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COVID-19 Questions About Group Insurance Benefits and Leaves

Updated April 5, 2022

As we continue to face business disruptions due to COVID-19, The Standard will remain flexible and work with affected customers and employers.

 

For Policyholder Administrators | For Policyholder Employees | New York Paid Leave

Ongoing Preparedness

What actions is The Standard taking to prepare for potential spikes in activity related to COVID-19?

The Standard is actively monitoring numerous components of COVID-19 including demographic, health, treatment and socioeconomic trends to plan for potential customer impacts. Additionally, we are engaged with numerous healthcare professionals from around the world to understand new variant potential, as well as long-term health impacts. We use that information to inform our continuity plans and staffing levels across the organization, as has been the case throughout the pandemic.

How have claims volumes at The Standard been impacted?

To date related to COVID-19 we have predominantly seen Life claims, and our team has managed the volume with no lag to responsiveness or service.

What resources are in place to ensure a timely response for customers if new challenges arise?

The Standard stood up a COVID-19 Rapid Response Team in March 2020 to proactively address customer issues, and that team remains in place. This cross-functional team reviews market and health information to anticipate potential future customer needs arising from COVID-19 and respond to any questions or concerns that arise.

Coverage and Eligibility

Will The Standard provide continuity of coverage for new lines of coverage?

The Standard will provide continuity of coverage for all Life, Short Term Disability, Long Term Disability, Dental, Hospital Indemnity, Critical Illness, and Accident insurance policies for all effective dates through April 1, 2021.

The Standard will allow an individual who experienced a furlough, temporary layoff, reduction in hours or salary to become insured under The Standard’s group insurance policy with the following conditions:

  • The employee was insured on the date before the effective date of The Standard’s group policy.
  • Coverage was continued with premium payment under the prior carrier’s accommodation.

The Standard will extend coverage until the earlier of the date on which the prior carrier’s accommodation would have expired or 90 days after the effective date of the policy.

Will employees’ Group Life, Disability, Supplemental, Dental and Vision coverage continue if their work hours are reduced, they are on an unpaid leave of absence, or they are subject to a furlough or a temporary layoff?

Group Life, Disability, Supplemental (including Accident, Critical Illness and Hospital Indemnity), Dental and Vision coverage normally ends when an employee loses eligibility because the employee is no longer working the required minimum number of hours or they are on an unpaid leave of absence.

However, as an accommodation to our policyholders during this time of uncertainty, subject to continued payment of premium, while employees are not working due to a partial or full furlough or temporary layoff occurring between March 1, 2020 and September 30, 2020, these coverages can be continued for 90 days or through June 30, 2020 whichever is longer.

Will The Standard allow Life, Dental, Critical Illness, Hospital Indemnity and Accident coverage for dependents of insured employees to continue as well?

Subject to continued payment of premium, while employees are not working due to a partial or full furlough or temporary layoff occurring between March 1, 2020 and September 30, 2020, dependent coverage can be continued for 90 days or through June 30, 2020 whichever is longer.

For employees whose coverage ended following the accommodation described above, will The Standard reinstate coverage when employees regain eligibility and return to work?

If insurance ends for an employee as of June 30, 2020 or earlier, an employee may regain coverage if they return to work before March 1, 2021 and otherwise satisfy all eligibility requirements under the applicable group policy.

If an employee cancels their contributory coverage and then returns to work and enrolls for coverage again within 30 days of returning, any coverage that was in effect when the employee ceased to be insured can be reinstated subject to the group policy’s reinstatement provisions. Any coverage requirements (e.g., preexisting condition for Long Term Disability, two-year suicide exclusion for Life, etc.) that were not fully met when the employee’s work hours were reduced will continue to apply until the balance of the requirement period is served.

Employees who return to work after March 1, 2021, and employees who were not insured prior to the reduction in the employee’s work hours, may become insured as a new employee. All coverage requirements apply. Evidence of Insurability requirements for late enrollments will also apply.

If insurance ends for an employee after June 30, 2020, an employee may regain coverage if they return to work within 90 days, or the longer of the applicable policy provisions and otherwise satisfy all eligibility requirements under the applicable group policy.

What options does an employee have when insurance ends?

When coverage terminates, the continuation, conversion and portability provisions contained in the applicable Group Insurance policy will be available according to the terms of the policy.

When Dental or Vision coverage stops, members may have the option to elect COBRA. Upon notification within 30 days of their return to work, coverage will resume as normal.

For employees who are not yet insured, will they meet the active work requirement if their work hours are reduced or they are subject to a furlough or a temporary layoff?

