Sunday, June 05, 2005

Disability Insurance and Medical Insurance Definitions

Tonight is Sunday evening. I hope that you all had a fantastic Sunday. I have a 21 month old granddaughter who is the light of my life. This week-end she counted up to 10! However, I think that she believes that "six-seven" is one number. What fun.

Disability and Medical Insurance definitions. You have plans, and you have read about such things as: COBRA, OBRA, Own Occupation, Any Occupation, etc., and you REALLY want a simple definition. Well, we have them for you.

To see a Timeline that makes graphic sense about all of these definitions, please see www.disabilitykey.com. To ask a question, add onto one of these blogs.

DEFINITIONS

1. ACTIVE: Active medical insurance coverage means that you and/or your family are covered by a medical insurance plan. Usually, these plans are “group” plans carried by your, or your spouse’s employer (in which case, you are the “covered dependent”).

2. COBRA: COBRA is an acronym for “Consolidated Omnibus Budget Reconciliation Act”. It refers to an active medical coverage person’s ability to continue coverage as an inactive participant for 18 and, sometimes 36 months, when a “triggering event” occurs. Loss of active coverage status is a triggering event. A triggering event includes, but is not limited, to the following: loss of active coverage because the primary covered person lost his/her job (for any reason); divorce; a covered child's age exceeds that covered in the Plan. The cost of COBRA coverage is at least 100% of the Employer's cost, and can be 102% or 105%.

3. OBRA: OBRA rules allow a “qualified” disabled person to extend COBRA for an additional 11 months based on disability. There are key conditions; 1) the person must be SSDI qualified; 2) the person must request OBRA within the first 60 (sometimes 30) days of having received the SSDI determination letter; and, 3) the Plan Administrator may charge 150% of the COBRA price for coverage.

4. Medicare: When a person becomes SSDI-qualified, s/he is eligible for Medicare 24 months from the date of the first month of SSDI payment. As there is a 5-month waiting time from SSDI-qualification until the first month of payment (and this occurs the second Wednesday of the months AFTER the 5th month), the actual waiting time is 29 months.

5. HIPAA: HIPAA is an acronym for Health Insurance Portability and Accountability Act of 1996. It is a way for people who either do not choose COBRA, or who need to trigger additional health insurance before Medicare, to obtain some coverage.

6. 30-180 day Elimination Period for LTD: In most cases, a company’s LTD (long term disability) plan has an elimination period of time equal to the length of the company’s STD (short term disability) coverage. During this time, the employee is expected to obtain income any way s/he can.

7. Own Occupation: To be found “disabled from your own occupation” means that you have been determined to be unable to perform the “work” that you had successfully performed prior to evidence that your illness/injury symptoms impaired your satisfactory performance of the essential duties of your job. The key here, is that the evidence must prove that your inability to successfully perform your “own occupation” must ONLY be attributed to impairment caused by the symptoms from your proven, documented, disabling illness/injury.

8. Any Occupation: To be found “disabled from any occupation” means that, in spite of your age, level of education, and previous job history, the symptoms of your proven, documented disabling illness/injury impair you from performing work of any occupation. The reason, for LTD insurance purposes, that this impairment from performing work of any occupation is periodically reviewed, is that there are times when a person’s physical capabilities can improve. Disability pay only continues as long as there is proven evidence that the symptoms impair “work”. Often the "periodic review" occurs annually.

If you have any additional questions about any of these definitions, please ask them.

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