MetLife, Inc. · NYSE:MET
MetLife — Conference Presentation (December 2022)
33 slides from MetLife's conference presentation, December 2022
Slide 1: New Hampshire Paid Family & Medical Leave: Claims Process
New Hampshire Paid Family & Medical Leave: What you need to know about the claims process December 2022 The information contained in this presentation is not legal or tax advice and should not be relied upon or construed as legal or tax advice. This presentation is for general informational purposes
Slide 2: Today's agenda
Today’s agenda 01 Introductions 02 What is NH PFML 03 How to file a claim 04 Employer roles & responsibilities 05 Claim examples 06 Tools & resources 07 Timeline of activities 08 Wrap-up and Q&A Metropolitan Life Insurance Company, New York, NY L1122027589[exp1223][All States] © 2022 MetLife Service
Slide 3: What is New Hampshire Paid Family & Medical Leave (NH PFML)?
What is New Hampshire Paid Family & Medical Leave (NH PFML)? Metropolitan Life Insurance Company, New York, NY L1122027589[exp1223][All States] © 2022 MetLife Services and Solutions, LLC 3
Slide 4: What is New Hampshire's PFML plan?
What is New Hampshire’s PFML plan? An optional insurance plan that provides wage replacement for employers and individuals who cannot go to work because of a qualifying common life event Paid Medical Leave Paid Family Leave Own Serious Health Child Bonding Family Caregiver Military Exigency Military
Slide 5: What is NH PFML Individual Coverage?
What is NH PFML Individual Coverage? If an employer does not provide employer equivalent benefit coverage, eligible workers may purchase a NH PFML individual insurance plan for themselves from MetLife (employer obligations still apply). The NH PFML individual insurance plan provides workers: 6 weeks
Slide 6: NH PFML Individual Coverage: Premiums and Billing
NH PFML Individual Coverage: Premiums and Billing MetLife will communicate with both the NH worker and employer to communicate responsibilities and to set up billing and billing schedules. NH workers working for small NH employers will be billed directly by MetLife. Large NH employers will be respon
Slide 7: How do workers file a claim?
How do workers file a claim? Metropolitan Life Insurance Company, New York, NY L1122027589[exp1223][All States] © 2022 MetLife Services and Solutions, LLC 7
Slide 8: Leave request process
Leave request process How do workers file for benefits? 1 Apply for benefits 2 Submit supporting documentation 3 Stay connected until return to work • Workers contact MetLife within • Proof may be required before the • Employer and MetLife will need 30 days prior or within 20 days claim decision can
Slide 9: Roles & Responsibilities
Roles & Responsibilities Metropolitan Life Insurance Company, New York, NY L1122027589[exp1223][All States] © 2022 MetLife Services and Solutions, LLC 9
Slide 10: Workers' needs are our priority
Workers’ needs are our priority Highly trained, compassionate experts here to help your workers return to work Claim and Absence Claim and Absence Ongoing Service Resolution Submission Evaluation and Decision and Follow Up Worker MetLife …And MetLife MetLife We review the And then We continue And ke
Slide 11: Submitting claims made easy
Submitting claims made easy Keeping your workers educated and informed makes the submission process easy Claim and Absence Submission Worker submits , MetLife …And MetLife paid family leave or sends claim Claim Specialist paid medical leave information engages with worker, and employer if applicable
Slide 12: Thoughtful evaluation and review
Thoughtful evaluation and review We’ll always look to find the best course of action for each Worker Claim and Absence Evaluation and Decision MetLife We review worker’s And then proactively capacity/recovery let them know reaches out the decision* for medical information * Decision timeframe is gen
Slide 13: A model designed around customers' needs
A model designed around customers’ needs Highly trained, compassionate experts help workers return to work Ongoing Service Resolution and Follow Up We continue And keep Your worker returns to review their them informed to work capacity/recovery of any decisions including intermittent or reduced leav
Slide 14: Claims Examples
Claims Examples Metropolitan Life Insurance Company, New York, NY L1122027589[exp1223][All States] © 2022 MetLife Services and Solutions, LLC 14
Slide 15: Claim example 1: Jerry
Claim example 1: Jerry Jerry was injured shoveling snow and his healthcare provider recommended 4 weeks of physical therapy to help strengthen his back. His weekly wage is $600 for 5 days/week schedule. STD NH PFML FMLA Potential benefit = 60% Potential benefit = 60% Qualifies for FMLA – runs concur
Slide 16: Claim example 1: Jerry
