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NY “Emergency COVID-19 Paid Sick Leave”

NY “Emergency COVID-19 Paid Sick Leave”

NY “Emergency COVID-19 Paid Sick Leave”

From our preferred DBL Partners, ShelterPoint

Until the Federal program (“Families First Coronavirus Response Act”) becomes effective in April to help ease some of the financial strains from the COVID-19 outbreak (the illness caused by the novel Coronavirus), NY State is helping fill the void on the State level through “Emergency COVID-19 Paid Sick Leave” for employees who can’t work while under quarantine. This means, starting April 1st, the Federal program becomes the primary source of COVID-19 paid sick leave.

​How is COVID-19 quarantine defined under the NY law? Under what circumstances does a quarantine qualify for benefits under this act?

“Emergency COVID-19 Paid Sick Leave” applies to employees who are ordered by the State of NY, Department of Health, a local Board of Health, or any other governmental entity to be under mandatory or precautionary quarantine/isolation due to COVID-19.

  • The “Order for Quarantine” is official written documentation issued to individuals who need to be isolated. See a sample here.
  • The quarantine/isolation under this act does NOT apply to New York State on Pause or general stay-at-home orders.
  • The Centers for Disease Control and Prevention (CDC)* define isolation and quarantine as follows:
  • Isolation separates sick people with a quarantinable communicable disease from people who are not sick.
  • Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.

Further, in order to qualify, the employee must be unable to perform their core job duties or any alternative responsibilities the employer may offer during the quarantine.

If the employee doesn’t show any symptoms (or has not been diagnosed yet) and can work while under quarantine, “Emergency COVID-19 Paid Sick Leave” benefits do not apply.

Does the NY law apply to employees not working due to “New York State on Pause” or stay-at-home orders in NY State?

No, the “Emergency COVID-19 Paid Sick Leave” or “New York State on Pause” does not apply if an employee has to stay home or work remotely for circumstances other than a mandatory quarantine described above. This means, the following situations, for example, do not apply:

  • Watching kids during school closure
  • Working from home
  • Voluntarily self-quarantining “just in case”
  • Being home because the business is temporarily closed

How does the COVID-19 Paid Sick Leave work?

Eligible employees receive job protection (in form of job restoration and non-retaliation provisions) and paid sick leave during the time of their qualified quarantine. The actual benefit structure depends on the size and annual net income of the employer:

Employer Size (by employee count) Job protection

 

Covered Duration

Starting 3/18/20

Employer’s Role

 

Employee’s pay/benefits

Starting 3/18/20

1-10

(less than $1m annual net income)

Yes Duration of quarantine until Federal program starts (unless NY has richer benefits) Unpaid sick leave until end of quarantine

Sick leave is entirely compensated through DBL/PFL benefits concurrently:

Combined maximum of $2,884.62/week

1-10

(more than $1m annual net income)

Yes Duration of quarantine until Federal program starts (unless NY has richer benefits)

At least 5 days paid sick leave by ER

+

Unpaid sick leave until end of quarantine

Days 1-5:

Full salary continuation by employer

 

Days 6+

Concurrent DBL/PFL benefits:

Combined maximum of $2,884.62/week

11-99 Yes Duration of quarantine until Federal program starts (unless NY has richer benefits)

At least 5 days paid sick leave by ER

+

Unpaid sick leave until end of quarantine

Days 1-5:

Full salary continuation by employer

 

Days 6+

Concurrent DBL/PFL benefits:

Combined maximum of $2,884.62/week

100+ Yes At least 14 days Full duration paid at regular salary by ER Full salary continuation by employer
Public Employers Yes At least 14 days Full duration paid at regular salary by ER Full salary continuation by employer

 

How long does the COVID-19 Sick Leave last?

The intended duration is the period of quarantine only, i.e. 14 days. However, there are a few things to note:

  • “Emergency COVID-19 Paid Sick Leave” became effective on March 18th and does not retroactively apply to quarantines before that date.
  • If an eligible quarantine started prior to that date and stretches past March 18th, only the days from March 18th onward qualify.
  • Once the Federal program goes into effect, benefits under the NY program will be replaced by the Federal program (unless NY has richer benefits, see below for details), even if the 14-day quarantine is not completed yet. This means, employees will have to file a new, federal claim for the remainder of their quarantine. Visit this post for details on the Federal “Families First Coronavirus Response Act”.

Is the COVID-19 sick leave coming from the employee’s own bucket of accrued sick leave days?

No, the Sick Leave provided under this act is not taken from an employee’s accruals.

