N.Y. Comp. Codes R. & Regs. tit. 11 § 365.5

Current through Register Vol. 46, No. 50, December 11, 2024

Section 365.5 - Collection and redistribution of funds from an adjustment

(a) On or before May 1 of every year following a plan year in which an adjustment was made pursuant to section 365.4, each insurer participating in the family leave benefits market shall, pursuant to instructions issued by the department, deposit into the COVID-19 Risk Adjustment Pool an amount equal to the total amount of premium it collected that is attributable to the adjustment made under section 365.4.

(b) On or before June 1 of every year following a plan year in which an adjustment was made pursuant to section 365.4, the superintendent shall disburse the moneys in the COVID-19 Risk Adjustment Pool collected pursuant to subdivision (a), to those insurers who have made payments pursuant to subdivision (a), in proportion to the actual claims experience of those insurers related to COVID-19 claims. Provided, however, that:

(1) no disbursement shall be made to an insurer that would render the total payments made to that insurer from this mechanism greater than the amount it paid in COVID-19 claims;

(2) any disbursement that would be made to an insurer who obtained an immediate relief payment under section 365.2 shall be reduced proportionately based on the total amount of COVID-19 claims compared to the total relief payments received and the funds subject to such reduction shall instead:

(i) if the relief payment was funded entirely by contributions of the State Insurance Fund, be disbursed to the State Insurance Fund; or

(ii) if the relief payment was not funded entirely by contributions of the State Insurance Fund, be disbursed proportionately to each insurer that made a contribution that funded the relief payment.

(3) any disbursement that would be made to an insurer who obtained an immediate relief payment under section 365.2 that has failed to make interest payments as required shall be withheld and the superintendent may disburse the funds to cover the interest obligation of the insurer, provided that if the amount withheld is greater than the remaining interest obligation of the insurer, then excess funds shall be disbursed to all other insurers who have made payments pursuant to subdivision (a), in proportion to the actual claims experience of those insurers related to COVID-19 claims.

(c) Any funds remaining in the COVID-19 Risk Adjustment Pool that were collected pursuant to subdivision (a) of this section, after the application of the rules in subdivision (b) shall be distributed to cover any remaining interest charge owed pursuant to an immediate relief payment under section 365.2 by any member of the COVID-19 Risk Adjustment mechanism or if no such charge exists, shall be distributed in such other manner as the superintendent deems appropriate.

(d) For the purposes of this section the term insurer shall include the State Insurance Fund. The term may also include self-insured employers in the discretion of the superintendent, who shall render such a decision after reviewing the actual COVID-19 claims experience for the entire market.

(e)

(1) No insurer that received an immediate relief payment under this Part shall be permitted to discontinue offering coverage for disability and family leave benefits before the entire amount received has been recouped pursuant to this section and the entire interest obligation has been repaid.

(2) Notwithstanding paragraph (1) of this subdivision, an insurer who has, outside of the recoupment process described in section 365.4 of this Part, paid to each insurer that funded the relief payment it received an amount equal to the relief payment and the total amount of interest required to be paid may request to discontinue offering coverage for disability and family leave benefits in accordance with subdivisions (l) and (m) of section 363.6, subject to such other requirements as may be applicable.

(3) In the event that an insurer exits the market for family leave benefits and the total amount of immediate relief payments it received or any interest obligation it has related to such payments has not been repaid such amounts shall be combined and treated as COVID-19 claims costs incurred by the insurer or insurers who funded the immediate relief payment. Any interest obligation of the insurer shall thereafter be paid by the exiting insurer into the COVID-19 Risk Adjustment Pool.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 365.5

Adopted New York State Register September 9, 2020/Volume XLII, Issue 36, eff. 9/9/2020