Tag Archives: New York

NY State fights back on $272,000 Orkambi Drug Cost

From MSN Money:  Click here


A wave of breakthrough drugs is transforming the medical world, offering hope for people with deadly diseases despite their dizzying price tags.

But what if it turns out that some of these expensive new drugs don’t work that well?

That’s the quandary over Orkambi, a drug that was approved in 2015 for cystic fibrosis and was only the second ever to address the underlying cause of the genetic disease. Orkambi, which is sold by Vertex Pharmaceuticals, costs $272,000 a year, but has been shown to only modestly help patients.

Now, in a case that is being closely watched around the country, New York state health officials have said Orkambi is not worth its price, and are demanding that Vertex give a steeper discount to the state’s Medicaid program. The case is the first test of a new law aimed at reining in skyrocketing drug costs in New York’s Medicaid program.

How to file PFL Claims in New York

From Shelterpoint:

New Year, New Regulations: How to Apply for Paid Family Leave Now that it’s Here

Paid Family Leave is officially here, and we want to make sure that everything goes smoothly when you need to take time off with PFL. Here are the 4 easy steps you need to take to apply for PFL paid time off.

Step 1: Employer Notification
Paid Family Leave requires that you notify your employer in writing at least 30 days in advance of taking PFL when possible. It isn’t always possible to give such advanced notice for some qualifying events, but it is important that you notify your employer as soon as you know you will need to take paid time off.

If you plan on taking recurring paid time off — for example, if you have a family member who needs assistance getting to and from regular medical appointment, like physical therapy or dialysis treatment — make sure you remind your employer regularly to avoid any complications.   This also helps give your employer time to prepare for your time away.

Step 2: Download and Fill-Out PFL Claim Forms
To receive your Paid Family Leave benefits, you need to fully complete the required PFL claims forms.  You can download claim forms here.

The forms, and documentation (more on that in a bit), you need depends on the type of leave taken.  Read more about that, and get visual guides to the process at here.

Step 3: Obtain Supporting Documentation
Depending on your qualifying leave event, the kind of documentation you need to provide will vary. Some of the common types of supporting documentation are listed below.

Bonding with a new child:

  • Birth certificate
  • Adoption forms
  • Foster care placement forms

Active military family members:

  • Deployment certifications
  • Ceremony dates

Family member with a serious medical condition:

  • Medical forms
  • Doctors notes
  • Therapy schedules

Visit this article for more details on claim forms and supporting documentation. Each leave-specific claim form packet, by the way, includes a checklist with all applicable documentation.

It is recommended that you make copies of your forms and supporting documentation for your own records before submitting.

Step 4: Submit Claims Forms and Supporting Documentation to Your Insurance Carrier
As the person requesting Paid Family Leave, it is your responsibility to file the necessary paperwork with your employer’s NY Statutory Disability (DBL) Carrier.  Send your fully completed PFL claim forms and documentation to your insurance carrier.   If you are a ShelterPoint client check out this blog post with visual PFL claim guideswith all the information you need on where to send your claim.  Once your fully completed claim form and documentations are received, your DBL insurance carrier will review the claim and either let you know if information is missing, and what you still need to provide, or review the claim and determine if you are eligible for payments or not.  Eligible PFL claims that are submitted within 30 days of the first day of leave taken and properly completed are paid within 18 days of receipt, otherwise, within 18 days of submission of the missing information.


New York Paid Family Leave Update

A few clarifications and updates have been released.  Also, we have a great guide on this program, just email us at reeve@reevewillknow.com and we will happily send it to you.


OUT-OF-STATE Coverage:   You are required to provide DBL/PFL coverage for any employee in NY that you employ for at least 30 days.  If the Employee lives in NY but works in another state they are not required to be covered.  Additionally those employees would not be eligible for voluntary coverage either.

COVERAGE IN OTHER STATES- If you have employees in New Jersey, Rhode Island, California, Puerto Rico or Hawaii they may be required to be on the DBL policy for that state…

New York Small Group Rate Increases

new york small group rate increase with arrow climbing bar graph

We are starting to get a look at small group rate increase filings in New York.  Note that these are only what was applied for – typically, New York State knocks these increases down.  We will find out the approved increases mid-summer.

Read more ...



family mom dad son daughter

This is a nice article released by Shelterpoint on May 17, 2017

We’ve spent the last few weeks combing through Paid Family Leave draft regulations to pull out the most important information, so you don’t have to. Here are your absolute must-knows based on the drafts:

Read more ...

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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