Is the COVID-19 benefit duration under DBL/PFL reducing the total available benefit time available under those coverages?

Yes, DBL/PFL time taken under COVID-19 benefits counts as duration taken under State disability (maximum of 26 weeks per year) and Paid Family Leave (maximum of 10 weeks in 2020) and  reduces the remaining benefit durations accordingly.

How much is the DBL/PFL benefit?

The combined maximum of $2,884.62/week consists of a Paid Family Leave portion and a short-term disability portion. Both benefits run concurrently, meaning one part of your COVID-19 sick pay is paid through PFL and the rest through DBL at the same time:

  • The first 60% of the weekly salary are paid through the Paid Family Leave benefit bucket, to a maximum of $840.70/week.
  • The amount of the DBL benefit depends on the employee’s weekly salary – it’s the difference between the salary less the PFL portion of the benefit. The DBL portion is capped at $2,043.92/week.

Here are 3 examples:

  Weekly salary

 

PFL benefit portion

(60% of weekly salary, capped at $840.70)

 

Weekly salary minus PFL amount

(capped at $2,043.92)

Total Benefit amount/week
Jane $1,000.00 $600.00 $400.00 $1,000.00
Jamal $2,000.00 $840.70 $1,159.30 $2,000.00
Anne $3,000.00 $840.70 $2,043.92 $2,884.62

 

 

When does the DBL/PFL benefit start?

For purposes of the “Emergency COVID-19 Paid Sick Leave”, the 7-day waiting period under DBL is waived. Benefits start on the employee’s first full day of unpaid quarantine starting March 18th. Here’s what that means:

  • If an eligible quarantine started prior to that date and stretches past March 18th, only the days from March 18th onward qualify.
  • Employees at a small business with less than 10 employees – and that has less than $1m in annual net income – are eligible to get their income replacement back to day 1 of the quarantine through their DBL/PFL insurance.
  • However, if a small business with 1-10 employee has more than $1m in annual net income, the employer has to pay the first 5 days before DBL/PFL benefits become payable to cover the remaining quarantine time from day 6 on.
  • The same applies to businesses that have between 11 and 99 employees.
  • Employees at organizations with 100+ employees and employees of public employers do not get their paid sick leave through DBL/PFL benefits under this act – their employer must continue their full salary for the duration of the quarantine.

Does Emergency COVID-19 Paid Sick Leave apply to the Quarantine/Isolation of an Employee’s Child?

Yes. The legislation provides Paid Family Leave for working parents if their minor dependent child has to go into mandatory or precautionary quarantine/isolation. In addition to job protection, eligible employees may receive a maximum benefit of $840.70 per week for the duration of the quarantine.

When does the Emergency COVID-19 Paid Sick Leave take effect?

The provisions of the quarantine legislation take effect immediately upon the date of Governor Cuomo’s signature (March 18, 2020) ensuring that New York workers will be able to take advantage of these benefits starting March 18th.  However, the “Emergency COVID-19 Paid Sick Leave” does not retroactively apply to quarantines before that date. So, if an eligible quarantine started prior to that date and stretches past March 18th, only the days from March 18th onward qualify.

How does NY’s Emergency COVID-19 Paid Sick Leave relate to the Federal “Families First Coronavirus Response Act”?

Once the Federal Program goes into effect in April, it will become the primary source for COVID-19 benefits. In other words, most New Yorkers looking to request benefits after that date, need to file for support on the Federal, not the State, level.

After that date, the NY program will only be available for New Yorkers who exceed the Federal program’s salary cap and can file for supplemental benefits bridging between the Federal and State caps.

  • NY program apply to quarantines that started before the Governor signed enacted the “Emergency COVID-19 Paid Sick Leave”

 

Learn how our PEO Partnership can help your group please contact us at info@360peo.com or (855)667-4621.

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Disability Insurance: New York vs. New Jersey Infographic

Disability Insurance: New York vs. New Jersey Infographic

Comparing NY’s Disability Benefits Law (DBL) and NJ’s Temporary Disability Insurance (TDI)

From our preferred DBL Partners, ShelterPoint

Do you need to stay on top of the differences between the statutory short-term disability programs in New York and New Jersey?  It may seem hard to keep track of the details, particularly since there are many scheduled changes for New Jersey’s disability program in 2020.

New York vs. New Jersey: How Does Their Statutory Disability Insurance Coverages Compare?

