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.