Insurance Services

A PPO (preferred provider organization) plan is based on a “preferred” network of providers in the subscriber’s area. A primary care physician is not required, and referrals are not necessary to see a specialist. The subscriber’s responsibility for bills depends on the network status and the plan structure. A PPO allows subscribers to visit out-of-state providers who are considered in-network.

An EPO (exclusive provider organization) plan combines features of an HMO and a PPO. Similar to a PPO, a referral is not needed to see a specialist. And, like an HMO, the subscriber is responsible for paying out-of-pocket costs if seeking care from a doctor outside the plan's network.

A POS (point of service) plan also combines features of HMO and PPO plans. Like an HMO, subscribers need a referral from to see a specialist. And, like a PPO, subscribers pay less for visits to providers in the plan’s network and have access to out-of-network providers at a higher cost.

Exemptions include:

Sole proprietors, partners and members of limited liability companies (though their employees must be covered)
A minor child of an employer
Government, railroad, maritime or farm workers
Ministers, priests, rabbis, imams, sextons, Christian Science readers or members of religious orders
View a full list of coverage requirements on the Workers’ Compensation Board website.

Members of the Retail Council are offered some of the lowest quarterly-billed rates available on statutory disability insurance through our program. For more information or a free quote, call (518) 465-3586. Employers can also obtain DBL insurance from the New York State Insurance Fund or from private carriers. They may also apply to be self-insured through the Workers’ Compensation Board.

Employers may pay the entire DBL insurance premium or choose to share the cost with the employee. New York State law allows employers to deduct 0.5% of an employee’s wage, up to a maximum of $.60 per week, to offset the cost of providing disability benefits insurance.

Cash benefits are 50% of the claimant’s average weekly wage, but no more than the maximum amount allowed, currently $170 per week. Benefits are paid for a maximum of 26 weeks of disability during 52 consecutive weeks. The benefits begin on the eighth consecutive day of disability.

Yes. The disabled employee (claimant) must submit himself/herself to regular exams by the employer’s designated physician, if requested by the employer, or the employee may jeopardize his/her benefits. However, the exams must be at reasonable times and cannot be more than once a week; the employee is not responsible for payment of the exam.

For a worker who has been disabled for more than seven days, an employer must supply him/her with a Statement of Rights under the Disability Benefits Law (form DB-271S). The form must be submitted within five days of learning the employee is disabled.

Depending on the plan, an employer might need a minimum of just three to five employees to qualify.