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Active Work Requirement

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The minimum number of hours per week that an employee is required to work to qualify for and maintain eligibility for benefits.

Beneficiary

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The person who is getting a benefit.

Benefits Planner

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A trained expert who can help you understand and apply for benefit programs. Their goal is to help you develop a plan for your future and organize your financial life to run as smoothly as possible.
  • For questions about work and your Social Security benefits, use Social Security's "Find Help" tool to locate a WIPA project near you. You can also call the Ticket to Work Help Line at 1-866-968-7842 / 1-866-833-2967 (TTY/TDD). The Department of Rehabilitation (DOR) also has Work Incentives Planners (WIPs).
  • If you need assistance with your Medicare, the Health Insurance Counseling & Advocacy Program can help. HICAP provides free information and counseling to people with Medicare. You can call HICAP at 1-800-434-0222 or visit the HICAP website.
  • If you need assistance with Medi-Cal and have a disability, you can contact Disability Rights California at 1-800-776-5746 or visit their website. You may also be able to get help with Medi-Cal from a local legal aid organization. The Health Consumer Alliance website has a lot of useful information about Medi-Cal, including a web page that can direct you to a local legal organization for assistance.
  • If you have questions or need assistance with a program or benefit not listed here, contact an Independent Living Center (ILC). Independent Living Centers provide peer support and information on a wide range of topics for people with disabilities.

Coverage Effective Date

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The date an individual is enrolled in coverage. The effective date is usually not the same as the date of hire.

Disability (Definition used by private insurers)

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A level of impairment that causes private insurers to provide benefits to people who have paid a monthly premium for coverage.

There are two common levels of disability according to private insurers:

  1. Own-Occupation Disability (or “Own Occ” ) means your disability prevents you from performing your own occupation, which means you cannot do the work or job you have been trained to do and have experience in
  2. Any-Occupation Disability (or “Any Occ”) means your disability prevents you from performing any occupation:
    • Sometimes Any Occ means that your disability prevents you from performing any occupation that pays at least a specified percentage of what you earned before your disability

Own-occupation insurance policies pay you if you are unable to perform your own occupation, even if you are able to get a different type of job. They have higher premiums than policies that require you to be unable to perform any occupation. Check with your insurer to see which definition of disability your plan has.

Earned Income (EI)

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Salaries, wages, tips, professional fees, and other amounts you receive as pay for physical or mental work you perform. This can include things you get in exchange for work instead of wages, such as food, shelter, or other items. Funds received from any other source are not included. (Contrast: unearned income.)

Gross Income

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Your earned income (before taxes and other deductions are made) plus your unearned income.

Gross Pre-disability Salary

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The total pre-tax income paid to an individual by an employer before a disability began and while the individual was covered by disability insurance.

Group Coverage

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Coverage offered to an individual through a group, such as employer-sponsored, association-affiliated or professional group coverage.

Individual Disability Policy

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Wage-replacement coverage you buy directly from an insurance company, usually through an agent, that provides benefits if you become disabled. You are responsible for paying for the entire premium, and most individual policies require medical underwriting.

Initial Enrollment Period (Private Coverage)

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The first time an individual is eligible to enroll in a group’s benefits programs.

Long-Term Disability Insurance

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Private insurance that replaces some of your income when you can't work because of a disability. Long-Term Disability (LTD) generally covers disabilities that last more than a year. To apply for LTD, speak with your employer's human resources department, or contact a private insurance company.

Medical Underwriting

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The review of an individual’s medical history and/or medical records to determine if the individual is eligible for coverage. Medical underwriting, which may include new medical testing, can be used to deny coverage or determine if a particular pre-existing condition will be covered.

The Affordable Care Act prohibits health insurance companies from doing medical underwriting and excluding pre-existing conditions from coverage. Other forms of insurance, like private disability insurance, can do medical underwriting and exclude pre-existing conditions.

Net Benefit Amount

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The benefit amount an insurance company pays after deducting income.

Potentially Disabling Condition

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A condition that does not yet interfere with your abilities or keep you from working, but may one day develop into a disability that keeps you from working.

Pre-Disability Income

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Pre-Existing Condition

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Any condition for which “medical care” was received within six months prior to the effective date of insurance coverage. Medical care includes the use of prescription drugs and physician consultations and services. During a pre-existing condition exclusionary period, coverage for that condition is either not provided or can be limited.

The Affordable Care Act prohibits health insurance companies from doing medical underwriting and excluding pre-existing conditions from coverage. Other forms of insurance, like private disability insurance, can do medical underwriting and exclude pre-existing conditions.

Pre-Existing Condition Exclusionary Period

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The period of time from the coverage effective date that the insurer does not cover a pre-existing medical condition. The individual will normally be covered for the condition once the specified time has elapsed.

The Affordable Care Act prohibits health insurance companies from doing medical underwriting and excluding pre-existing conditions from coverage. Other forms of insurance, like private disability insurance, can do medical underwriting and exclude pre-existing conditions.

Premium (General)

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A regularly scheduled payment to an insurer or health care plan.

Retroactive Payments

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Payments made for the period between disability onset and application approval.

Service Wait

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The period of time an individual is required to be employed by a company or be a member of an association before becoming eligible to enroll for the group’s health coverage. Also known as the minimum service requirement.

Short-Term Disability Insurance

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Private insurance that replaces some of your income when you can't work because of a disability. Short-Term Disability (STD) generally covers disabilities that last a year or less. To apply for STD, speak with your employer's human resources department, or contact a private insurance company.

Wage Replacement

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A type of benefit that provides money each month to make up for wages you no longer receive due to disability. It can be either a percentage of your pre-disability income or a fixed dollar amount. Short-Term or Long-Term Disability Insurance are private wage replacement programs, while Social Security Disability Insurance (SSDI) is a public program. Wage replacement is also known as pay replacement or income replacement.

Waiting Period (Short- and Long-Term Disability)

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The amount of time you have to wait between becoming disabled and receiving a benefit. For example, many private disability plans begin paying benefits 7 days after an illness forces you to leave work.