11 CRR-NY 363.3NY-CRR
OFFICIAL COMPILATION OF CODES, RULES AND REGULATIONS OF THE STATE OF NEW YORK
TITLE 11. INSURANCE
CHAPTER XIV. INDIVIDUAL AND SMALL GROUP HEALTH INSURANCE AND FAMILY LEAVE BENEFITS COVERAGE
PART 363. MINIMUM STANDARDS FOR THE FORM AND RATING OF FAMILY LEAVE BENEFITS COVERAGE, INCLUDING THE ESTABLISHMENT AND OPERATION OF A RISK ADJUSTMENT MECHANISM
11 CRR-NY 363.3
11 CRR-NY 363.3
As used in this Part:
(a) Chair shall mean the chair of the Workers’ Compensation Board of this State.
(b) Community rated means a rating methodology in which the premium for all persons covered by a policy is the same based on the wages of the covered person and the experience of the entire pool of risks covered by family leave benefits coverage in the State by all issuers and self-funded employers without regard to utilization or expected utilization of the family leave benefits or any factor that may correlate with such utilization including, without limitation, age, gender, health status or occupation.
(c) Covered employer means an employer subject to article 9 of the Workers’ Compensation Law.
(d) Earned premium means the premium amounts due to issuers for family leave benefits coverage provided for a calendar year, without regard to when the premium is actually paid or collected.
(e) Employee means an employee or other self-employed person who is eligible for family leave benefits in accordance with Workers’ Compensation Law section 203.
(f) Family leave benefits means the coverage for family leave set forth in article 9 of the Workers’ Compensation Law.
(g) Incurred claims means all paid claims and unpaid claims (reported and unreported) for family leave benefits coverage provided for a calendar year. Incurred claims for a calendar year shall be calculated as: claims paid during the current calendar year plus current end of year unpaid claim reserves minus end of year unpaid claim reserves for the prior calendar year minus amounts received by the issuer pursuant to 12 NYCRR section 380-7.7(f). For purposes of this calculation, end of year unpaid claim reserves shall be determined in accordance with Insurance Law section 1303.
(h) Issuer means:
(1) an authorized insurer writing a policy; and
(2) subject to 363.2(c) of this Part, the State Insurance Fund of this State.
(i) Maximum employee contribution means the maximum amount a covered employer is authorized to collect from each of its employees to fund the family leave benefits.
(j) Policy means a group accident and health insurance policy that provides family leave benefits.
(k) Rate means the premium rates determined by the superintendent in accordance with section 363.4(a)(3) of this Part.
(l) Self-funded employer means an employer providing family leave benefits in the manner authorized by Workers’ Compensation Law section 211(3).
(m) Statewide average weekly wage means the average weekly wage of employees in this State for the previous calendar year as reported by the Commissioner of Labor of this State.
(n) Statewide median weekly wage means the median weekly wage of employees in this State for the previous calendar year as reported by the Commissioner of Labor of this State. In the absence of the Commissioner of Labor’s report, the superintendent shall estimate the statewide median weekly wage using the available wage data as reported by the Commissioner of Labor of this State.
(o) Wages means the money rate at which employment with a covered employer is recompensed by the employer as more fully set forth in 12 NYCRR section 357.1 and in the case of a self-employed person, the person’s self-employment income as defined in 26 U.S.C. section 1402(b).
11 CRR-NY 363.3
Current through December 31, 2020
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