Claim example 1: Jerry Jerry is still experiencing back pain and his doctor schedules outpatient surgery. His weekly wage is $600 for 5 days/week schedule. STD NH PFML FMLA Potential benefit = 60% Potential benefit = 60% Qualifies for FMLA – runs concurrently with Qualifies for STD – Not qualified –
Slide 17: Claim example 2: Rose
Claim example 2: Rose Rose is having a baby in 6 months and she experiences severe morning sickness. Her doctor certifies that she may miss partial days during this phase of her pregnancy. Her weekly wage is $1,000 for a 5 days/week schedule. STD Salary NH PFML PTO FMLA Continuation Potential benefi
Slide 18: Claim example 2: Rose
Claim example 2: Rose Rose is having a baby in 2 weeks, and she starts to experience complications prior to the due date. The doctor puts her on bedrest before the baby is due as a precaution. Her weekly wage is $1,000 for a 5 days/week schedule. STD Salary NH PFML PTO FMLA Continuation Potential be
Slide 19: Claim example 2: Rose
Claim example 2: Rose Rose had a healthy baby girl. She had a complicated delivery, and the doctor has ordered 8 weeks for her recouperation. Her weekly wage is $1,000 for a 5 days/week schedule. STD Salary NH PFML PTO FMLA Continuation Potential benefit = 60% Potential benefit = 100% Potential bene
Slide 20: Claim example 2: Rose - Benefit Overlap
Claim example 2: Rose Benefit Overlap Child born July Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Benefits NH PML 5 days NH PFL 4 weeks 1week STD 2 weeks 4 weeks 4 weeks SalCon 4 weeks 2 weeks PTO 5 days FMLA 5 days 2 weeks 4 weeks 4 weeks 1week Metropolitan Life Insurance Company, New York, NY
Slide 21: Claim example 2: Why employer would purchase NH PFML
Claim example 2: Rose Why would Rose’s employer choose to purchase NH PFML when they already offer STD and salary continuation for child bonding? You may not have You may get an equivalent plan financial incentives Employer equivalent NH PFML • Help offset the cost of paid plan must include: child b
Slide 22: Tools & Resources
Tools & Resources Metropolitan Life Insurance Company, New York, NY L1122027589[exp1223][All States] © 2022 MetLife Services and Solutions, LLC 22
Slide 23: Tools & Resources
Tools & Resources September Webinar : Replay | Presentation Deck November Webinar : Replay | Presentation Deck www.metlife.com/pfml Employer FAQ Worker FAQ Statutory Benefit Guide PaidFamilyMedicalLeave.nh.gov Metropolitan Life Insurance Company, New York, NY L1122027589[exp1223][All States] © 202
Slide 24: Timeline of Activities
Timeline of Activities Metropolitan Life Insurance Company, New York, NY L1122027589[exp1223][All States] © 2022 MetLife Services and Solutions, LLC 24
Slide 25: NH PFML Timeline of Activities
NH PFML Timeline of Activities September October November December January • NH PFML webinars • NH PFML webinars • NH PFML webinars • NH PFML webinars • NH PFML claims may be o Brokers o Brokers o Broker o Employers submitted o Employers o Employers o Employers o Workers • NH PFML benefits • Website
Slide 26: Wrap-up
Wrap-up Metropolitan Life Insurance Company, New York, NY L1122027589[exp1223][All States] © 2022 MetLife Services and Solutions, LLC 26
Slide 27: In Summary
In Summary Benefits are payable beginning January 1, 2023 Employer R&R in the claims process: • Instruct workers to call MetLife or log into www.paidfamilymedicalleave.nh.gov to file a claim • Coordinate STD leave with STD carrier • Provide requested information to MetLife to assist in establishing
Slide 28: Q&A
Q&A If you have any questions after this webinar, please contact your MetLife Representative, or visit https://www.paidfamilymedicalleave.nh.gov Metropolitan Life Insurance Company, New York, NY L1122027589[exp1223][All States] © 2022 MetLife Services and Solutions, LLC 28
Slide 29: Thank you
Thank you Metropolitan Life Insurance Company, New York, NY L1122027589[exp1223][All States] © 2022 MetLife Services and Solutions, LLC 29
Slide 30: Appendix
Appendix Metropolitan Life Insurance Company, New York, NY L1122027589[exp1223][All States] © 2022 MetLife Services and Solutions, LLC 30
Slide 31: Claims and Appeals Processes: A detailed look
Claims and Appeals Processes: A detailed look Metropolitan Life Insurance Company, New York, NY L1122027589[exp1223][All States] © 2022 MetLife Services and Solutions, LLC 31
Slide 32: Claims process
Claims process Submission and Initial Evaluation Initial Decision Ongoing Service and Follow Up Claim and Leave Resolution 0-60 days prior to leave Within 5 days of receiving all materials Benefit payments within 9 days of decision • MetLife helps coordinate NH PFML • Worker submits claim • MetLife
Slide 33: Appeals process
Appeals process Initiate Appeal Appeal Final Determination 10 days Within 30 days of receiving all materials • MetLife will call and send a letter to • MetLife will send a letter • MetLife will call and send a letter with the final explain why the claim was denied confirming the appeal request was a