N.Y. Comp. Codes R. & Regs. Tit. 12 §§ 380-7.3

Current through Register Vol. 46, No. 45, November 2, 2024

Section 380-7.3 - Health insurance during paid family leave

In accordance with the Family and Medical Leave Act (29 U.S.C. sections 2601-2654) :

(a) An employee who is provided health insurance by his or her employer is entitled to the continuation of that group health insurance coverage during paid family leave on the same terms as if he or she had continued to work. The employee must continue to make any normal contributions to the cost of the health insurance premiums.

(b) If an employer provides a new health plan or benefits, or changes health plans or benefits while an employee is on paid family leave, the employee is entitled to the new or changed plan or benefits to the same extent as if the employee was not on leave.

(c) Any share of health plan premiums which had been paid by the employee prior to paid family leave shall continue to be paid by the employee during the paid family leave period. If the premiums are raised or lowered, the employee is required to pay the new premium rates.

(d)

(1) A covered employer's obligations to maintain health insurance coverage cease under PFL if an employee's premium payment during a period of family leave is more than 30 days late. In order to drop the coverage for an employee whose premium payment is late, the employer must provide written notice to the employee that the payment has not been received. Such notice must be mailed to the employee at least 15 days before coverage is to cease, advising that coverage will be dropped on a specified date at least 15 days after the date of the letter unless payment has been received by that date.

(2) If the employer has established policies regarding other forms of unpaid leave that provide for the employer to cease coverage retroactively to the date the unpaid premium payment was due, the employer may drop the employee retroactively in accordance with that policy, provided the 15-day notice was given. In the absence of such a policy, coverage for the employee may be terminated at the end of the 30 day grace period, where the required 15-day notice has been provided.

(e) If health insurance coverage lapses because an employee has not made the required premium payments, upon the employee's return from paid family leave the covered employer must restore the employee to coverage/benefits equivalent to those the employee would have had if paid family leave had not been taken and premium payment(s) had not been missed, including family or dependent coverage.

(f) If an employee chooses not to retain health plan coverage during paid family leave, upon the employee's return from paid family leave, the employee shall be reinstated into the health plan on the same terms the employee had prior to taking leave.

(g) A covered employer shall provide notice of any opportunity to change plans or benefits to an employee on paid family leave.

N.Y. Comp. Codes R. & Regs. Tit. 12 §§ 380-7.3

Adopted New York State Register July 19, 2017/Volume XXXIX, Issue 29, eff. 7/19/2017