© 2019 MetLife Services and Solutions, LLC

New York Paid Family Leave2020What Customers Needs to Know

Information is for general informational purposes only and does not constitute legal advice. It does not purport to be complete or to cover every situation. You must consult with your own legal advisors to determine how the New York Paid Family and Medical Leave law affects you.

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Agenda

1. Benefit Plan Design

2. Funding & Costs

3. Claim Submission Best Practices

4. Key Dates

5. Tools & Resources

All Panelists

Throughout the session use the chat feature

to ask questions!

Benefit Plan Design

Benefits

Weekly benefit payment is a percent of wages up to a maximum 10 weeksChild bondingCare of family

Military exigency

50 DaysIf taken intermittently

$840.70/week(Up from $746.41 in 2019)

Benefit Calculation:

60% of the employee’s average weekly wage up to the cap

(Up from 55% in 2019)

2019 State average weekly wage$1,401.17

Or Up to

Polling Question

Will the changes being made to the NY PFL plan for 2020 cause your company to make any changes/modifications to your internal leave plans?

A. Yes

B. No

Funding and Costs

Community RateMetLife uses the NY State published community rate as the premium for our NY PFL product offering

2019

Maximum Wage*: $70,569.92

Community Rate: 0.153% per dollar of wages

Maximum Employee Contribution: $107.97

2020

Maximum Wage*: $72,860.84

Community Rate: 0.270% per dollar of wages

Maximum Employee Contribution: $196.72

* Annual wage based on the AWW of 2019: $1,357.11, 2020 $1,401.17

Reminder: NY PFL payroll deduction calculation FICA-like tax deductions

Claim Submission Best Practices

Submitting a ClaimSubmission Tips

2020 Benefits will be available after 1/1/2020 for new claim submissions when the first absence date is taken 1/1/2020 or after.

• Claims should be filed within 30 days (before or after) of the first absence needed for the NY PFL leave.

• Approved time can be for a full intermittent day or for continuous leave.

• If an employee works part of the day, it is not approved for PFL benefit payment

Filing a Claim• If possible, employees should alert their supervisor/

employer 30 days in advance that they will be taking a NY PFL leave

• MetLife does not require 30 days' notice to file the claim

• A claim cannot be approved until the 1st absence day of the claim

Advance Notice

Carry Over ClaimsTips for successful administration

Claim Benefit year is determined when the employee takes their first day of absence. That benefit year carries through the entire claim entitlement.

• Claim filed for a PFL absence with a start date in 2020, even if filed in 2019.

• Claim closed in 2019 with 3 months of no activity (continuous or intermittent) afterwards and then a new claim for the same reason is filed in 2020

2020 Benefit Applied• Claim filed in 2019 with first absence date in 2019

• Claim filed in 2020 with first absence date in 2019

• Claim closed in 2019 and reopened within 3 months for the same leave reason (recurrent claim)

• Intermittent claim started in 2019 and continues into 2020

2019 Benefit Applied

Coordinating Statutory BenefitsNY PFL will work in harmony with NY DBL and FMLA

PFL1 DBL1 FMLAQualifying Leaves • Child bonding2

• Care of family• Military exigency

Employee’s own disability • Employee’s own serious health condition

• Child bonding• Care of family• Military exigency

Paid Leave Yes; Max $840.70 Yes; Max $170 No

Leave Duration • 10 weeks in 20201

• Increasing to 12 weeks in 2021

Up to 26 weeks1 Up to 12 weeks in most cases

Minimum Work Period Necessary To Be Eligible

• Full Time (20 hrs+ / week) - 26 consecutive weeks

• Part Time (<20 hrs./week) – working 175 Days

4 consecutive weeks • 1 year• Minimum hours worked:

1,250 hours in the past 12 months

Covered Family • Spouse/ Domestic partner • Child• Parent/ Parent-in-law• Grandparent• Grandchild

None • Spouse• Child• Parent

Eligibility Must be with the same employer

Any covered employer Must be with the same employer

1NY PFL and NYDBL combined cannot exceed 26 weeks in a 52 week period; and a claimant cannot collect both NYPFL and NYDBL at the same time2NY PFL – Child Bonding claim can be initiated directly after delivery

Polling Question

With the number and complexity of the statutory leave plans on the horizon, how well prepared do you feel your company is to integrate these new plans into your own internal leave policy?

