The Empire Plan is a unique health insurance plan designed especially for public employees in New York State. Empire Plan benefits include inpatient and outpatient hospital coverage, medical/surgical coverage, Centers of Excellence for transplants, infertility and cancer, home care services, equipment and supplies, mental health and substance abuse coverage and prescription drug coverage.
ANDREW M. CUOMO
Governor
LOLA W. BRABHAM
Acting Commissioner
NY19-05
TO: New York State Agency Health Benefits Administrators
FROM: Employee Benefits Division
SUBJECT: Paid Family Leave (PFL) Reporting Enhancements in NYBEAS
DATE: February 20, 2019
The Employee Benefits Division (EBD) has made changes to the "PFL Claims Information-HBA" page and "PFL Claims Information for HBA" query in the New York Benefits Eligibility and Accounting System (NYBEAS). Several fields have been removed from the former report and new fields have been added, see HBA Memo 18-07 for comparison.
New NYBEAS Page: PFL Claims Information – HBA Paid Family Leave > PFL Claims Information – HBA
This new page provides the following information:
|
Field Name (*denotes new field) |
Definition |
|
National ID (NID) |
SSN |
|
Emplid |
OSC Payroll ID |
|
Last Name |
The claimant’s last name |
|
First Name |
The claimant’s first name |
|
Department ID |
Agency ID |
|
As of Date |
The date PFL claims reporting is current through |
|
From Date |
The first date in the range of the page’s claim information |
|
To Date |
The last date in the range of the page’s claim information |
|
Report Number |
New York State’s PFL Group Number, "0211911" |
|
Claim Number |
PFL claim number for member |
|
Claim Status |
The current state or condition of the claim. Open: The employee has been approved for benefits and will be or currently is receiving benefits. Denied: The claim for benefits has been denied. Suspended: Payment of benefits has been discontinued. Benefits may recommence upon receipt and review of requested information. Closed: The claim has been closed and no further benefits are payable. Pending: Claim has all needed information and is awaiting a decision. |
|
First Absence Date* |
The original date of leave. |
|
Absence Begin Date* |
Represents the first date that benefit payments begin. Absence means a day not at work. |
|
Absence End Date* |
Last absence taken for the specified time period. Absence means a day not at work |
|
Received Date |
The date a claim was received by MetLife. |
|
Approval Date |
The date the claim/absence event is first approved. |
|
Denied Date |
The last date the claim was placed in a decline status. |
|
Last Date Worked |
The last date on which the employee worked before the current absence. |
|
Benefit Start Date |
The date benefit payments begin. |
|
Subcode* |
Requested on PFL Claim Form -1, Part B Section 4.2 |
|
Paypoint* |
Requested on PFL Claim Form -1, Part B Section 4.2 |
|
Claim End Date |
The date the benefit payments end. Day prior to Return to Work Date for a continuous claim OR the last absence taken on an intermittent claim. |
|
Continuous/Intermittent * |
Represents the claim as Continuous "C" or Intermittent "I" |
|
Approved Absence Days* |
All approved absence days taken for a continuous or intermittent claim; represents the number of days absent for the specified range of time. |
|
Claim Status Explanation |
Provides a reason/explanation supporting the current claim status other than Open. If claim status is Open then field will be blank. Some examples: If a PFL claim is denied due to incomplete claim information, the claim should be ended/closed using the following reason: Other Closure/Other information not received. If a PFL claim is in "pended" status waiting for completion of forms and/or supporting documentation/certification, the inactive claim |
.
Each week, PFL claim information will be updated for claimants. HBAs can identify the PFL claim information that is being reported by referring to the "As Of Date". In the example above, the PFL claim information presented is current through 12/28/2018.
New NYBEAS Query – PFL Claims Information for EBD
NYBEAS has been enhanced to provide a new report for NYS agency HBAs to identify Paid Family Leave claim status for its employees. Please refer to the instructions from memo NY15-19 regarding running reports.
The Report Run Control ID is PFL and the Report Name is BEA_PFL_CLM_HBA. This report is a snapshot of an agency’s employees who are or have used PFL. This report is specific to an agency code (Department ID). If you are responsible for more than one agency code, you will need to run a separate report for each one.
If you have any questions related to the PFL Claims Report, please contact the HBA Help Line at 518-474-2780.