Statutory Disability: What s New for 2017 & Hot Topics

Transcription

1 Statutory Disability: What s New for 2017 & Hot Topics DMEC Webinar November 17, 2016 The Prudential Insurance Company of America (Prudential)

2 Presenters Allyson Kambach Director, Disability & Absence Product Management Prudential Group Insurance Allyson Kambach is the director of Disability and Absence Product Management at Prudential Group Insurance with primary responsibility for Short Term Disability and Absence Management. She has over 15 years of experience with state-mandated disability plan compliance, including 10 years managing the contract team responsible for filing private plans with the states. Most recently, she authored a series of Frequently Asked Questions for employers focused on each of the six statutory disability jurisdictions. Allyson is a Fellow of the Life Management Institute (FLMI). 2

3 Presenters Karen Oudine is the director of Disability Product Management at Prudential Group Insurance. She has over 15 years of experience with state-mandated disability sales and plan compliance. Karen is a member of the California Voluntary Plan Advisory Group and is a Fellow of the Life Management Institute (FLMI). Karen Oudine Director, Disability Product Management Prudential Group Insurance 3

4 Program Overview Recent Developments Statutory Disability Overview Maternity Scenarios in 6 Jurisdictions Q&A 4

5 The Basics 6 Jurisdictions Have Statutory Disability Programs Provide short-term income replacement for employees with non-work related disabilities California State Disability Insurance (SDI) 3 Jurisdictions Have Statutory Paid Leave Programs Provide short-term income replacement for employees during a qualified leave California Paid Family Leave (PFL) Hawaii Temporary Disability Insurance (TDI) New Jersey Temporary Disability Benefits (TDB) New Jersey Family Leave Insurance (FLI) New York Disability Benefits Law (DBL) New York Paid Family Leave (PFL) effective 1/1/18 Puerto Rico Disability Benefits Act (SINOT) Rhode Island Temporary Disability Insurance (TDI) Rhode Island Temporary Caregivers Insurance (TCI) Administered by the Same State Agencies Similar Employer Requirements, Employee Eligibility, and Benefit Calculations 5

6 Recent Developments 6

7 Recent Developments: Hawaii Temporary Disability Insurance (TDI) Effective Date Change 1/1/2016 Annual Updates announced by December 1, Weekly Benefit Maximum $552 $570 TBD Maximum Weekly Employee Contribution $4.76 $4.91 TBD 7

8 Recent Developments: Rhode Island Temporary Disability Insurance (TDI) Effective Date Change 7/3/2016 Weekly Benefit Maximum Increased from $795 to $817 1/1/2017 Annual Updates will be announced in mid-november Employee Contribution Rate 1.2% 1.2% 1.2% Maximum Annual Employee Contribution $ $ $

9 Recent Developments: California State Disability Insurance (SDI) Effective Date Change 7/1/2016 Recurrence Period Extended The time between claims for the same or related cause or condition to be considered one disability benefit period is extended from 14 days to 60 days. The seven-day waiting period is waived for individuals who have satisfied the waiting period for the initial claim and a subsequent claim for the same or related condition is filed within 60 days. 1/1/2017 Annual Updates announced by mid-november Maximum Weekly Benefit $1,104 $1,129 $1,173 Employee Contribution Rate 0.9% 0.9% 0.9% Taxable Wage Ceiling $104,378 $106,742 $110,902 1/1/2017 Physician's Assistants Can Certify Disability The definition of Physician for Disability Insurance purposes is extended to include a Physician Assistant (PA). PA may certify a disability after a physical examination has been conducted under the supervision of a physician or surgeon. 9

10 Recent Developments: California (continued) State Disability Insurance (SDI) Effective Date Change 1/1/2018 Assembly Bill 908 Increases benefits for both Disability and PFL. Formulas will be revised in a manner designed to raise the amount of wage replacement from the current of 55% of weekly wages to approximately 60% to 70%. Removes the 7 day waiting period from PFL. 10

11 Recent Developments: New Jersey Temporary Disability Benefits (TDB) Family Leave Insurance (FLI) Effective Date Change 1/1/2017 Annual Updates announced by mid-november Maximum Weekly Benefit $604 $615 $633 TDB Employee Contribution Rate FLI Employee Contribution Rate 0.25% $80.00 max 0.09% $28.80 max 0.20% $65.20 max 0.08% $26.08 max 0.24% $80.40 max 0.10% $33.50 max Taxable Wage Base $32,000 $32,600 $33,500 Pending Partial Return to Work Benefit Employees would be eligible to receive a prorated benefit if they are able to return to work on a part-time basis after a qualifying period of total disability. 11

12 Recent Developments: New York Disability Benefits Law (DBL) Paid Family Leave (PFL) Effective Date Change 1/1/2018 Launch Paid Family Leave Program On April 4, 2016, Governor Cuomo signed into law a state budget bill which included a 12-week paid family leave program the longest and most comprehensive in the nation. (Press Release) 1/1/18 1/1/19 1/1/20 1/1/21 & later Benefit percentage of weekly wage 50% 55% 60% 67% Maximum duration in weeks Benefit duration not to exceed 26 weeks within a consecutive 52-week period when combined with DBL. 12

13 Comparing NY DBL and PFL Qualifying Absence Maximum Benefit Minimum Benefit DBL Employee s non-occupational disability $170 per week $20 or the employee s weekly wage if less than $20 PFL Care of a seriously ill family member New child bonding Military exigency as defined by federal FMLA Calculated annually: Benefit Percentage x NY Average Weekly Wage Using current average weekly wage of $1,266.44, maximum benefit in 2018 (50%) would be $ $100 or the employee s weekly wage if less than $100 Elimination Period 7 Days None Employee Contribution Up to ½ of 1% of weekly wage not to exceed $0.60 per week TBD 13

