N.Y. Comp. Codes R. & Regs. tit. 9 § 210.5

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

Section 210.5 - Proof of Benefit Coverage

(a) A fire district, department or company must submit to the Office of Fire Prevention and Control by January 1, 2019 and annually thereafter an attestation that the fire district, department or company will provide the enhanced cancer disability benefit by:

(1) carrying an insurance policy issued by an insurance company authorized to engage in the business of insurance in this State sufficient to cover its eligible volunteer firefighters and provide a death benefit to their beneficiaries; or

(2) proof that the authority having jurisdiction:

(i) possesses taxing authority;

(ii) has agreed in writing to fund any and all claims of eligible volunteer firefighters and their beneficiaries through existing and future revenues.

(b) The policy coverages and or financial responsibilities of a fire district, department or company shall include:

(1) A lump sum payment of $25,000 for each diagnosis payable to the eligible volunteer firefighter upon acceptable proof to the benefit provider of a diagnosis by a board-certified physician in the medical specialty appropriate for the type of cancer diagnosed that there are one or more malignant tumors characterized by the uncontrollable and abnormal growth and spread of malignant cells with invasion of normal tissue and that either:

i. there is metastasis; and

a. surgery, radiotherapy, or chemotherapy is medically necessary; or

b. there is a tumor of the prostate, provided that it is treated with radical prostatectomy or external beam therapy; or

c. the firefighter has terminal cancer, his or her life expectancy is 24 months or less from the date of diagnosis, and will not benefit from, or has exhausted, curative therapy;

(2) A lump sum payment of $6,250 for each diagnosis, payable to the eligible volunteer firefighter upon acceptable proof to the benefit provider of a diagnosis by a board-certified physician in the medical specialty appropriate for the type of cancer involved that either:

ii. there is a carcinoma in situ such that surgery, radiotherapy, or chemotherapy has been determined to be medically necessary; or

iii. there are malignant tumors that are treated by endoscopic procedures alone; or

iv. there are malignant melanomas;

(3) A monthly benefit of $1500, of which the first payment shall be made six months after total disability and submission of acceptable proof of said disability to the benefit provider that such disability is caused by cancer and that the cancer precludes the eligible volunteer firefighter from serving as a firefighter, provided that the benefit shall continue for up to thirty-six (36) consecutive months; and

(4) A death benefit of $50,000 payable to the eligible volunteer firefighter or his or her beneficiary upon acceptable proof by a board-certified physician that the firefighter's death resulted from complications associated with cancer.

N.Y. Comp. Codes R. & Regs. Tit. 9 § 210.5

Adopted New York State Register October 17, 2018/Volume XL, Issue 40, eff. 10/17/2018