rule if coordinating benefits. Based on 1986 National Association of Insurance Commissioner Rules model. (New York Comp. Codes R. & Regs. tit. 11, Section 52.23)

 

NEW YORK - COST-OF-LIVING

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian cost-of-living data and U.S. Automobile Cost Survey.

 

NEW YORK - DRUG TESTING AND EMPLOYEE ASSISTANCE BENEFITS

State has no statutory requirements.

 

NEW YORK - GROUP HEALTH CODE ADDITIONS (MANDATED)

Alcoholism and Substance Abuse Treatment: Group or school blanket policies providing inpatient hospital care must cover at least 60 outpatient visits per year for diagnosis or treatment. (New York Insurance Law Sections 3221( I) (&), 4303( I).) Insurers offering group or school blanket policies covering inpatient hospital care must make available to policyholders coverage for diagnosis and treatment of alcoholism and substance abuse of at least 7 days of inpatient detoxification treatment and 30 days of inpatient rehabilitation care per year. (New York Insurance Law Sections 3221 ( I)(J), 4303(k).)

 

Ambulatory Care: Ambulatory care in hospital outpatient facilities must be made available. (New York Insurance Law Sections 3221 ( I)(3), 4303(e)-(f).)

 

Breast Reconstruction: Effective January 1, 1998, group health insurers must provide coverage for breast reconstruction surgery after a mastectomy. Breast reconstruction benefits must include all stages of surgery on the breast on which the mastectomy has been performed and surgical procedure done on the other breast in order to produce a symmetrical appearance. (S761, 1997) (New York Insurance Law Sections 3216, 3221, 4303.)

 

Cervical Cytology Screening and Pap Smear: Cervical cytology screening, which includes an annual pelvic examination and a Pap smear, must be made available for women age 18 and older, coverage may be subject to annual deductibles and co-insurance payments. (New York Insurance Law Section 3221(1).)

 

Coverage Continuation and Conversion: Group hospital and surgical policies must provide continuation and conversion rights to terminating employees for themselves and their dependents. (New York Insurance Law Sections 3221 (3)(1), 3221(e)(3), 3221 (e)(11), 4305(e).) Policies must provide conversion rights to dependents who cease to be eligible family members. (New York Insurance Law Sections 3216( c)(5)(A), 3221(e)(7), 4304(3), 4305(d).)

 

DES: Insurers may not deny coverage to a person solely because the person has been exposed to diethylstilbestrol (DES). (New York Insurance Law Section 3225.)

 

Emergency Services: Policies covering inpatient care must cover costs of emergency medical service in hospital facilities. (New York Insurance Law Sections 3216( i)(9), 3221(k)(4), 4303(a)(2).)

 

Enteral Formulas: Health policies which provide prescription drug coverage must also provide benefits for medically necessary in home use of enteral formulas which have been prescribed by a physician or other licensed health care provider. The use of enteral formulas, effective in treating diseases of amino acid or organic acid metabolism, Crohn's disease, gastroesophageal reflux, gastrointestinal motility, and severe food allergies, must be covered for up to $2,500 per calendar year. (AB352, 1997) (New York Insurance Law Section 3216(21).)

 

Handicapped Dependents: Coverage for dependent children cannot be terminated while the dependent is incapable of employment due to mental illness, developmental disability, mental retardation, or physical handicap and is chiefly dependent on the insured. (New York Insurance Law Sections 3216( c)(4)(A), 4304(d)(1), 4305( c).)

 

Home Health Care: Policies must cover costs of home health care provided in lieu of inpatient care in a hospital or skilled nursing facility, with deductibles of no more than $50 and co-insurance of no more than 25 percent annually. At least 40 home health care visits must be covered. (New York Insurance Law Sections 3216( I)(6), 3221(k)(1), 4303(a)(3).)

 

Hospice Care: Hospice care must be made available. (New York Insurance Law Sections 3221( I)(10, 4303(o).)

