Key Takeaways
- New York requires a 10-day free look period for disability insurance policies
- New York has a mandatory state disability program (NYS DBL) for most employees
- NY Paid Family Leave (PFL) provides up to 12 weeks of paid leave
- Long-term care policies must offer inflation protection and nonforfeiture benefits
- NY Partnership for Long-Term Care provides Medicaid asset protection
New York Disability and Long-Term Care Insurance
New York has specific regulations for disability income insurance and long-term care insurance, plus mandatory state programs for employees.
New York State Disability Benefits Law (DBL)
New York has a mandatory state disability program for most employees:
Coverage
| Feature | Detail |
|---|---|
| Who's Covered | Most New York employees |
| Funding | Employee and employer contributions |
| Benefit Amount | 50% of wages (up to weekly max) |
| Maximum Benefit | $170 per week (2024) |
| Duration | Up to 26 weeks |
| Waiting Period | 7 days |
Key Points
- Covers off-the-job illness or injury
- Does NOT cover work-related disabilities (that's Workers' Comp)
- Most employers required to provide coverage
- Can purchase through private insurers or state fund
New York Paid Family Leave (PFL)
New York provides Paid Family Leave benefits:
Coverage
| Feature | Detail |
|---|---|
| Duration | Up to 12 weeks |
| Benefit Amount | 67% of average weekly wage |
| Maximum | 67% of state average weekly wage |
| Funding | Employee payroll deductions |
Qualifying Reasons
- Bond with a new child (birth, adoption, foster)
- Care for family member with serious health condition
- Assist with family obligations when family member deployed to active military duty
Exam Tip: NY PFL provides up to 12 weeks at 67% of wages. This is one of the most generous state paid leave programs in the country.
Private Disability Insurance
Free Look Period
New York requires a 10-day free look period for individual disability insurance:
- Policyholder can return for full premium refund
- Begins when policy is delivered
- Applies to individual policies
Required Policy Provisions
New York disability policies must include:
| Provision | Requirement |
|---|---|
| Grace Period | Minimum 31 days for annual premium |
| Reinstatement | Must allow reinstatement within 3 years |
| Notice of Claim | 20 days after loss begins (or as soon as reasonably possible) |
| Time to Pay Claims | Within reasonable time after proof of loss |
| Legal Actions | No earlier than 60 days after proof of loss |
Long-Term Care Insurance
New York has comprehensive LTC insurance regulations:
Free Look Period
- 10-day free look for LTC policies
- Applies to all individual LTC policies
- Policyholder can return for full refund
Required Provisions
| Provision | Requirement |
|---|---|
| Renewability | Must be guaranteed renewable |
| Pre-existing Conditions | Max 6-month look-back |
| Inflation Protection | Must offer option |
| Nonforfeiture | Must offer option |
| Contingent Benefit Upon Lapse | Required after 3 years |
NY Partnership for Long-Term Care
New York participates in the Long-Term Care Partnership Program:
How It Works
- Purchase a Partnership-qualified LTC policy
- Use benefits for care
- If benefits exhaust, apply for Medicaid
- Asset protection - Keep assets equal to benefits received
Example
| Without Partnership | With Partnership |
|---|---|
| Spend down to $16,800 | Protect assets up to benefits paid |
| May lose home equity | Enhanced asset protection |
| Standard Medicaid rules | Dollar-for-dollar protection |
Producer Requirements
To sell LTC insurance in New York:
- Complete 8 hours of LTC-specific training
- Complete training before selling
- Additional CE requirements for LTC
- Document suitability of recommendations
What is the maximum duration of benefits under New York Paid Family Leave?
What is the primary benefit of purchasing a NY Partnership-qualified long-term care policy?
What is the maximum weekly benefit under New York State Disability Benefits Law (DBL)?