Our group insurance policies require the employee to be Actively At Work at least a specified number of hours each week. Our language specifies Actively At Work includes regularly scheduled days off, holidays, or vacation days, so long as the employee is capable of Active Work on those days. An employee who is on furlough does not meet the Active Work requirement of the group policy. However, as an accommodation to our policyholders during this time of uncertainty:

  • For employees who experience a furlough, temporary layoff, reduction in hours or salary prior to June 30, 2020, if they return to work and satisfy Actively At Work requirements prior to March 1, 2021, credit towards the eligibility waiting period will be given for Actively at Work time prior to June 30, 2020.
  • For employees who experience a furlough, temporary layoff, reduction in hours or salary between July 1, 2020 and September 30, 2020, if they return to work and satisfy Actively At Work requirements within 90 days, credit towards the eligibility waiting period will be given for Actively at Work time prior to furlough, temporary layoff, reduction in hours or salary.
Do any of your Voluntary benefits — Accident, Critical Illness, Hospital Indemnity — contain specific provisions relating to coverage of COVID-19?

Yes. The Standard’s Hospital Indemnity product provides daily benefits for hospitalization due to an illness. Members are eligible for a benefit if they spend at least 20 consecutive hours for examination by a physician for diagnosis or treatment of an illness in a hospital setting. In addition, The Standard’s Hospital Indemnity product includes a waiver of premium provision which waives the premium after a member has been hospitalized for 30 days or more.

Do any of your Voluntary benefits — Life, STD, LTD, Accident, Critical Illness, Hospital Indemnity — include exclusions for pandemics?

No. These benefits do not include pandemic exclusions.

Will an employee's eligibility for coverage or benefits be affected by receiving one of the COVID-19 vaccines?

No.

Does a work-from-home arrangement for my employees affect their coverage?

If the employer has approved work-from-home arrangements and the employee continues to meet the requirements to be insured, we will consider the covered employee actively at work.

If employees are traveling and unable to return home due to COVID-19 concerns, can they use the Travel Assistance benefit under our group policy?

Yes. Travel Assistance for employers with that benefit will remain available to your covered employees. If an individual has tested positive for COVID-19, their request would be treated like a standard medical case. If the individual is eligible for transport benefits, those benefits would be arranged in accordance with the departing and receiving country’s government clearance on flying.

All individuals should ensure they have the latest travel advisories regarding the coronavirus and their intended destination. This information can be accessed here: travel.state.gov/content/travel/en/traveladvisories/traveladvisories.html.

Life and Disability Benefits

Are employees eligible for Short Term Disability benefits if placed under quarantine?

There are a wide variety of scenarios under which an individual may be quarantined, ranging from a voluntary self-quarantine without a COVID-19 diagnosis to a mandated quarantine with a diagnosis.

If an individual is quarantined as directed by a licensed health care professional or government agency, we will assess a claim for benefits as follows:

  • If the individual has been diagnosed with COVID-19 and is unable to work from home, they will remain insured and eligible under the group STD policy.
  • If the individual has not been diagnosed and is unable to work from home, they will retain coverage and eligibility under the STD policy should they eventually become disabled.

It is important to remember that under most STD policies a covered individual must be unable to work, either at their place of employment or from home, and must experience a loss of income to be eligible for STD benefits in all cases.

Does a diagnosis of COVID-19 qualify an employee for STD benefits?

Such individuals will retain coverage under the STD policy for the duration of the quarantine, and we will evaluate any claim for disability benefits individually.

How will Pre-Disability Earnings be determined if an employee becomes disabled during a furlough, temporary layoff, reduction in hours or salary?

For 90 days, or through June 30, 2020, whichever is longer, Pre-Disability Earnings are based on the employee’s last day of active work prior to the furlough, temporary layoff, reduction in hours or salary. Premium remitted to The Standard should be based on the amount of coverage prior to the furlough, temporary layoffs, reduction in hours or salary.

After 90 days of accommodation, or through June 30, 2020 whichever is longer, normal policy provisions apply.

What amount of Group Life insurance will be in effect during a furlough, temporary layoff or reduction in hours or salary?

For 90 days, or through June 30, 2020, whichever is longer, the amount of Life insurance, dependent Life insurance and spousal Life insurance during a furlough, temporary layoff or reduction in hours shall be the amount in force on the employee’s last day of active work prior to the furlough, temporary layoff or reduction in hours or salary. Premium remitted to The Standard should be based on the amount of coverage prior to the furlough, temporary layoffs, reduction in hours or salary.

After 90 days of accommodation, or through June 30, 2020 whichever is longer, normal policy provisions apply.

What is The Standard doing to make it easier for individuals to provide medical certification forms and medical records from treatment providers during the COVID-19 pandemic?