 

Infertility: Policies covering hospital, surgical, or medical care cannot exclude coverage for diagnosis and treatment of covered correctable medical conditions solely because the condition results in infertility. (New York Insurance Law Sections 3216( I)(12), 3221(k)(6), 4303(q).)

 

Mammography Screening: Policies covering hospital, surgical or medical care must cover costs of mammography screening as described. (New York Insurance Law Sections 3216( i)(11), 3221( l)(11), 4303(p).)

 

Managed Health Care: Disclosure of Information: Written disclosure must be made to each insured individual and, upon request, to prospective plan enrollees; health coverage information which must be disclosed includes benefit maximums, benefit limitations, exclusions of coverage, and definitions of what constitutes a medical necessity. Among other information to be disclosed is descriptions of requirements for treatments and services; utilization review policies and procedures; methodologies used to reimburse providers; financial responsibilities; provisions for emergency services; procedures for referrals to specialists; and procedures to be used if providers leave a network. Emergency Care: Policies which provide coverage for inpatient hospital care must also include coverage for services to treat emergency conditions in hospital facilities. (S7553, 1996) (New York Insurance Law Section 4408.) Mastectomy: Effective January 1, 1998, health care policies which provide coverage for inpatient hospitalization care must provide benefits to an individual who undergoes a lymph node dissection, a lumpectomy, or a mastectomy for the treatment of breast cancer. Written notification of the availability of breast cancer treatment coverage must be provided to an individual prior to inception of the policy and on an annual basis thereafter. (S11, 1997) (New York Insurance Law Sections 3216( i), 3221(k), 4303(v)-(w), 2803, 2404.)

 

Maternity: Group health policies (HMOs included) which supply benefits for hospital, surgical, or medical coverage must provide coverage for maternity care to the same illness or disease. Maternity care coverage, except for perinatal complications, must include benefits for a mother and her newborn infant for at least 48 hours after childbirth for any delivery other than a Caesarean section, and for at least 96 hours after a Caesarean section. Mothers must be allowed early hospital discharge options and, in these cases, they must receive 1 home care visit in addition to, rather than in lieu of, other home health care visit coverage. The home health care visit may be requested at any time within 48 hours -- within 96 hours in the event of Caesarean section -- of the time of delivery and must take place within 24 hours after discharge or within 24 hours after the time of the mother's request, whichever is later. Benefits provided for maternity care must also include parental education, which consists of assistance in training in breast or bottle feeding, and the necessary clinical assessments for a mother and her newborn infant. (S5742, 1997) (New York Insurance Law Sections 3216, 3221, 4303, 2803-N, 2803-J.)

 

Medicare Supplemental Coverage: Insurers must make available supplemental coverage for Medicare patients so that the aggregate number of visits covered equals 365 annually. (New York Insurance Law Sections 3216( J)(2), 3221( l)(1).)

 

Mental Health: Diagnosis and treatment (including social worker services) of mental, nervous, or emotional disorders or ailments must include 30 days per year of inpatient treatment, and $700 per year of outpatient benefits. (New York Insurance Law Sections 3221 ( l)(4)-(6); 4303( i)-(n).)

 

Newborns: Policies must cover newborn children from the moment of birth for injury or sickness including treatment of medially diagnosed congenital defects, birth abnormalities, and prematurity. (New York Insurance Law Sections 3216( c)(4)( C), 4304(d)(1), 4315( c). Every medical, major medical, or comprehensive type coverage policy shall provide coverage for the preventive and primary care services from birth to age 19. (New York Insurance Law Section 3216(l)( i)(17)(A)-(B).)

 

Nursing Home Care: Insurers must make available to policyholders coverage for nursing home care. (New York Insurance Law Sections 3216(j), 3221(1)(2), 4303(d)(1).)

 

Outpatient Services: Policies must cover costs of laboratory tests and diagnostic x-rays on the same basis as they would be covered on an inpatient basis. (New York Insurance Law Section 3216(i)(5). Policies covering inpatient care must cover pre-admission tests performed on surgery patients. (New York Insurance Law Sections 3216( i)(7), 3221(k)(2), 4303(a)(1).)

