| You have read the information about the need | | | | that prevents an employee from performing the |
| for disability insurances, and have checked out | | | | job that they occupied at the time the illness |
| your company benefits to find that you DO NOT | | | | injury occurred. To receive the disability benefits |
| have short term disability (STD) or long term | | | | insurance payment, the plan participant must |
| disability (LTD) plan coverage. If this is your | | | | qualify, based on the particular plan requirements. |
| situation, read the following. The time to do so is | | | | There also is a qualifying period of time for LTD, |
| BEFORE you need to use that insurance! | | | | just like for STD, only the average LTD qualifying |
| The rest of you have checked out your company | | | | period of time is usually 6 months. Again, like |
| benefits and find that you DO have STD and LTD | | | | STD, the payment out of an LTD plan is |
| plans. Now you want to learn more about Social | | | | plan-specific, and can range from a finite dollar |
| Security Disability Insurance (SSDI) and | | | | amount to a percentage of base pay. |
| Supplemental Security Income (SSI). | | | | Key issues to research in your LTD disability |
| (Note: a denial on behalf of an insurance company | | | | insurance plan include, but are not limited to: |
| for LTD does not necessarily have an impact on | | | | pre-existing conditions; "own occupation" vs "any |
| your ability to successfully apply and be accepted | | | | occupation" timeframes; whether or not the |
| for SSDI coverage.) | | | | monthly benefit payment is taxable or tax free; |
| Social Security Disability Insurance | | | | etc. (Normally, the rule of thumb is that if the |
| If you qualify for Social Security (i.e., if you have | | | | company pays for the LTD plan premiums, the |
| acquired at least 40 quarters of Social Security | | | | benefit is taxable upon receipt; if the covered |
| contributions) and are suffering from a disability, | | | | person pays for the plan premiums, the benefit is |
| you may be able to receive monetary benefits | | | | tax free.) Again, for specifics about your LTD |
| from the Social Security Administration. Also, in | | | | plan, check out your Summary Plan Description. |
| some situations these disability benefits may be | | | | Disability and Medical Insurance definitions. You |
| awarded to you and your dependents. | | | | have plans, and you have read about such things |
| Social Security Disability Benefits or SSDI are paid | | | | as: COBRA, OBRA, Own Occupation, Any |
| to individuals who have worked in the recent | | | | Occupation, etc., and you REALLY want a simple |
| years. Usually you have to work 5 out of the last | | | | definition. Well, we have them for you. |
| 10 years. For individuals under 31 years old, the | | | | To see a Timeline that makes graphic sense |
| requirements are a little different since they have | | | | about all of these definitions, please see To ask a |
| not been in the work force as long. | | | | question, add onto one of these blogs. |
| Under the federal Social Security Disability Act, | | | | DEFINITIONS |
| "disability" means the "inability to engage in any | | | | 1. ACTIVE: Active medical insurance coverage |
| substantial gainful activity by reason of any | | | | means that you and/or your family are covered |
| medically determinable physical or mental | | | | by a medical insurance plan. Usually, these plans |
| impairment which can be expected to last for a | | | | are "group" plans carried by your, or your |
| continuous period of not less than 12 months or | | | | spouse's employer (in which case, you are the |
| result in death." | | | | "covered dependent"). |
| The Workbook described at contains a | | | | 2. COBRA: COBRA is an acronym for |
| step-by-step "How To" guide to assist you in | | | | "Consolidated Omnibus Budget Reconciliation Act". |
| documenting your illness/injury symptoms and | | | | It refers to an active medical coverage person's |
| their impact on your every day normal living | | | | ability to continue coverage as an inactive |
| activities. | | | | participant for 18 and, sometimes 36 months, |
| Supplemental Security Income (SSI) | | | | when a "triggering event" occurs. Loss of active |
| The Supplemental Security Income program is | | | | coverage status is a triggering event. A triggering |
| funded by the general revenues of the Federal | | | | event includes, but is not limited, to the following: |
| Treasury and is intended to provide a minimum | | | | loss of active coverage because the primary |
| level of income to persons who are aged, | | | | covered person lost his/her job (for any reason); |
| disabled, or blind and demonstrate economic need. | | | | divorce; a covered child's age exceeds that |
| The SSI program is meant to supplement any | | | | covered in the Plan. The cost of COBRA |
| income an individual might already have to ensure | | | | coverage is at least 100% of the Employer's cost, |
| a certain level of income to meet basic living | | | | and can be 102% or 105%. |
| expenses. The dollar amount received in SSI on a | | | | 3. OBRA: OBRA rules allow a "qualified" disabled |
| monthly basis varies from person to person and | | | | person to extend COBRA for an additional 11 |