The Standard will be flexible and seek alternate methods to obtain the medical details needed to substantiate disability claims. We have adapted our processes to collect information verbally and electronically wherever possible. Alternate sources of medical information, such as telehealth summaries, patient portal records and telephonic confirmation from treatment providers are some of the potential solutions that may be acceptable. Our clinical resources will also gather medical documentation over the phone to assist with the disability claims management process. To comply with any new state or federal regulations, we will adjust the timeframes or requirements as needed.

Does The Standard have the ability to track the new emergency paid FMLA?

The Standard will administer tracking the FMLA leave under the FFCRA. However, we do not have the capabilities to administer the paid sick leave or the pay aspects of the FMLA.

Details about the FFCRA can be found at dol.gov/agencies/whd/pandemic/ffcra-questions.

Are benefits paid under the Families First Coronavirus Response Act considered deductible income under The Standard’s STD/LTD policies?

If employees receive paid sick leave due to their own medical condition, The Standard will determine if that benefit is offset, or in any way reduced, by the facts of their claim and the applicable policy provisions. If sick leave or family leave is paid to employees under FFCRA that is unrelated to their own medical condition, that benefit would not be offset under our group STD and LTD policies. Please note that protected leaves granted by FFRCA terminated as of December 31, 2020. Employers should consult with their employment counsel if they desire to continue to provide similar leaves on a voluntary basis.

Details about the FFCRA can be found at dol.gov/agencies/whd/pandemic/ffcra-questions.

How will The Standard approach complying with recent Department of Labor and Internal Revenue Services regulatory directives extending certain ERISA and Internal Revenue Code timelines due to COVID-19?

The Standard is aware of the new regulations and guidance issued jointly by the United States Department of Labor and the Internal Revenue Service that extend certain time frames under ERISA and the Internal Revenue Code due to the COVID-19 pandemic. At present, The Standard does not plan to issue amendments to plans to address these guidelines. However, we are taking steps to ensure that each of our impacted group insurance policies are administered in compliance with the extended time frames. Such steps may include, but are not limited to, updating practices and procedures, staff training and modifications to some claims administration letters.

Will The Standard be deferring Social Security taxes on disability benefits in accordance with the President’s Memorandum on Deferring Payroll Taxes in Light of the Ongoing COVID-19 Disaster?

No. The Memorandum provides an option to defer taxes but does not eliminate the taxes. The deferral period in the Memorandum is September 1, 2020 through December 31, 2020. If The Standard were to defer taxes, it would have to collect them from claimants in the period from January 1, 2021 through April 2021. We are concerned that this would create a significant financial burden on our claimants. As such, given that the deferral is voluntary on the part of The Standard we are electing to not defer payroll taxes at this time. We will evaluate this position further if additional guidance is provided that requires the deferral.

Dental

If employees are unable to utilize Dental benefits due to stay-at-home orders, will the frequency limit criteria be waived?

We will waive frequency limitations for covered exams and cleanings from July through December 31, 2020. Additionally, we will waive deductibles for members and dependents for any claim incurred from July through December 31, 2020.

Does The Standard cover Teledentistry claims?

It is our practice to adjudicate Teledentistry claims the same as we do for claims from a traditional practice setting. Providers have been advised through ADA guidance on how to submit claims accordingly. Please see the Guide to Teledentistry.

Can Dental premiums be included within the employee benefits cost evaluation when applying for loans through the SBA Payroll Protection Plan?

The Standard is prepared to provide detailed information on 12 months of bills for small groups who request it to apply for Small Business Administration loans. The Coronavirus Aid, Relief and Economic Security (CARES) Act states that funds can be used for “payments required for group health care benefits (including insurance premiums).” There are no parameters listed that are specific to Dental and/or Vision benefits. If you have questions about how to use the funds, please contact your lawyer.

Billing and Payment

What if a policyholder is unable to make premium payments within the applicable grace period?

In order to help those who may need additional time to collect and remit premiums during the COVID-19 crisis The Standard extended the premium payment grace period to 90 days through June 2020 payments for all customers.

Starting with July payments we will honor existing policy grace periods and align the grace period for a longer duration in accordance with any applicable State insurance directive.

Enrollment

Given that we have had to cancel face-to-face and group meetings for open enrollments, what advice is The Standard offering on how to conduct enrollment meetings?

We have a nationwide network of trained and licensed benefits counselors and services to help with virtual group meetings for our entire product portfolio, including our suite of Supplemental products.

Will The Standard allow extensions for clients currently in open enrollment?

Given the circumstances we understand that enrollments in process will require additional time, and we will re-engage on this activity as business conditions normalize. Since enrollment completion is a dependency to onboard customers, our priority in this period is to work with our customers to get their policies in force on their effective date so that claims can be paid. We will work with customers currently in annual or open enrollment on a case-by-case basis to ensure that all enrollments are completed timely.