Our handy infographic illustrates the similarities and differences between New York’s Disability Benefits Law (DBL)versus New Jersey’s Temporary Disability Insurance (TDI) with the latest information you need to know for 2020. This visual guide gives you a side-by-side look at each program, ranging from eligibility, and qualification periods to rates/premiums and maximum employee contributions.

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Empire Strikes Back – 2020 Health Plans

Empire Strikes Back – 2020 Health Plans

Empire Strikes Back – 2020 Health Plans

Empire Blue Cross Blue Shield has added a 3rd network – Empire Connections to their 2020 roster. The Downstate Network will be the smallest of the 3 featuring top hospitals & providers. The discounts are 11% and 20% discount off of #1 Empire EPO/PPO and Blue Access networks respectively. The middle network Blue Access has expanded significantly adding Memorial Sloan Kettering. Blue Access shares 92% of #1 Empire EPO/PPO network. Empire Blue Cross New Network Trifecta_2020

Additionally, all 3 networks, Empire EPO/PPO, Blue Access, Empire Connections will offer access to the national BlueCard PPO program. As a result of Empire Blue Cross participation in the BlueCard PPO program members enjoy unparalleled national access network to 96% of hospitals and 93% of doctors across the country. This national program will be on 18 of 28 plans below.

Network Overview

  1.  PPO/EPO Network – a traditional non-gatekeeper large network of approximately 91,000 physicians, 160 facilities and the BlueCard PPO. This is the #1 broadest network. All major NY hospitals. National Access with Blue Card PPO. Uses the Traditional Open Formulary (except for one PPO Fair Health Plan)
  2. Blue Access Networkhybrid of broad PPO/EPO 160 facilities and 83,000 physicians network. BlueCard PPO Access from home. All of #1 Empire EPO/PPO Hospitals except Stoney Brook Hospital in Suffolk County.  Uses the Traditional Open Formulary (this is better than the Select Formulary from 2019)
  3. Connections Network-will have a 70% provider match with PPO/EPO network. Network tailored to deliver the greatest premium savings, 20% off EPO/PPO.Available in 9 downstate counties (Bronx, Kings, Nassau, New York, Queens, Richmond, Rockland, Suffolk, and Westchester). Offers the BlueCard PPO National Access, however, Gated plans must have PCP referral for Out-of-Network coverage.  Uses the Select Formulary (mostly generic).  Examples of hospitals:

    Empire Blue Cross 2020 Participating Hospitals (Click Above)

    • NY Columbia Presbyterian
    • Mt Sinai Health System
    • Montefiore
    • Westchester Medical Center
    • Maimonides
    • Staten Island University Hospital
    • Northwell Health (formerly North Shore LIJ)
Resource:Best Hospitals – US News 2019-2020

Additional Features:

  • Telemedicine will be $0 on all products except H.S.A. which will cost $49.
  •  Vision Empire Blue View Vision will be available on all products at no additional cost. 38,000 doctors and 27,000 locations.
  •  Dental –  price competitive plans with 127,000 Dentists and 385,000 locations. empires-whole-health-connection
  • New Pharmacy – Empire will be using their own Ingenio Rx as Pharmacy Benefit Management. With Pharmacy becoming a 22% average expense and close second only to hospitalization its novel focus on whole-health cost management is crucial. Enhanced digital tools, 24/7 support with no intermediary is a welcome All plans use their large BCBS formulary Except Empire Connections. They will be utilizing what they call the Select Formulary. No Pharmacy deductibles.
  • Preventive drugs included in all Small Group H.S.A Plans. NO DEDUCTIBLES on certain maintenance drugs for conditions like asthma, diabetes, osteoporosis, high cholesterol, heart health clots and stroke.
  • Clinical Programs – health coaching/advocacy, disease management, behavioral health, maternity and Gaps in Care
  •  Online Resources – wellness coaching, discounts, health assessments, and The Weight Center.
  • TravelBlueCard PPO national access and Blue Cross Blue Shield Global Core Program.
  • Sydney Health – new mobile app. Uses artificial intelligence to meet member’s needs. A personalized dashboard that recommends programs and contact based on claims. Interactive smart chat feature to help members find what they need faster.A complete view of medical, pharmacy, dental, and vision benefits.Access to the member’s well-being programs and incentives Digital ID card that can be emailed or printed.
  •  Gym Reimbursements Cash Rewards and Healthy Support – Wellness program offers easy ways to earn up to $700 per member, per year.  Gym Reimbursement of $400 single + $400 for dependents 18+, $100 Wellness + Flu Shot, Online Wellness toolkit, up to $150, and $50 Tobacco-free certification online.

