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AIDS Drug Assistance Program (ADAP)
ADAP pays for HIV/AIDS-related
prescription drugs for individuals who are uninsured. To be eligible, individuals
must be HIV+ and meet financial eligibility requirements.
AIDS Service Organizations (ASOs)
Americans
with Disabilities Act (ADA)
The ADA is a federal law
that protects the civil rights of individuals with disabilities, including
people with HIV/AIDS. The ADA prohibits discrimination by employers of
15 or more employees.
Benefit Analyst
The LTD insurer's employee
assigned to the client's (your) case. This is a data gathering and evaluation
position.
Benefits
What you receive from the
government or an insurance company based on your disability or need. Benefits
may include cash/checks, food stamps, rent subsidy and health insurance
coverage.
Case Manager
The person in contact with
the client when a Benefits Analyst and the client agree that it may be
time to return to work. It is important to emphasize that an HIV disability
does not track the same way as a physical handicap. Sometimes Case Managers
must be educated about HIV/AIDS and the resulting disability.
COBRA/OBRA
Disability
(As defined by the Social
Security Administration)
"...a condition that is
expected to last for at least a year (or result in death) and results in
the inability to do the work for which you are suited. Disability programs
give benefits when an individual is unable to work."
Disability
(According to the Americans
with Disabilities Act — ADA)
"...one who has a physical
or mental impairment that substantially limits one or more of the individual's
major life activities, has a record of having a disability, or is perceived
to have disability."
Earned Income
Usually refers to wages
and salary. Earned income is payment received for your efforts or work
that can be used to pay for food, clothing or shelter.
Entitlement
Another word for benefits.
ERISA
Extended Period of Eligibility (EPE)
For 36 months after a successful
trial work period, if you are still disabled, you will be eligible to receive
a monthly benefit without a new application for any month your earnings
drop below $500.00
Functional
Limitations
Functional Limitations as
defined by the Americans with Disabilities Act of 1990 is described as
a task or action that a person is unable to perform, or has difficulty
performing because of the disability. There is a lack of consistency between
the definitions of functional limitations and capabilities in the Americans
with Disabilities Act (ADA) and the definitions in private insurance policies.
Be sure to insist that the people you work with from insurance companies
define their terms when they use these terms.
Impairment
Related Work Expenses
A provision for SSI and
SSD recipients which recognizes disability-related items and services (such
as special transportation or adaptive devices) needed for an individual
to work. Social Security recognizes the cost of these items and/or services
and subtracts them from gross income when figuring countable earned income.
Long Term
Disability Insurance (LTD)
Acronym which stands for
Long Term Disability and is found most often referring to a private disability
insurance policy.
Long Term
Disability Gap
Pre-existing Condition Clause
Medicaid
A health insurance program
for individuals who cannot afford medical care. Medicaid is issued to everyone
who receives SSI. Other individuals with limited income and high medical
expenses may receive Medicaid based on income guidelines.
Medical
California’s version of
Medicaid.
Medicare
A health insurance program
for individuals who have received SSD for two years. Medicare includes
Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B).
Partial
Disability
Some policies classify the
disability of individuals able to work at a permanent part time position
as a "Partial Disability."
People With
HIV
Plan for Achieving Self Support (PASS)
A written plan that allows
an SSI recipient to set aside or shelter some income and/or resources in
order to attain a work goal (such as special training, tools or transportation).
The specified income and/or resources are not counted in eligibility tests
and do not reduce the SSI check. The PASS Plan must be approved in advance
and monitored by the Social Security Administration.
Qualified
Individual with a Disability
The term "qualified individual
with a disability" means an individual with a disability who, with or without
reasonable modifications to rules, policies, or practices, the removal
of architectural, communication, or transportation barriers, or the provision
of auxiliary aids and services, meets the essential eligibility requirements
for the receipt of services or the participation in programs or activities
provided by a public entity.
Qualified
Medicare Beneficiary (QMB)
Program pays the $768 hospital-admission
deductible, the $100 annual doctor-bill deductible and the 20 percent co-payment
required for doctor and outpatient bills.
Qualified
Working Disabled Individuals (QDWI)
If, after 45 months at work,
your total monthly salary is below $2,832 this program will pay your Part
A premium.
Reasonable Accommodations
Any change in a job or work
environment that enables a disabled person to work.
Recurrent
Disability
A Recurrent Disability clause
allows the insured to return to employment previously held and resume coverage
under the old group policy with no waiting period.
Residual
Disability
If a policy includes a Residual
Disability clause, the insured may be able to take a lower-paying job and
the insurer would make up all or part of the salary difference between
your employment salary and the disability income. In most cases there is
no change in income for a specified period of time. In some cases, income
actually increases.
Social Security Administration (SSA)
The federal agency that
administers both SSD and SSI. Local offices are situated throughout the
State.
Social Security Disability Insurance (SSDI)
Also referred to as SSD
is the long-term disability insurance plan sponsored by SSA. SSD recipients
have worked, paid taxes (FICA) and are disabled. SSD is granted to individuals
regardless of income and/or resources. Recipients receive monthly checks
on the third of every month. After receiving SSD for two years, individuals
automatically receive Medicare.
Specified Low Income Medicare Beneficiary (SLIMB)
Program pays the $45.50
monthly premium for Medicare Part B (which covers doctor bills and outpatient
care) that's automatically deducted from Social Security Disability Insurance
(SSDI) checks.
Substantial Gainful Activity (SGA)
Social Security Law bestows
a disability status not only on the individual who is conditionally disabled
but also upon that individual’s inability to engage in any substantial
gainful activity ("SGA") which exists in the national economy. Generally,
monthly earnings of over $500 trigger Social Security to declare work to
be disqualifying "SGA".
In situations where someone
is working, or trying to work, over a period of several months, though,
earnings as low as $200 monthly can considered to be "SGA" thereby affecting
your monthly SSDI payment.
Summary
Plan Description (Group Long-Term Disability)
The Summary Plan Description
is
an easy-to-understand overview of your group Long Term Disability Insurance
Policy. The Summary Plan Description tells you what your policy does and
does not cover, as well as eligibility requirements, prerequisites and
qualifiers. Important references:
-
Residual Disability
-
Recurrent Disability
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Allowance for Retraining or
Vocational Rehabilitation
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Trial Work Period
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Partial Disability
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Rehabilitatioin Plan(s)
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Conversion Options
Supplemental
Security Income (SSI)
Administered by SSA, SSI
is given to disabled individuals who have limited income or resources.
This includes people who did not pay into Social Security because they
worked "off-the-books." Recipients receive Medicaid. Checks are paid on
the first of each month.
Trial Work Period (TWP)
A Term of nine not necessarily consecutive months during which one can return to work without Social Security
without impacting current Social Security Disability Insurance Benefits.
WIIA
Work Incentives Improvement
Act
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