If the current enrollment doesn’t meet minimum participation requirements, will The Standard waive minimum participation requirements?

Our contracts require a minimum of 10 lives or the specified minimum participation stated in the group policy. As an accommodation during this time, we will temporarily suspend application of the minimum participation requirements for groups with effective dates through December 1, 2021 with the understanding that those groups will bring participation up to minimums at the next enrollment or within one-year of the effective date. Once business conditions are deemed to have normalized, all group policy provisions will be applied as written.

Does The Standard accept electronic signatures?

Yes, we accept electronic signatures. For beneficiary designations, The Standard has policy language available that will support employers' use of electronic signatures. Please refer to your contract for more information.

Rates and Renewals

Does The Standard anticipate any change in proposal, proposal rates or time it will take to respond to requests for quotes?

For those employers wishing to move to The Standard who prefer to move later in the year, we can accommodate those requests. The Standard will honor any quoted rates out to January 1, 2021 effective dates. Quoted rate guarantees will be honored unless there is a material change in covered lives. Our Underwriting teams have been working remotely and we have not experienced delays in RFP responses.

Does The Standard anticipate any change in timing of renewals or delivery of renewal rates?

The Standard plans to continue renewing our policies as scheduled and we do not currently foresee any delays.

Will The Standard consider deferring renewal rate increases for small business customers during this time?

As we face the challenges surrounding COVID-19 together, The Standard recognizes that this may be taking a particular toll on our small business customers. To help with that, we are holding rates on all groups up to 500 employees with renewal dates of May, June and July 2020.

Will The Standard consider extending Dental rate guarantees for new small business customers during this time?

All Dental new customers up to 500 employees will receive a 2-year rate guarantee. This applies to new customers with effective dates of May 2020 through June 2021. These customers also had the ability to defer their effective date to any time within 2020 if they chose with quoted rates being honored.

For in-force groups, will you waive the ability to increase rates if enrollment changes for companies with layoffs due to COVID-19?

The Standard will take into consideration the reasons for enrollment changes. Plans that are being reviewed for renewal pricing during COVID-19 and experience layoffs will be addressed on a case-by-case basis. Our contracts have a 25% enrollment change clause.

Ongoing Preparedness

What actions is The Standard taking to prepare for potential spikes in activity related to COVID-19?

The Standard is actively monitoring numerous components of COVID-19 including demographic, health, treatment and socioeconomic trends to plan for potential customer impacts. Additionally, we are engaged with numerous healthcare professionals from around the world to understand new variant potential, as well as long-term health impacts. We use that information to inform our continuity plans and staffing levels across the organization, as has been the case throughout the pandemic.

How have claims volumes at The Standard been impacted?

To date related to COVID-19 we have predominantly seen Life claims, and our team has managed the volume with no lag to responsiveness or service.

What resources are in place to ensure a timely response for customers if new challenges arise?

The Standard stood up a COVID-19 Rapid Response Team in March 2020 to proactively address customer issues, and that team remains in place. This cross-functional team reviews market and health information to anticipate potential future customer needs arising from COVID-19 and respond to any questions or concerns that arise.

Coverage Eligibility

Will my Group Life, Accidental Death & Dismemberment, Disability, Supplemental, Dental and Vision coverage continue if my work hours are reduced, I am on an unpaid leave of absence or I am subject to a furlough or a temporary layoff due to COVID-19?

Group Life, Accidental Death & Dismemberment, Disability, Supplemental, Dental and Vision coverage normally ends when you lose eligibility because you are no longer working the required minimum number of hours or you are on an unpaid leave of absence.

However, as an accommodation during this time of uncertainty, subject to continued payment of premium, while employees are not working due to a partial or full furlough or temporary layoff occurring between March 1, 2020 and September 30, 2020, these coverages can be continued for 90 days or through June 30, 2020 whichever is longer.

As long as I am insured, will The Standard allow coverage for my dependents to continue through June 30, 2020 as well?

Subject to continued payment of premium, while you are not working due to a partial or full furlough or temporary layoff occurring between March 1, 2020 and September 30, 2020, dependent coverage can be continued for 90 days or through June 30, 2020 whichever is longer.

If my coverage ended following the accommodation described above, will The Standard reinstate my coverage when I regain eligibility and return to work?

If your insurance ends as of June 30, 2020 or earlier, you may regain coverage if you return to work on or before March 1, 2021 and otherwise satisfy all eligibility requirements under the applicable group policy.

If you cancel your contributory coverage and then return to work and enroll for coverage again within 30 days of returning, any coverage that was in effect when you ceased to be insured can be reinstated subject to your group policy’s reinstatement provisions. Any coverage requirements (e.g., preexisting condition for Long Term Disability, two-year suicide exclusion for Life, etc.) that were not fully met when your work hours were reduced will continue to apply until the balance of the requirement period is served.