Empire Blue Cross Enhanced Embedded Dental and Vision Plans **New for 2020**

Empire’s new model – Enhanced Embedded Dental & Vision Plans – is a care ecosystem where plans work together seamlessly to coordinate care Empire can afford to add these benefits at 50% discount below the stand-alone plan. For example, an individual Gold Blue Access Plan with Dental/Vision is only $20/month.

 

 


DOCTOR SEARCH:  Click Here

BENEFITS SUMMARY:  Empire Blue Cross 2020 Top Plans 

Small-Group Rates:  2020 Small Group NYC    

Drug Formulary: 

Ask us about Empire’s flexible low participation voluntary group dental, vision,  disability, and life insurance plans. Stay proactive and contact us today for a customized consult on how your organization can prepare ahead  for ACA, Benefits, Payroll, and HR  @ (855) 667-4621 or info@medicalsolutionscorp.com.

empire-voluntary-ancillary-dental-whole-life


 

 Contact Us Now    Learn how our Agency is helping businesses thrive in today’s economy. Please contact us at info@medicalsolutionscorp.com or (855)667-4621. 
Best Hospitals – US News 2019-2020

Best Hospitals – US News 2019-2020

Recently,  U.S. News and World Report released their annual top hospitals rankings. The top ten nationally were:

1. Mayo Clinic, Rochester, Minn.
2. Massachusetts General Hospital, Boston
3. Johns Hopkins Hospital, Baltimore
4. Cleveland Clinic
5. New York-Presbyterian Hospital-Columbia and Cornell, N.Y.
6. UCLA Medical Center, Los Angeles
7. UCSF Medical Center, San Francisco
8. Cedars-Sinai Medical Center, Los Angeles
9. NYU Langone Hospitals, New York, N.Y.
10. Northwestern Memorial Hospital, Chicago

They also reported regional rankings for 200 metropolitan areas and the top five hospitals in selected specialties such as Cardiology and Heart Surgery and Cancer.

The top five NY Metro Hospitals were:

  1. New York-Presbyterian Hospital-Columbia and Cornell, N.Y.
  2. NYU Langone Hospitals, New York, N.Y.
  3. Mount Sinai Hospital
  4. North Shore University Hospital
  5. Lenox Hill Hospital

For patients and their physicians, these rankings and ratings should be seen as just a starting point. While this is helpful information to have, benefit plan participants should also research quality hospitals using transparency tools if these services are available through the health plan or benefits package.

For information about transparency providers and new tech tools contact us at info@medicalsolutionscorp.com or (855)667-4621.

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NYS 2020 Final Rates Approved    

NYS 2020 Final Rates Approved    

NYS has approved 2020 health inusrance rate requests today.   Small group rates increase 7.9% and 6.8 8.6% for individuals.

As per NY State Law, Health Insurers are required to send out early notices of rate request filings to groups and subscribers see original –NYS 2020 Rate Requests.  Despite only 3 months of mature claims data experience for 2019  health insurers’ original requests were noticeably below average.  Ultimately NYS reduced this request substantially by approximately 55%.

The 2020 small group rate increase was in line at 7.9% vs  2019’s approval of  7.5%. This reflect a stabilizing ACA market. Insurers’ financial performance improved nationwide last year to its highest level since the passage of the law. The average medical-loss ratio, which represents the portion of premiums spent on medical claims and quality improvement, was 70% last year in the individual market nationwide. That led to plans paying $800 million in rebates for failing to meet requirements on medical spending, according to the Kaiser Family Foundation

Rate Factors

The state noted that premiums increases  main driver are medications.  “The drug costs account for the largest share of medical expenses, followed by inpatient hospital costs, and outpatient hospital costs.”

More than one million New Yorkers are enrolled in small group plans, which cover employers with 1 to 100 employees. Insurers requested an average rate increase of 12.2% in the small group market.  DFS cut the weighted average requested rate increases by 4.3 percentage points, or 35%, from 12.2% to 7.9% for 2020, saving small businesses over $313 million. The federal ACA Health Insurance Tax, which was reimposed for 2020, accounts for approximately 3% of these rates.  Without this tax, the increase would have been 4.7%. A number of small businesses will also be eligible for tax credits that may lower those premium costs even further.

Health Insurance Tax is Back

The HIT (Health Insurance Tax) is back. For Small business, this translates to an estimated 2.5%-3% added surcharge. For States like NYS where there is already approx. 16% added surcharge to high premiums, this becomes daunting.  It is no surprise the unpopular HIT was suspended. In 2017, payers escaped making $13.9 billion in payments due to the moratorium, according to a 2018 analysis by Oliver Wyman, commissioned by UnitedHealth Group.  This may have saved consumers billions on their insurance coverage.“The taxes on health insurance are non-deductible for federal tax purposes for health insurers,” the report explained. 