A. Well prepared

B. Moving in the right direction

C. Needs some help

D. Needs a lot of help

Employer Reimbursement Tips Identify potential overlapping paid benefits: Company benefit policy and NY PFL leave Example: Company Paid Parental leave overlaps with NY PFL-Child Bonding

Make sure your employees know how the benefits work together Example: The company’s benefit website informs employees about the company’s paid parental leave as well as

the NY PFL benefits so employees who work in New York (that could be eligible) understand they should apply for both benefits at the same time

Share the overlapping benefits with your MetLife Service team so it can be recorded on a NY PFL Claim Administration Tip Sheet to use with every claim Example: Our Company Paid parental leave offers 100% of pay for 4 weeks and will overlap with NY PFL. We

would like MetLife to reimburse us when an employee applies for NY PFL child bonding benefits for the same absence days

Confirm reimbursement is requested on the Employer section of the claim form/ or the ER Email Confirmation response that is part of every claim processed Example: Jane Doe will be taking our company’s Paid Parental leave January 10-February 4 which will give her

100% of her normal salary. The NY PFL claim request is for the same timeframe therefore, the PFL benefit should be reimbursed to us, not the employee

Key Dates

Key DatesRecommended plan to prepare for 2020 changes

October 2019

• Engage resources for updating company policies

• Update payroll systems; confirm the new 2020 community rate with payroll vendors

• 2020 Community Rate and related rules published

January 2020November 2019September 2019

December 2019

• New payroll deductions begin

• New Benefit calculations begin

• Communicate the new benefit and payroll deduction rate to Employees

• Confirm company benefit materials for 2020 NY PFL have been updated

• Refresh training for HR, Management & Supervisors

• Hang new posters

Tools & Resources

Tools and Resources

State Poster MetLife BrochureStatement of Rights

Wrap Up

Benefit Plan Design

Funding & Costs

Claim Submission Best Practices

Key Dates

Tools & Resources

Appendix

Overview

NY Paid Family Leave (NY PFL) is a rider on the existing NY Disability Benefit Leave (NY DBL) contract

If DBL is self-insured, Employers can purchase a fully insured NY PFL coverage

Coverage Program Eligibility

State establishes the plan design and sets the community rate

In September, the new community rate and benefits will be published for the following January 1 effective date

2020 is the 3rd year of the 4 year implementation Plan

Full-Time Employees• work ≥20 hours/week

• will become eligible after working 26 consecutive weeks with the employer

Part-Time Employees• work <20 hours/week

• will become eligible after completing 175 days with the employer

Waiver available if employee will not meet work hour criteria

Claim Workflow

Claim Submission Claim Evaluation & Decision Ongoing Service &Follow Up

• Employees submit claim via phone, fax, mail, or web1

• Claim facts are reviewed to determine eligibility under the NY PFL plan

• Employee receives acknowledgement package with the claim form and number

• Employee completes the employee section of the form, gathers additional supporting information required and sends to MetLife

• While the claim form will not be pre-filled, MetLife will proactively identify any information already provided by that specific customer and will not require that information again

• Employee and Employer are notified of the claim decision• If declined, arbitration process is defined by the

state• If approved, benefit payments sent for days

reported absent

• MetLife will close the claim if the approved time allotted has been exhausted or if the employee notifies MetLife of a return to work before the end of the approved period

• Intermittent claims: employee or employer contacts MetLife to report days taken3

• MetLife will not pay a benefit based on a future date. We require confirmation that the day was taken.

• MetLife reviews all information and will render a decision within 10 business days of receipt of complete information

• MetLife contacts employer to obtain employer information.

• If information is missing, employee will be contacted by phone and mail outlining the missing information2

• If no receipt of missing employee information received by the 31st business day, follow up of the missing information letter & a final denial letter will be sent2

• A claim cannot be approved until the 1st absence day of the claim if filed more than 2 weeks prior to first absence date

MetLife sends Employee Acknowledgement Package within 48 hours of phone intake

Employee may take the full 10 weeks or up to 50 days if taken intermittently in 1 full day

increments as approved3NY PFL Payment Complete

1Web intake may not be available to every customer. 2Claims specialist will reach out every 3-10 days to obtain missing information. It can take up to 61-64 days to formally deny a claim based on missing information. 3MetLife requires the employee or employer to contact MetLife after an intermittent day has been taken to initiate benefit payment.