14 Survey Question #1 What will be the impact to your company when New York s Paid Family Leave Benefit goes into effect? A. No impact B. Employees opting for PFL instead of DBL due to higher benefit C. Shorter duration absences D. Increased administration E. Employee confusion F. Don t know 14

15 Maternity Scenarios 15

16 Comparing Maternity Guidelines Definition of Disability Unable to perform job duties Under the care of a physician Maternity handled the same as any other disability Ante-Partum 4 weeks Duration CA SDI HI TDI NJ TDB NY DBL PR DBA* RI TDI based upon medical 4 weeks 4 weeks N/A Duration Post-Partum 6 weeks 6 weeks 6 weeks N/A Post-Partum for C-Section Maternity Guidelines 8 weeks Duration based upon medical necessity * DBA benefits generally not payable for maternity disabilities. Puerto Rico Working Mothers Act applies. N/A based upon medical 16

17 Maria s Story For the past 2 years, Maria has worked fulltime for the XYZ Corporation. She is pregnant and is due in 4 weeks. Her doctor has provided medical certification of her disability. XYZ offers a Short Term Disability (STD) plan to its employees. How will her maternity claim be handled if Maria works in a statutory state? 17

18 Maria s Absence Experience Hawaii TDI Waiting Period 3 Weeks Ante Baby Born STD Waiting Period 3 Weeks Ante HI FMLA 4 Weeks Ante 2 Weeks Bonding HI PDL 4 Weeks Ante HI Family Leave 4 Weeks Bonding Weeks 18

19 Comparing STD & Statutory Plans Administrator Contributions Plan Design Definition of Disability Employer Insurer or TPA STD Contributory vs. Non-Contributory Employer Decides Determined by Employer Total vs. Partial Employer Decides State Employer Insurer or TPA SMD State Sets Maximum Contribution Rates Minimum Requirements Set by State Generally, Total Only Offsets Offset Other Income No Offsets Appeals Insurer or Claim Fiduciary Reviews State Reviews 19

20 Maria s Absence Experience New York Baby Born DBL Waiting Period 3 Weeks Ante NY STD Waiting Period 3 Weeks Ante FMLA 4 Weeks Ante 2 Weeks Bonding Weeks 20

21 Maria s Absence Experience Rhode Island Baby Born TDI 4 Weeks Ante TCI 4 Weeks Bonding RI STD Waiting Period 3 Weeks Ante FMLA 4 Weeks Ante 2 Weeks Bonding RIPFMLA 4 Weeks Ante 3 Weeks Bonding Weeks 21

22 Comparing State Disability & Leave Covered Absences Maximum Duration Contributions Benefit Amount Elimination Period Subject Employers Statutory Disability Employee s disability CA: 52x the weekly benefit NJ: 26 weeks RI: 30 weeks NJ TDB: Employer and Employee Statutory Paid Leaves Care of seriously ill family member New child bonding following birth or adoption CA : 6x the weekly benefit NJ: 6 weeks RI: 4 weeks NJ FLI: Employee only CA & RI: 100% Employee paid; Disability & Leave Contributions Combined Same benefit % and maximum weekly benefit for both plans CA & NJ: 7 days 1,2 RI: None Based upon number of employees working in the jurisdiction or covered payroll Subject Employees Based upon employee s state employment history 1 7 day elimination period waived for paid leave when bonding leave immediately follows maternity disability. 2 Effective1/1/18, no elimination period applies to CA PFL. 22

23 Survey Question #2 What is your company s approach to benefits in a multi-state employee population? A. Company-wide program with state exceptions B. Company-wide program exceeds minimum state requirements for all employees C. State-specific benefit program D. No out-of-state employees E. Don t know 23

24 Pregnancy Disability Scenario Montclair, New Jersey Baby Born Paid Sick Leave 40 Hrs TDB Waiting Period 3 Weeks Ante NJ FLI 6 Weeks Bonding STD Waiting 3 Weeks Ante Period FMLA 4 Weeks Ante 2 Weeks Bonding NJ FLA 12 Weeks Bonding Weeks 24

25 Pregnancy Disability Scenario California CA Paid Sick Leave 24 Hours Baby Born SDI Waiting Period 3 Weeks Ante CA PFL STD Waiting 3 Weeks Ante Period 6 Weeks Bonding FMLA 4 Weeks Ante 2 Weeks Bonding PDL 4 Weeks Ante CFRA 12 Weeks Bonding Weeks 25

26 Maria s Absence Experience Puerto Rico Baby Born WMPA 4 Weeks Ante 4 Weeks Post DBA 2 Weeks Post PR STD Waiting Period 3 Weeks Ante* * FMLA 4 Weeks Ante 2 Weeks Bonding Weeks *STD benefits are generally offset by the amount that a claimant receives from salary continuation. A minimum benefit will be paid until Maria s salary continuation ends. 26

27 Working Mothers Protection Act Working Mothers Protection Act Separate from DBA benefits 100% salary continuation for 8 weeks Reduces 26-week DBA duration 27

28 (More) Questions? 28

29 State Websites California Hawaii New Jersey New York Puerto Rico Rhode Island

30 Presenters Allyson Kambach, Director, Disability and Absence Product Management The Prudential Insurance Company of America Karen Oudine, Director, Disability Product Management The Prudential Insurance Company of America

31 Group Insurance coverages are issued by The Prudential Insurance Company of America, Newark, NJ Prudential Financial, Inc. and its related entities. Prudential, the Prudential logo, the Rock symbol, and Bring Your Challenges are service marks of Prudential Financial, Inc. and its related entities, registered in many jurisdictions worldwide. 31