Website Stop The Hit calculates $5,000 as the average tax for a 10-man small business for example.Calculates how the HIT affects your State and your business, here. Take action now: tell Congress to repeal the HIT! Join small business owners across the country in stopping the HIT. Sign the petition here.

Small Group Market

Learn how a Private Exchange and our PEO Partnership can help your group please contact us at info@medicalsolutionscorp.com or (855)667-4621.

Put You & Your Employees in Good Hands

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For more information on PEOs or a custiomized quote please submit your contact. We will be in touch ASAP. 

NYS 2020 Rate Requests

NYS 2020 Rate Requests

The NYS 2020 Rate Requests filings were released today.  The total weighted average increases were a modest 8.4%  for Individual Market and 12.0% Small Group Market. Final rate approval expected early August. The past reductions averaged 10-50%.

The lower requests reflect a stabilizing ACA market. Insurers’ financial performance improved nationwide last year to its highest level since the passage of the law. The average medical-loss ratio, which represents the portion of premiums spent on medical claims and quality improvement, was 70% last year in the individual market nationwide. That led to plans paying $800 million in rebates for failing to meet requirements on medical spending, according to the Kaiser Family Foundation

 This early filing request deadline request requirement is not an Obamacare requirement.  As per NY State Law carriers are required to send out notices of rate increase filings to groups and subscribers.These are simply requests and the state’s Department of Financial Services has authority to modify the final rates. But they are the first indication of what New Yorkers can expect when shopping for health insurance on the individual marketplace at the end of this year.

Background:

By contrast last year’s  NYS 2019 Rate Request early filing request were higher at 7.5% small group and an astounding 24% for individuals. The NYS final August 2020 rate approval are expected to be lower.  For example, the final filing rates were approved  NYS 2019 Final Rates Approved at a modest 3.8% small group and 8.6% for individuals. Using these past figures one projects a 2019 Final Rates of 5% small groups and 8% individuals.

A spokeswoman for the state Health Plan Association said insurers have worked to control costs, which have been driven up by rising prescription drug prices and state mandates that require coverage of certain services. 

“Our member health plans have been committed to making health care more affordable, working hard to rein in rising health care costs and contain their own costs,” she said. “The proposed premium rate requests are reasonable, reflecting the cost of care.”

In the small-group market, insurers asked for a weighted average 12% boost in 2020 after they were granted a 3.8% bump for this year. UnitedHealthcare’s Oxford, which controls more than half of the small-group market, asked for a 15.9% increase, which was the highest among all plans. Oscar, at 15.8%, was close behind. Notably, Healthfirst has requested a 5% reduction.

Conclusion

Defined Contribution Choice:  Instead, the correct approach for a small business in keeping with simplicity is a defined contribution model using a Private Exchange.  This is a true defined contribution empowering employees with the choice of leading insurers offering paperless technologies integrating HRIS/Benefits/Payroll.  Both employee and employers still gain tax advantage benefits under the business.  Also, the benefits, rates and network size are superior under a group plan as THE RISK OUTLINED ABOVE ARE HIGHER FOR INDIVIDUAL MARKETS THAN SMALL GROUP PLANS.

To be clear: These trends affect a small subset of the insurance market—non-group plans that cover less than 2 percent of the population. Many qualify for tax credits that lower their net costs and reduce or eliminate the impact of year-to-year rate increases.However, non-group customers with incomes above 400% of the poverty level ($48,560 for a single adult) get no subsidy—and feel the full brunt of any hikes.

Resource

  • You may view the NYS 2019 Rate Requests DFS press release, which includes a recap of the increases requested and approved by clicking here.
  • For a custom analysis detailing YOUR upcoming 2019-2020 renewal please contact our team at Millennium Medical Solutions Corp  (855)667-4621.  We work in coordination with Navigators to assist with Medicaid, CHIP Child Health Plus, Family Health Plus and Medicare Dual Eligibles.   We have Spanish, Russian, and Hebrew speakers available.  Quotes can also be viewed on our site.
  •  See Health Reform Resource

*These averages may change based on DFS’s review of the rate applications.** Empire submitted a filing that DFS is evaluating.

Learn how a Private Exchange and our PEO Partnership can help your group please contact us at info@medicalsolutionscorp.com or (855)667-4621.

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