 

Prescription Drugs: Policies that cover prescribed drugs with FDA approval for treatment of certain types of cancer must cover costs of drugs recognized in other drug reference manuals. (New York Insurance Law Sections 3216(i)(12), 3221( I)(12), 4303(q).)

 

Preventive Care and Primary Care: Preventive care and primary care must be made available. (New York Insurance Law Sections 3221( l)(8), 4303(j).

 

Providers: Optometrists, podiatrists, dentists, psychiatrists, registered psychologists and registered professional nurses: Costs for services must be covered if the provider is licensed, the service is within the provider's scope of services and the service is covered by the policy. (New York Insurance Law Sections 3216( I)(1)-(4), 3221(1)(9), 4303(m).)

 

Second Opinions: Policies covering inpatient surgical care must cover costs of second surgical opinions. (New York Insurance Law Sections 3216( i)(8), 3221(k)(3), 4303(b). In the event of a positive or negative diagnosis of cancer; a recurrence of cancer; or a recommendation of a course of treatment for cancer, group policies which provide medical; major medical; or similar comprehensive type coverage must provide benefits for a second medical opinion by an appropriate medical specialist. (S11, 1997) (New York Insurance Law Sections 3216( i), 3221(k), 4303(v)-(w), 2803, 2404.)

         

NEW YORK - GROUP HEALTH FOR SMALL EMPLOYERS

No reported statutory requirements.

 

NEW YORK - GROUP LIFE CODE ADDITIONS

Employer required to pay part of premium: No.

 

Percent of employees who must elect coverage (if employees pay part of premium): 50%, or 50 or more persons if less than 50% elect coverage.

 

Percent of employees who must be covered if employer pays all of premium: No statutory requirements.

 

Minimum number of employees in group plan: No statutory requirement.

 

Employer prohibited as beneficiary: Yes.

 

Grace period (days): No statutory requirement.

 

Mandatory conversion: No.

 

Other provisions: None.

 

(New York Ins. Law Sections 4216(b)(1), 4216(d))

 

NEW YORK - HOLIDAYS

January 1, Washington's Birthday (or 3rd Monday in February), Memorial Day (or last Monday in May), July 4, Labor Day (or 1st Monday in September), Veterans Day, and December 25 are state holidays in all 50 states and in the District of Columbia. Other holidays under State law include: Martin Luther King's birthday (or 3rd Monday in January), Lincoln's Birthday, Columbus Day (or 2nd Monday in October), Thanksgiving. Other: If holiday falls on Sunday, following Monday is a holiday (except for Flag Day). (New York Gen. Const. Section 24.)

 

NEW YORK - IMMIGRATION (PREVAILING WAGE POLICY)

See U.S. Federal General Administrative Letter 1-2000

 

NEW YORK - JURY DUTY & WITNESS TIME OFF

Employer Restriction For Discharging Employee For Taking Leave For Jury Service: Yes.

 

Remedies and Penalties: Violator is guilty of criminal contempt.

 

Other Requirements: Employer may withhold employee's wages while on jury service, except employers with 10 or more employees, who shall not withhold more than $27.50 per day for first three days of service. Employee must notify employer prior to commencement of jury service. (New York Jud. Law Section 519 and New York Penal Law Section 215.14.)

 

Employer Restriction For Discharging Employee For Taking Leave to be a Witness: Yes.

 

Remedies and Penalties: Violator is guilty of a Class B misdemeanor.

 

Other Requirements: Employer may request verification of witness service.

 

NEW YORK - LEAVES OF ABSENCE

Employers Subject to Leave Laws: All employers.

 

Criteria for Eligibility: If employer allows leave benefits for birth of a child, it must offer the same leave benefits to adoptive parents; no minimum employment requirements.

