Help Wanted: Denial of same-sex benefits

A domestic partner of an employee may be A domestic partner of an employee may be refused insurance if the plan is self-insured and not subject to state laws, said the state Department of Financial Services. Photo Credit: iStock

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Carrie Mason-Draffen Newsday columnist Carrie Mason Draffen

Mason-Draffen, a business reporter, writes a column about workplace issues. ...

DEAR CARRIE: My daughter, who is an electrician, asked her union to include her domestic partner in its health-benefits program. But the union turned my daughter down because it contends its insurance carrier doesn't recognize domestic partners. Is this legal in New York State, which has legalized same-sex marriage and has laws prohibiting discrimination on the basis of sexual orientation? -- -- Legally Denied?

DEAR LEGALLY DENIED: The denial may be legal and here's why: The union's health care program is most likely self-insured, said the state Department of Financial Services, which includes insurance. If that's the case, the plan wouldn't be subject to state insurance laws.

Even when insurers are subject to state insurance law, they might not provide coverage for same-sex domestic partners, depending on the plan. As for same-sex married couples, state law requires New York insurers to provide coverage for same-sex married couples if they provide coverage for spouses.

DEAR CARRIE: How much notice must an employer give you before canceling your benefits? As I was renewing a prescription in mid-July, the pharmacist noted that my coverage is scheduled to stop at the end of this month. I thought I would have found out this important news from my employer first and well in advance. -- How much notice?

DEAR HOW MUCH: The required notification could be as little as nine days or as many as 60 days, depending on the circumstances. And sorting through those circumstances is akin to peeling an onion.

But here's one key layer: The length of the notification depends on whether the employee's medical benefits are from a current or former employer, said employment attorney Ellen Storch of Kaufman Dolowich Voluck & Gonzo in Woodbury.

In your case, you're dealing with a current employer. So on to the next layer: How long the notification has to be depends on whether a company is self-insured. That term generally means that companies assume the liabilities for health-insurance claims, as opposed to paying to have them covered by insurance companies, or third parties. This difference is usually imperceptible to employees because self-insured companies often have insurance companies administer their benefits.

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Here's the bottom line: A self-insured company must give employees a 60-day notice of a benefits termination.

The nine-day period applies if the company isn't self-insured but instead pays an insurer for employees' benefits.

"Once the provider notifies the employer of the intended termination of benefits, the employer must notify the employee within nine days of the intended date of termination," Storch said.

DEAR CARRIE: We have an employee who works two days a week, fewer than 15 hours. Do we have to pay her when we close for a holiday on a day she is supposed to work or when we shut down for two weeks at the end of our season? She is the only one who works part time. Also, are we obligated to provide her paid time off like sick and personal days and vacation? -- What's the Law?

DEAR WHAT'S: It sounds as if she's an hourly, or nonexempt employee. If so, by law, you have to pay her only for the time she works. So if you close for two weeks, and she doesn't work, you don't have to pay her. And you aren't obligated to provide any paid time off. Many employers offer paid time off, because they can always give employees more than the law requires.

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  • For more information on state labor law and paid time off go to http://bit.ly/OhVNDt
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    For more on state insurance laws and same-sex coverage, contact the state Department of Financial Services' consumer hotline at 800-342-3736

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