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It explains how to obtain a predetermination of dental benefits, including when a dental provider should submit planned treatment and cost details. The document then details New York State Paid Family Leave (PFL) changes for 2021, including duration, wage calculations, caps, filing timelines, appeals, and how to report intermittent or emergency absences.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/fyb-february-2021-new-york-state-paid-family-leave-updates-for-2021/301367/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/fyb-february-2021-new-york-state-paid-family-leave-updates-for-2021/301367.png","ImageObject",442,249,{"name":88,"@type":89},"Jiven","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-24","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":76},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What should participants do if their dentist requests predetermination of benefits?","Question",{"text":108,"@type":109},"Get a predetermination of benefits for the planned procedure, ideally having the dental provider submit details of the treatment and cost for extensive dental work. 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COVID-19 benefits, support, and updates are featured on our Web site at [rnbenefits.org](rnbenefits.org). You may also call the Fund office and ask one of our representatives about the support available to you. |\n\nIf your dentist asks fora predetermination of benefits—get one  \nIn the event your dentist asks for a predetermina  \ntion of benefits for a planned procedure, it’s best to get one. Although it’s not required, it’s a good idea to have your dental care provider submit a predetermination of benefits detailing the planned treatment and cost of extensive dental work such as periodontics, oral surgery, or any dental services that cost at least $300.  \nAetna uses this information to determine which benefits are payable for each service and notifies your dentist. That way, there are no surprises. You’ll know before work begins what is covered and how much coinsurance, if any, you’ll be responsible for.  \nRemember that basic restorative services, endodontics, periodontics, maintenance of prosthodontics, and oral surgery are paid at 80 percent of the negotiated fee schedule with an in-network provider and at 80 percent of the recognized charge with anout-of-network provider (after the applicable deductible).  \nMajor restorative services, installation of prosthodontics, and orthodontics are paid at 50 percent  \nof the negotiated fee schedule in  \nnetwork and at  \n50 percent of the recognized charge outof-network  \n(after the applicable deductible).  \n-FYB  \nNew York State Paid Family Leave updates for 2021  \nThere are several changes to the  \nNew York State Paid Family Leave (PFL) coverage for the 2021 calendar year, as we have outlined in the chart below. Participants may take the maximum benefit length, 12 weeks, in any given 52-week period. The 52-week period starts on the first day the participant takes PFL. All participants are guaranteed to be able to return to their job after taking PFL.  \nDuring the 2021 calendar year, Fund participants may receive up to  \n12 weeks of leave at 60 percent of their average weekly wage, subject toa statutory cap of $840.70 per week. Any Paid Family Leave that began in 2020 and continues into 2021 will be paid based on the number of weeks/ weekly benefits amount for 2020 for the length of the paid family leave.  \nClaims for paid family leave should be filed within 30 days of leave. If not, all or a portion of the leave may be  \ndenied. Denied claims can be appealed. For more information, please call the Benefits Fund at (877) RN BENEFITS [762-3633] to speak with a Participant Service Representative.  \nIntermittent and emergency absences need to be reported the same or next business day.  \nPaid family leave coverage benefits are insured and administered through MetLife on behalf of the Benefits  \nFund. Claims can only be made by calling MetLife at (888) 767-8910, Monday through Friday. When you call, you must first choose option 3 to file a new claim. Next, choose option 3 again, to report a new leave or absence from work. You must call MetLife to file a PFL claim, not the Fund.  \nFor more information visit www. [ny.gov/new-york-state-paid-family](ny.gov/new-york-state-paid-family)leave/paid-family-leave-information-employees. -FYB  \n\n| New York Paid Family Leave | Effective\u003Cbr>1/01/2020 | Effective\u003Cbr>1/01/2021 |\n| --- | --- | --- |\n| Wage Cap | $72,860.84/year or $1,401.17/week | $75,408.00/year or $1,450.17/week |\n| Benefit | 60% of statewide average weekly wages or $840.70/week | 67% of statewide average weekly wages or $971.61/week |\n| Benefit Duration | 10 weeks | 1","cbCaiqsgr2q8mgNF","https://ap.wps.com/l/cbCaiqsgr2q8mgNF","pdf",2191685,"English","# FYB (February 2021)\n## Dental benefits predetermination guidance\n## New York State Paid Family Leave updates for 2021\n## New York Paid Family Leave benefit table\n## Summary of Material Modifications: network pharmacy out-of-pocket maximum","[{\"question\":\"What should participants do if their dentist requests predetermination of benefits?\",\"answer\":\"Get a predetermination of benefits for the planned procedure, ideally having the dental provider submit details of the treatment and cost for extensive dental work. This helps ensure you know coverage and coinsurance before work begins.\"},{\"question\":\"How long can participants take Paid Family Leave in 2021?\",\"answer\":\"Participants may take a maximum benefit length of 12 weeks within any given 52-week period, with the 52-week period starting on the first day the participant takes PFL.\"},{\"question\":\"When must Paid Family Leave claims be filed in 2021?\",\"answer\":\"Claims should be filed within 30 days of leave. If filed late, all or part of the leave may be denied, and denied claims can be appealed.\"}]","FYB - February 2021 - New York State Paid Family Leave Updates for 2021 | PDF",1789781414]