11 CRR-NY 363.8NY-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 363.8
11 CRR-NY 363.8
363.8 Data collection.
(a) In addition to any information requested by the superintendent or the chair pursuant to Workers’ Compensation Law section 208(2), an issuer or self-funded employer shall electronically submit the following data to the superintendent, in a manner prescribed by the superintendent:
(1) for each employer covered under a policy with family leave benefits and for each self-funded employer:
(i) identification of the group number, if applicable;
(ii) zip code of employer’s location;
(iii) employer’s SIC industry code;
(iv) the group size as referenced in section 363.5(g)(1) of this Part;
(v) the number of employees that are male and the number of employees that are female;
(vi) total earned premiums received for family leave benefits by the issuer or the total employee contributions received by the self-funded employer;
(vii) total amount of benefits paid for:
(a) family care pursuant to Workers’ Compensation Law section 201(15)(a);
(b) bonding pursuant to Workers’ Compensation Law section 201(15)(b); and
(c) a qualifying exigent circumstance pursuant to Workers’ Compensation Law section 201(15)(c); and
(viii) whether the employer provides any additional or enhanced family leave benefits beyond those specified in Workers’ Compensation Law section 204(2) and, if so, a description of the additional or enhanced benefits;
(2) details for each claim for employees covered under a policy with family leave benefits and for each self-funded employer as follows:
(i) identification of the group number, if applicable, to which the employee belongs;
(ii) year of birth of the employee;
(iii) gender of the employee;
(iv) employee’s annual wages;
(v) zip code of employee’s residence; and
(vi) type of claim:
(a) for family care pursuant to Workers’ Compensation Law section 201(15)(a):
(1) identify the familial relationship of the family member to the employee;
(2) date family leave benefits commenced;
(3) the total number of days for which benefits were paid;
(4) total amount of benefits paid; and
(5) if applicable, a description of any additional or enhanced family leave benefits and amounts paid to the employee beyond those specified in Workers’ Compensation Law section 204(2);
(b) for bonding pursuant to Workers’ Compensation Law section 201(15)(b):
(1) identify the event (i.e., birth, placement for adoption, or placement for foster care) giving rise to the claim;
(2) identify the date of birth, or date of placement for adoption or foster care;
(3) date family leave benefits commenced;
(4) the total number of days for which benefits were paid;
(5) total amount of benefits paid; and
(6) if applicable, a description of any additional or enhanced family leave benefits and amounts paid to the employee beyond those specified in Workers’ Compensation Law section 204(2);
(c) for a qualifying exigent circumstance pursuant to Workers’ Compensation Law section 201(15)(c):
(1) date family leave benefits commenced;
(2) the total number of days for which benefits were paid;
(3) total amount of benefits paid; and
(4) if applicable, a description of any additional or enhanced family leave benefits and amounts paid to the employee beyond those specified in Workers’ Compensation Law section 204(2).
(3) Each issuer shall also report electronically the following data separately for each of the three group sizes referenced in section 363.5(g)(1) of this Part:
(i) earned premiums due to the issuer for family leave benefits provided for the period subject to the data submission, without regard to when the premium is actually paid or collected; and
(ii) incurred claims (separately reporting paid claims, current reserve amount, and change in reserves from the beginning of the reporting year).
(4) In addition to the information provided pursuant to paragraphs (1), (2), and (3) of this subdivision, an issuer or self-funded employer shall submit electronically any other data requested by the superintendent.
(5) The data submissions made in accordance with paragraphs (1) and (2) of this subdivision shall be provided by each issuer and self-funded employer every quarter to the superintendent as follows: the data submissions for January 1st through March 31st shall be submitted by April 30th; the data submissions for April 1st through June 30th shall be submitted by July 31st; the data submissions for July 1st through September 30th shall be submitted by October 31st; the data submissions for October 1st through December 31st shall be submitted by January 31st of the following year.
(6) The data submissions made in accordance with paragraph (3) of this subdivision shall be provided by each issuer every quarter to the superintendent as follows: the data submissions for January 1st through March 31st shall be submitted by April 30th; the data submissions for April 1st through June 30th shall be submitted by July 31st; the data submissions for July 1st through September 30th shall be submitted by October 31st; the data submissions for October 1st through December 31st shall be submitted by March 31st of the following year.
(7) The data submissions made in accordance with this subdivision shall be:
(i) cumulative through all quarters in a calendar year;
(ii) with the exception of the data reported pursuant to subparagraph (1)(viii), subclauses (2)(vi)(a)(5), (2)(vi)(b)(6), (2)(vi)(c)(4) of this subdivision, limited to the maximum benefit and maximum duration specified in Workers’ Compensation Law section 204(2), provided that any additional or enhanced benefits beyond those specified in Workers’ Compensation Law section 204(2) shall not be included in the data submission; and
(iii) signed by an officer of the issuer or self-funded employer attesting to the best of his or her knowledge and belief that the data provided is accurate.
(8) Every issuer shall also submit to the superintendent the loss ratio calculations required by section 363.5(g) of this Part.
(b) Audit mechanism.
The superintendent may audit the data submissions of issuers each calendar year. An issuer shall cooperate with the superintendent in providing information necessary to ensure the accuracy of the data reported to the superintendent or to any third party vendor selected by the superintendent.
11 CRR-NY 363.8
Current through March 31, 2021
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