If you return to work after March 1, 2021 and were not insured prior to the reduction in work hours you may become insured as a new employee. All coverage requirements apply. Evidence of Insurability requirements for late enrollments will also apply.

If your insurance ends after June 30, 2020, you may regain coverage if you return to work within 90 days, or the longer of the applicable policy provisions and otherwise satisfy all eligibility requirements under the applicable group policy.

What options do I have if my insurance ends?

When coverage ends, the continuation, conversion and portability options in your group policy will be available to you, according to the terms of the policy.

If I am not yet insured and my work hours are reduced or I am subject to a furlough or a temporary layoff, will I meet the active work requirement?

Our group insurance policies require you to be actively at work for a minimum number of hours each week. Our language specifies actively at work includes regularly scheduled days off, holidays, or vacation days, so long as you are capable of active work on those days. An employee who is on furlough does not meet the Active Work requirement of the group policy. However, as an accommodation to our policyholders during this time of uncertainty:

  • If you experience a furlough, temporary layoff, reduction in hours or salary prior to June 30, 2020, if you then return to work and satisfy Actively At Work requirements prior to March 1, 2021, credit towards the eligibility waiting period will be given for Actively at Work time prior to June 30, 2020.
  • If you experience a furlough, temporary layoff, reduction in hours or salary between July 1, 2020 and September 30, 2020, if you then return to work and satisfy Actively At Work requirements within 90 days, credit towards the eligibility waiting period will be given for Actively at Work time prior to furlough, temporary layoff, reduction in hours or salary.
Does a work-from-home arrangement affect my eligibility for coverage?

If your employer has approved work-from-home arrangements and you continue to meet the requirements to be insured, we will consider you actively at work.

Do my insurance benefits exclude coverage for pandemics?

No. Our policies do not include pandemic exclusions.

Will my eligibility for coverage or benefits be affected by receiving one of the COVID-19 vaccines?

No.

If I am traveling and unable to return home due to COVID-19, can I use the Travel Assistance benefit?

Travel Assistance will remain available. If you test positive for COVID-19, your request would be treated like any other medical case. If you are eligible for transport benefits, those would be arranged according to the departing and receiving countries’ government clearance on flying. Review the latest travel advisories regarding the coronavirus and your intended destination: travel.state.gov/content/travel/en/traveladvisories/traveladvisories.html.

Life and Disability Benefits

Am I still eligible for Short Term Disability benefits if I am placed under quarantine?

There are a wide variety of scenarios under which you may be quarantined, ranging from a voluntary self-quarantine without a COVID-19 diagnosis to a mandated quarantine with a diagnosis.

If an individual is quarantined as directed by a licensed health care professional or government agency, we will assess a claim for benefits as follows:

If the individual has been diagnosed with COVID-19 and is unable to work from home, they will remain insured and eligible under the group STD policy.

If the individual has not been diagnosed and is unable to work from home, they will retain coverage and eligibility under the STD policy should they eventually become disabled.

It is important to remember that under most STD policies a covered individual must be unable to work, either at their place of employment or from home, and must experience a loss of income to be eligible for STD benefits in all cases.

How are my pre-disability earnings calculated if I become disabled while on furlough?

For 90 days, or through June 30, 2020, whichever is longest, your pre-disability earnings and premiums will be based on your last day of active work prior to the furlough, temporary layoff or reduction in hours or salary. Premium remitted to The Standard should be based on the amount of your coverage prior to the furlough, temporary layoffs, reduction in hours or salary.

After 90 days of accommodation, or through June 30, 2020 whichever is longer, normal policy provisions apply.

What amount of Group Life insurance will be in effect during a furlough, temporary layoff or reduction in hours?

For 90 days, or through June 30, 2020, whichever is longer, the amount of Life insurance, dependent Life insurance and spousal Life insurance during a furlough, temporary layoff or reduction in hours or salary shall be the amount in force on your last day of active work prior to the furlough, temporary layoff, reduction in hours or salary. Premium remitted to The Standard should be based on the amount of coverage prior to the furlough, temporary layoffs, reduction in hours or salary.

After 90 days of accommodation, or through June 30, 2020 whichever is longer, normal policy provisions apply.

How do I provide medical records if I can’t get in to see my doctor?

The Standard will be flexible and seek alternate methods to obtain the medical details needed to substantiate disability claims. We have adapted our processes to collect information verbally and electronically wherever possible. Alternate sources of medical information, such as telehealth summaries, patient portal records and telephonic confirmation from treatment providers are some of the potential solutions that may be acceptable. Our clinical resources will also gather medical documentation over the phone to assist with the disability claims management process. To comply with any new state or federal regulations, we will adjust the timeframes or requirements as needed.

