Disability and Medical Coverage Timelines

Definitions:
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 you, or your spouse’s employer (in which case you
are the covered dependent).
COBRA: COBRA is an acronym for
Consolidated Omnibus Consolidation 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 website for more information about COBRA
is:
http://www.cms.hhs.gov/hipaa/hipaa1/cobra/default.asp
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. See this site for
more general information:
http://www.apla.org/apla/benefits/cobra.html
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. See the following web sites for additional
information:
http://www.ican.com/news/fullpage.cfm/articleid/3E9C3113-7F9D-4B00-A61066518467175D/cx/money.find_funding/article.cfm
http://www.medicare.com/faq_prescription.asp.
Also see
http://info.insure.com/medigap/medigap.html
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. For additional information, see:
http://www.cms.hhs.gov/hipaa/hipaa1/default.asp
and
http://www.hhs.gov/ocr/hipaa/
30-180 day Elimination Period for LTD:
In most cases, a company’s LTD plan has an elimination period
of time equal to the length of the company’s STD coverage.
During this time, the employee is expected to obtain income
any way s/he can.
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. 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.
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.
When Medicare kicks in for SSDI covered
individuals: In addition to providing health
coverage for persons age 65 and over, the Federal Medicare
program also covers individuals who are collecting disability
benefits from Social Security Disability Insurance (SSDI).
However, a person collecting SSDI benefits does not become
eligible for Medicare until he/she has collected SSDI benefits
for 24 months. With the five month waiting period for SSDI
benefits to begin, Medicare doesn’t start until 29 months
after the Onset Date of the disability.

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