| is computed each month, taking into account an | | | | months based on disability. There are key |
| individual's current financial situation. | | | | conditions; 1) the person must be SSDI qualified; |
| For an individual to be eligible for SSI they must | | | | 2) the person must request OBRA within the first |
| be disabled, or blind, or aged and have little or no | | | | 60 (sometimes 30) days of having received the |
| income and resources. A person must fit into one | | | | SSDI determination letter; and, 3) the Plan |
| of the following categories: Disabled, Blind (20/200 | | | | Administrator may charge 150% of the COBRA |
| or less in your better eye with glasses or a filed | | | | price for coverage. |
| of vision less than 20 degrees), or Aged (refers | | | | 4. Medicare: When a person becomes |
| to be 65 years of age or older). | | | | SSDI-qualified, s/he is eligible for Medicare 24 |
| To be eligible for SSI a person must meet an | | | | months from the date of the first month of SSDI |
| income as well as resource test. SSI resource | | | | payment. As there is a 5-month waiting time |
| limits are set by statue and a person's countable | | | | from SSDI-qualification until the first month of |
| or real personal property, including cash, must not | | | | payment (and this occurs the second Wednesday |
| exceed the specified amount to qualify. The | | | | of the months AFTER the 5th month), the actual |
| current resource limit is $ 2,000 for an individual | | | | waiting time is 29 months. |
| and $3,000 for a couple. Income includes earned | | | | 5. HIPAA: HIPAA is an acronym for Health |
| income (which refers to monthly gross earnings), | | | | Insurance Portability and Accountability Act of |
| and unearned income such as Social Security | | | | 1996. It is a way for people who either do not |
| Disability Insurance (SSDI) or any other type of | | | | choose COBRA, or who need to trigger additional |
| benefit or monetary support a person receives. A | | | | health insurance before Medicare, to obtain some |
| standardized formula, which takes into account | | | | coverage. |
| earned and unearned income is used by SSA to | | | | 6. 30-180 day Elimination Period for LTD: In most |
| compute the dollar amount of SSI cash benefit | | | | cases, a company's LTD (long term disability) plan |
| that a person qualifies for. This formula is applied | | | | has an elimination period of time equal to the |
| during the initial eligibility determination and an | | | | length of the company's STD (short term |
| individual must qualify for some dollar amount of | | | | disability) coverage. During this time, the employee |
| SSI to meet the income test. | | | | is expected to obtain income any way s/he can. |
| The specifics of qualifying for SSI are quite | | | | 7. Own Occupation: To be found "disabled from |
| complicated. | | | | your own occupation" means that you have been |
| The next time, we will talk about COBRA (and no, | | | | determined to be unable to perform the "work" |
| it is NOT a snake) OBRA, and their relationship to | | | | that you had successfully performed prior to |
| Medicare and/or another health insurance plan. | | | | evidence that your illness/injury symptoms |
| These are all of the traditional disability insurances. | | | | impaired your satisfactory performance of the |
| Now we will discuss what they are, and why you | | | | essential duties of your job. The key here, is that |
| should care! | | | | the evidence must prove that your inability to |
| STD is an insurance that you are usually provided | | | | successfully perform your "own occupation" must |
| by your Employer. It is an Insurance plan that | | | | ONLY be attributed to impairment caused by the |
| pays out a certain amount of money for a short | | | | symptoms from your proven, documented, |
| period of time (normally, no longer than 6 | | | | disabling illness/injury. |
| months). There is usually a week of what is called | | | | 8. Any Occupation: To be found "disabled from |
| "qualifying" time before the STD payment will kick | | | | any occupation" means that, in spite of your age, |
| in. Most folks can take sick leave, vacation time, | | | | level of education, and previous job history, the |
| paid time off, or some other sort of time for this | | | | symptoms of your proven, documented disabling |
| qualifying time. This type of disability payment is | | | | illness/injury impair you from performing work of |
| for an illness or injury of a limited period of time. | | | | any occupation. The reason, for LTD insurance |
| An STD payment ranges from a low amount that | | | | purposes, that this impairment from performing |
| would equate to a state's Unemployment | | | | work of any occupation is periodically reviewed, is |
| payment, to a maximum of about 66% of base | | | | that there are times when a person's physical |
| pay. To know about the specifics of your plan, | | | | capabilities can improve. Disability pay only |
| ask the appropriate people for a copy of your | | | | continues as long as there is proven evidence that |
| STD plan's Summary Plan Description. | | | | the symptoms impair "work". Often the "periodic |
| LTD, or long term disability insurance payment | | | | review" occurs annually. |
| usually results from a physical or mental illness | | | | |