Do you accept electronic signatures?

Yes, we accept electronic signatures.

Will the Families First Coronavirus Response Act (FFCRA) affect my Disability claim?

The Standard will determine whether your receipt of paid sick leave is due to your own medical condition based on the specific claim facts and the applicable policy provisions. Paid sick leave and family leave under FFCRA that is unrelated to your own medical condition will not affect STD and LTD payments. Please note that protected leaves granted by FFRCA terminated as of December 31, 2020.

Will The Standard be deferring Social Security taxes on disability benefits in accordance with the President’s Memorandum on Deferring Payroll Taxes in Light of the Ongoing COVID-19 Disaster?

No. The Memorandum provides an option to defer taxes but does not eliminate the taxes. The deferral period in the Memorandum is September 1, 2020 through December 31, 2020. If The Standard were to defer taxes, it would have to collect them from you in the period from January 1, 2021 through April 2021. We are concerned that this would create a significant financial burden to you. As such, given that the deferral is voluntary on the part of The Standard we are electing to not defer payroll taxes at this time. We will evaluate this position further if additional guidance is provided that requires the deferral.

Dental

If I am unable to utilize Dental benefits due to shelter in place restrictions, will the frequency limit criteria be waived?

We will waive frequency limitations for (covered) exams and cleanings from July through December 31, 2020. Additionally, we will waive deductibles for you and your dependents for any claim incurred from July through December 31, 2020.

Can I use Teledentistry under my plan?

Yes. The Standard handles Teledentistry claims under our Dental products. Consult with your employer for the proper procedures for filing and approving Teledentistry claims.

New York Paid Leave

New York COVID-19 Frequently Asked Questions

The Standard Life Insurance Company of New York

In March 2020, New York passed a law that provides wage replacement assistance to eligible New York employees who are unable to work due to their own or their minor child’s mandatory or precautionary COVID-19 quarantine or isolation.

The wage replacement available depends on employer size as of January 1, 2020, and the employer’s net annual income. This benefit is not available for employees who are able to work through remote access or other means.

See our Relatively Speaking blog post for details about this paid leave benefit in New York.

Benefits Eligibility

What wage replacement is available under the law?

The chart below is a high-level overview of pay and benefits that may be available to eligible New York employees who are unable to work while they or their minor child are the subject of a qualifying mandatory or precautionary COVID-19 order of quarantine or isolation. Note, benefits may be reduced or not payable at all if an employee receives pay or benefits from other sources.

Employer Size (by employee count on Jan. 1, 2020)NY COVID-19 Job-Protected Benefits for NY Employee’s Own Quarantine/IsolationNY COVID-19 Job-Protected Leave and Benefits for NY Employee’s Minor Child’s Quarantine/Isolation for Employee
1 – 10 (employees of private employers with less than $1 million annual net income in 2019)Beginning on the first day of leave, weekly Paid Family Leave (PFL) and Disability Benefits Law (DBL) payments up to the lesser of the employee’s Average Weekly Wage (AWW) or $2884.62.

PFL/DBL Benefit Calculation: PFL of 67% of AWW to a maximum of $840.70/week + DBL up to the lesser of AWW or $2,043.92/week.
Beginning on the first day of leave, weekly PFL payments of 67% of AWW up to a maximum $840.70.
1 – 10 (employees of private employers with more than $1 million net income in 2019)Beginning on the sixth day of leave, weekly concurrent PFL/DBL payments up to the lesser of the employee’s AWW or $2884.62.

PFL/DBL Benefit Calculation: PFL of 67% of AWW to a maximum of $840.70/week + DBL up to the lesser of AWW or $2,043.92/week.
Beginning on the first day of leave, weekly PFL payments of 67% of AWW up to a maximum $840.70.
11 – 99 (employees of private employers with $1 million or more net income in 2019)

Five days of additional employer provided sick time at 100% AWW while the employee is the subject of a qualifying COVID-19 order of quarantine or isolation.

Beginning on the sixth day of leave, weekly concurrent PFL/DBL payments up to the lesser of the employee’s AWW or $2884.62.

PFL/DBL Benefit Calculation: PFL of 67% of AWW to a maximum of $840.70/week + DBL up to the lesser of AWW or $2,043.92/week.

Beginning on the first day of leave, weekly PFL payments of 67% of AWW up to a maximum $840.70.
100+ employees of a private employerFourteen days of additional employer-provided sick time at 100% AWW.Beginning on the first day of leave, weekly PFL payments of 67% of AWW up to a maximum $840.70.
Public employers of all sizesFourteen days of additional employer-provided sick time at 100% AWW.New York COVID-19 PFL benefits are generally not available based on minor child quarantine/isolation unless the public employer has opted in for coverage.
Who is eligible for New York COVID-19 Paid Quarantine Leave Benefits?