 

Maximum length of leave: Same as those extended to biological parents. Exception: there is no entitlement to leave for adoptive parents of a child that has reached minimum age for attendance in public school (unless child is handicapped or otherwise considered difficult to place for adoption.

 

Paid Leave: Must be the same as those extended to biological parents.

 

Acceptable Reasons for Leave: Birth/adoption of a child.

 

Employment Guarantees After Leave: State reports no statutory requirements.

 

Use of Vacation or other Time-off Benefits: State reports no statutory requirements.

 

Certification Required: State reports no statutory requirements.

 

Effect Of Leave on Other Benefits: State reports no statutory requirements.

 

Effect of Seniority Accrual During Leave: State reports no statutory requirements.

 

Minimum Requirements for Notification to Employer: State reports no statutory requirements.

 

Conditions for Denial of a Request For Leave: State reports no statutory requirements.

 

(New York Labor Law Section 201-c.)

 

See U.S. Federal Family and Medical Leave Act

 

NEW YORK - LONG TERM DISABILITY CODE ADDITIONS

State does not require employer to provide long term disability benefits; although many employers do in order to remain competitive in hiring/retention of employees.

 

See LEAVES OF ABSENCE (above), WORKERS' COMPENSATION (below) and U.S. Federal Americans With Disabilities Act

 

NEW YORK - MANDATED PROVIDERS

Optometrists, chiropractors, dentists, psychologists, podiatrists, and social workers. Mandatory coverage for physical therapists, speech pathologists, and audiologists. (New York Ins. Law Sections 3221(l)(4)(D), 4235(f)(4)(B ), 4235(f)(4)(C ), 4235(f)(4)(D), 4235(f)(4)(E), 4235(f)(4)(F), 4235(f)(4)(G), 4235(f)(4)(H))

 

NEW YORK - MENTAL HEALTH CARE

Employer option.

 

Minimum yearly inpatient coverage: 30 days.

 

Minimum yearly outpatient coverage: $700.

 

Minimum lifetime coverage: no statutory requirements. (New York Ins. Law Section 3221 (l)(5)(A))

 

NEW YORK - MINIMUM WAGE

Refer to the Federal minimum wage: $5.15 per hour (effective September 1, 1997).

 

Exemptions: Certain professionals, agriculture workers, domestics, outside sales, students, apprentices, and handicapped workers in special environments. (New York Labor Law Sections 651, 652)

 

See U.S. Minimum Wage

 

NEW YORK - NEW HIRE REPORTING

Who is required to report: All employers.

 

Who must be reported: All new employees and rehires.

 

Exempt from reporting: No exemptions.

 

Form(s) to file: W-4 form or at the employer’s option, an equivalent form. Employers may file by paper, fax, or magnetically.

 

Filing deadline: Within 20 days of hire.

 

Employer information to be included: Name, address, and EIN.

 

Employee information to be included: Name, address, SSN, date of birth, and annual gross wages.

 

Penalty for failure to report: Fine of $20 per employee for each failure to report. If failure is due to conspiracy between employer and employee, $450 fine per employee for each occurrence.

 

(New York Tax Law Section 171-h)

 

NEW YORK - NEWBORN CARE MANDATE

Mandated coverage.

 

Preventive care for children: Mandatory to age 19.

 

(New York Insurance Law Sections 3221(k)(5)(A), 3221(l)(8)(A), 3221(l)(8)(B), 4235(f)(1), 4235(f)(2); New York Public Health Law Section 2803-n)

 

NEW YORK - PARENTAL LEAVE

See U.S. Federal Family and Medical Leave Act

 

NEW YORK - PRE-EXISTING CONDITIONS

State reports no statutory requirements.

 

See U.S Federal Health Insurance Portability & Accountability Act

 

NEW YORK - PROTECTED CLASSIFICATIONS

Age:  Yes.

Race:   Yes, subject to arbitration, as are other protected classes.

Color:  Yes.

National Origin:  Yes.

Ancestry:   Yes.

Religion:   Yes.

Sex:  Yes.