Generally, New York employees of private employers with fewer than 100 employees are eligible for a job-protected combined PFL and DBL paid quarantine benefit (“New York COVID-19 Paid Quarantine Leave”) to replace one hundred percent of their salary up to $2884.62 per week following exhaustion of five days paid sick leave if they are unable to work while they are the subject of an affirmation of quarantine or isolation or mandatory or precautionary order of COVID-19 quarantine or isolation order.

It is our understanding that a Shelter In Place order or other broad closure of schools do not generally constitute an eligible quarantine or isolation needed to qualify for benefits under the law.

Is New York COVID-19 Paid Quarantine Leave available if an employee is unable to work while a minor child is under a COVID-19 quarantine or isolation?

If an employee’s minor child is the subject of COVID-19 quarantine or isolation, the employee is not eligible for the combined PFL/DBL benefit that constitutes New York COVID-19 Paid Quarantine Leave.

However, an otherwise eligible employee can file for PFL which will replace 67% of their weekly salary up to $840.70/week for the duration of the minor child’s COVID-19 quarantine.

What if an employee is unable to work because a family member other than a minor child is subject to COVID-19 quarantine or isolation?

Employees are not eligible for PFL to care for family members other than minor children who are COVID-19 quarantined or isolated. They may, however, be eligible for paid time off with their employer, and possibly for PFL if the family member suffers from a serious health condition.

What kind of documentation is needed to support an employee’s claim for New York COVID-19 Paid Quarantine Leave or for PFL while they care for their minor child who is under COVID-19 quarantine?

An affirmation of quarantine or isolation or a mandatory or precautionary order of quarantine or isolation.

Samples of such forms are shown here:

Guidance regarding how to obtain a quarantine or isolation order can be found here under the Obtaining a Quarantine Order tab: paidfamilyleave.ny.gov/new-york-paid-family-leave-covid-19-faqs.

What if employees are quarantined because they have recently returned from traveling to another country or from a high risk state?

Employees are not eligible for New York COVID-19 quarantine leave if they are subject to a quarantine because they voluntarily traveled to a country with a level two or three health notice from the CDC, if their travel was not at the direction of their employer, and they were provided notice of the travel health notice and knew about this restriction in the law.

If employees voluntarily travel to any state other than a contiguous state for more than 24 hours they will not be eligible for New York’s COVID-19 quarantine leave benefits if the travel was not taken as part of their employment or at their employer’s direction.

Can an employee work from home and receive New York COVID-19 Paid Quarantine Leave or PFL to care for a COVID-19 quarantined or isolated minor child?

No, employees must be unable to work due to their receipt of a qualifying COVID-19 quarantine or isolation affirmation or order to be considered for these new benefits.

Is an employee’s job protected when they are on New York COVID-19 Paid Quarantine Leave or while receiving PFL to care for a minor child under COVID-19 quarantine or isolation order?

Yes, job protection is guaranteed while employees are on these types of leave.

Can an employee receive the New York COVID-19 Paid Quarantine Leave or PFL more than one time if they are the subject of more than one affirmation or order of COVID-19 quarantine or isolation?

On January 20, 2021 the New York Department of Labor clarified that the special New York COVID-19 DBL/PFL quarantine benefit is available to employees a maximum of three times, and the second and third times require positive COVID-19 tests. coronavirus.health.ny.gov/system/files/documents/2021/01/guidanceonuseofcovid-19sickleave_0.pdf

New York COVID-19 Paid Quarantine Leave counts towards the maximum 26-week DBL duration, and PFL benefits for care of a minor child under quarantine or isolation affirmation or order count towards the maximum 12-week PFL duration in a 52-week period. In no event can an employee receive more than a total of 26 weeks of DBL and PFL combined in a 52-week period.

Claim Submission

How long do claimants have to submit their New York COVID-19 Paid Quarantine Leave or PFL claim to care for their minor child who is subject to a COVID-19 order of quarantine or isolation?

Claimants must submit their application to The Standard within 30 days from the first day they take leave to avoid losing any benefits.

How do claimants apply for New York COVID-19 Paid Quarantine Leave for themselves?

Together with their quarantine or isolation affirmation or order, the employee will need to complete the employee portions of The Standard’s Request for COVID-19 Quarantine Leave for Yourself package.

Examples of quarantine or isolation forms are shown here:

The employee should then send the completed package to the employer to complete the employer sections of the package. The employer has three business days to complete these sections and return the package to the employee. If the employee does not receive the package within three business days, they can proceed to the next step and submit the application.

Next, the employee will submit the completed package to The Standard together with the quarantine or isolation affirmation or order.

The Standard must pay or deny a New York COVID-19 Paid Quarantine Leave claim within 18 calendar days of receiving the completed request.

How do claimants apply for PFL if they are unable to work because their minor child is subject to a quarantine affirmation or order?

Together with their child's quarantine or isolation affirmation or order, the employee should complete the Request for COVID-19 Quarantine Leave for Minor Child package.

Examples of quarantine or isolation forms are shown here:

The employee should then send the completed package to their employer to complete the employer sections of the package. The employer has three business days to complete these sections and return the package to the employee. If the employee does not receive the package within three business days, they can proceed to the next step and submit the application.

Next, the employee will submit the completed package to The Standard together with the quarantine or isolation affirmation or order.

The Standard must pay or deny the claim within 18 calendar days of receiving the completed request.

Where do employees send their completed application for New York COVID-19 Paid Quarantine Leave or PFL to care for their minor child who is subject to a COVID-19 affirmation or order of quarantine or isolation?

Employees should submit their completed request package to The Standard within 30 days from the first day of leave. If you’d like to send a Request for COVID-19 Quarantine Leave package to us by email, please start by submitting this request form.

How should an employee appeal a claim denial?

If The Standard has denied a New York COVID-19 Paid Quarantine Leave claim or PFL, the employee may file a request for arbitration. Arbitration is handled by NAM (National Arbitration and Mediation). More information can be found on NAM’s website.

Benefits Payment

When will claimants get paid for the New York COVID-19 Paid Quarantine Leave?

Carriers must pay or deny benefits within 18 calendar days of receiving the completed request for benefits. To ensure timely payment, employees should make sure to completely fill out the appropriate Request for COVID-19 Quarantine Leave package for themselves or for their minor children and attach the order of mandatory or precautionary quarantine.

The leave packages are found here:

Examples of quarantine or isolation forms are shown here:

Guidance regarding how to obtain a quarantine or isolation order can be found here under the Obtaining a Quarantine Order tab: paidfamilyleave.ny.gov/new-york-paid-family-leave-covid-19-faqs.

How will New York COVID-19 Paid Quarantine Leave be taxed?

New York COVID-19 Paid Leave is comprised of both PFL and DBL.

DBL and PFL portions of this benefit may be treated differently for tax purposes.

DBL is third-party sick pay, and taxation depends on employee contributions. It is reported on Form W-2.

PFL when paid to care for a family member is ordinarily considered is non-wage income and is taxable regardless of employee contributions and is reported on Form 1099. However, tax advice should be consulted to determine if the PFL component of New York COVID-19 Paid Leave, which is payable for an employee’s own quarantine or isolation is considered third-party sick pay.

Is the number of Paid Sick Leave days work or calendar days?

It is our understanding that the number of additional COVID-19 related paid sick days a subject employer must provide equals the number of work days an employee would have been scheduled to work during a 5 or 14 calendar day period (number depends on employer size). Employers should confirm this understanding with their legal counsel.

What rate of pay applies to Paid Sick Leave?

It is our understanding that subject employers must provide additional paid sick leave during a 5- or 14-day period an eligible employee is unable to work while the subject of a mandatory or precautionary order of COVID-19 quarantine or isolation. The employee is eligible for the pay they would have otherwise received had they continued to work for that 5- or 14-day period (duration of the period depends on employer size).

For hourly, part-time, commissions salespeople, and other employees who are not paid a fixed wage, employers should determine the employee’s pay by looking at a representative period of time to set the employee’s average daily pay rate. This understanding should be confirmed with an employer’s own legal counsel.

For how many days of Paid Sick Leave are part-time employees required to be paid?

It is our understanding that part-time employees should be paid for the number of days/amount of time during a 5- or 14-day period that they would have otherwise worked. This understanding should be confirmed with an employer’s own legal counsel.

Other Information

New York has a Paid Sick and Safe Leave Law covering private sector New York workers that is separate and distinct from the New York COVID-19 quarantine leave law which is expected to expire at the end of the pandemic. The amount of paid sick leave available to employees varies by employer size and income. It is unclear at this time how the Paid Sick Leave Law interacts with the New York COVID-19 Paid Leave requirements. Details are on the New York state website:

ny.gov/new-york-paid-sick-leave/new-york-paid-sick-leave 
ny.gov/sites/ny.gov/files/atoms/files/PSL_FactSheet_General.pdf 
ny.gov/sites/ny.gov/files/atoms/files/PSL_FAQ_PaidSickLeaveFAQ.pdf

Notice to Group Life Insurance Policyholders in New Jersey

Please refer back to this page as information may be updated as needed.

This material is provided for informational purposes only. It is not intended to constitute legal advice. Recipients should consult with counsel before taking any actions based on information contained in this material.

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