Pregnancy:   Yes.

Sexual Harassment:  Yes.

 

(N.Y. Exec. Law Sections 291, 292, 296; N.Y. Civ. Rights Law Sections 40-c, 42-44; N.Y. Ex. Or. 6; Fletcher v. Kidder, Peabody & Co., 619 N.E.2d 998 (N.Y. 1993).

 

NEW YORK - SALARY SURVEY

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian wages & salaries (covering 3,000 positions).

 

NEW YORK - SHORT TERM DISABILITY CODE ADDITIONS

Covered Employers: 1 or more non-exempt employees.

 

Employer Contribution: Cost of plan minus employee contribution.

 

Covered Employees: Employees with more than 4 consecutive weeks of employment.

 

Employee Contribution: 0.5% of employee's weekly wages, not to exceed $0.60 per week.

 

Weekly Benefit Amount: One half employee's weekly wage, not to exceed $170.

 

Waiting Period: 7 consecutive days.

 

Coordinated with Workers' Compensation: Yes.

 

Responsible Agency:      

Workers' Compensation Board

Disability Benefits Office

100 Broadway

Albany, NY 12241

 

NEW YORK - TERMINATION & SEVERANCE PAY

Date pay is due if employee is discharged: Payday.

 

Date due if employee resigns: Payday.

 

Wages: Yes. (Wages defined to include commissions.)

 

Vacation Pay: Yes, unless employer's policy excludes or limits entitlement to vacation.

Holiday: Yes.

 

Sick leave: Yes.

 

Severance: No.

 

(New York Labor Law Sections 190, 191, 198-C. See Ross v. Specialty Insulation Mfg. Co., 419 N.Y.S. 2d 311 (NY App. Div 1979); Glenville Gage Co. v. Industrial Board of appeals 421 N.Y.S. 2d 408 (NY App. Div. 1979), aff'd, 417 N.E. 2d 408 (NY, 1980); First Coinvestors, Inc. v. Carr. 552 N.Y.S. 2d 20 (1990, 1st Dept.)

 

NEW YORK - UNEMPLOYMENT TAX

Employer Contributions:

 

 

Voluntary Contribution Provision: Yes. If made on or before April 1.

 

(New York Labor Law Sections 570, 575-577, 581.)

 

NEW YORK - VACATION PAY

 

NEW YORK - VOTING TIME OFF

As much time so that, when added to the hours available to vote outside of work time, employee will be able to vote; unless employee has 4 consecutive hours outside of work time while the polls are open. Up to 2 hours leave taken will be with pay. (New York Elec. Law Sections 3-110, 17-118, 17-142, 17-144, 17-150.)

 

NEW YORK - WORKERS' COMPENSATION

Private Employers: Mandatory as to all employments. Elective as to partner or self-employed, sole shareholder/officer, and 2 sole shareholder/officers. (Note: Elective as to unsalaried executive officer of not-for-profit unincorporated association or corporation, and as to executive officer of religious, charitable or educational corporation or veteran's organization.)

 

Public Employers: Mandatory coverage to state and sub-division when worker is engaged in hazardous occupations enumerated. Covers school aides and public school teachers in districts outside New York City. Voluntary as to municipal corporations in non-hazardous employments.

 

Exceptions: Farm labor if payroll for prior year was less than $1,200; volunteer workers, domestic worker not employed my same employer at least 40 hours per week; teacher or non-manual laborer for religious, charitable, or educational institution; certain real estate salespersons, sole shareholder officer and 2 shareholders/officers who have no other employees; baby sitter under age 18; and casual employment or repairs in or about a one-family owner occupied residence.

 

Special Coverage Provisions: Voluntary as to exempt employments and for certain employment in fulfillment of probationary sentence. Elective as to the individual offices of mental health organizations to provide participants in sheltered workshops with benefits. Jockeys covered by the NY Jockey injury compensation fund.

 

(U.S. Chamber of Commerce, 1994 Analysis of Workers' Compensation Laws.)