Medicare is a health insurance program for people 65 years of age and older, some disabled people under 65 years of age, and people with end-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant).
Medicare has two parts. Part A is hospital insurance. Most people do not have to pay for Part A. Part B is medical insurance. Most people pay monthly for Part B. Click here for Medicare Premiums for Part A & Part B. (This information is provided by the Center of Medicare & Medicaid Studies.)
Everyone eligible for Social Security Disability Insurance (SSDI) benefits is also eligible for Medicare after a 24-month qualifying period. The first 24 months of disability benefit entitlement is the waiting period for Medicare coverage. During this qualifying period for Medicare, the beneficiary may be eligible for health insurance through a former employer. The employer should be contacted for information about health insurance coverage.
A beneficiary may receive at least 93 months of hospital and medical insurance after the trial work period as long as she/he still has a disabling impairment. This provision allows health insurance to continue when a beneficiary goes to work and engages in substantial gainful activity. The beneficiary does not pay a premium for hospital insurance. Although cash benefits may cease, the beneficiary has the assurance of continued health insurance.
Answer: Yes, as long as your disabling condition still meets our rules. Your Medicare hospital insurance (Part A) coverage is premium-free. Your Medicare medical insurance (Part B) coverage will also continue. You or a third party (if applicable) will continue to pay for Part B. If your Social Security Disability Insurance cash benefits stop due to your work, you or a third party (if applicable) will be billed every 3 months for your medical insurance premiums. If you are receiving cash benefits, we will continue to deduct your medical insurance premiums from your check.
Answer: Yes. As long as you still have a disabling condition, you can purchase Medicare Part A (hospital insurance). If you purchase Part A, you may purchase medical insurance (Part B). You cannot purchase Part B in this situation, unless you also purchase Part A.
Example: Mary works full-time for GHI Company, which has 120 employees. She has large group health plan coverage for herself and her husband. Her husband has Medicare because of a disability. Therefore, Mary's group health plan coverage pays first for Mary's husband, and Medicare is his secondary payer.
If, for any reason, you lose your employer group health plan coverage, you can get your Medigap policy back. You must notify your Medigap insurance company that you want your Medigap policy back within 90 days of losing your employer group health plan coverage.
Your Medigap benefits and premiums will start again on the day your employer group health plan coverage stopped. The Medigap policy must have the same benefits and premiums it would have had if you had never suspended your coverage. Your Medigap insurance company can't refuse to cover care for any pre-existing conditions you have. So, if you are disabled and working, you can enjoy the benefits of your employer's insurance without giving up your Medigap policy.
Answer: If you are age 65 or older and have Medicare and COBRA continuation coverage, Medicare pays first. If you or a family member has Medicare based on a disability and COBRA coverage, Medicare is the primary payer. However, if you or a family member has Medicare based on ESRD, the COBRA coverage is the primary payer and Medicare is the secondary payer for the first 30 months.
To be eligible for TDI benefits, you must have at least 14 weeks of Hawaii employment during each of which you were paid for 20 hours or more, and earned not less than $400 in the 52 weeks preceding the first day of disability. The 14 weeks need not be consecutive nor with only one employer.
Some employees are excluded from coverage (refer to section 392-5 of the Hawaii Revised Statues for exclusions) such as the employees of the federal government, certain domestic workers, insurance agents and real estate salespersons paid solely on a commission basis, individuals under 18 years of age in the delivery or distribution of newspapers, certain family employees, student nurses, interns and workers in other categories specifically excluded by the law.
TDI benefits paid or payable to you are solely to partially replace the wage loss resulting from your inability to work. Your employer or insurance carrier is prohibited from receiving benefit assignments, in whole or in part, to pay for a debt or obligation you incurred. Benefits are also exempt from levy, execution, attachment, and garnishment except for child support with a Family Court order, as allowed under Section 571-52, HRS.
The law requires that you file your claim within 90 days from the date you were disabled. If you file your claim after 90 days, you may lose part of your benefits unless good cause can be shown. If you file your claim more than 26 weeks after your disability, you will not be entitled to any benefits. To avoid partial or complete loss of benefits, file your claim within 90 days.
Subrogation may also extend to benefits resulting from a legal action on liability if such benefits are awarded subsequently for the same disability covering the same disability period. Here is an example of what subrogation is:
Suppose while walking in a restaurant, you slipped on wet pavement and suffered a broken ankle. During your disability, you received TDI benefits from your employer or the insurance carrier. As a result of a suit you filed against the restaurant or of an agreement concluded between you and the restaurant, you received a cash settlement, which compensated you for wages lost during your disability. Since your employer or the insurance carrier paid you TDI benefits to replace your lost wages, the employer or the insurance carrier has the right to claim from the cash settlement or to require reimbursement from you for the amount of TDI benefits paid you.
Your employer or insurance carrier is required to send you a written notice (three copies of the Denial of Claim for Disability Benefits Form TDI-46) if your claim is denied. If you disagree with the denial, you may appeal by explaining why you disagree on the notice, and then send two copies to this Division in Honolulu or to the Department of Labor & Industrial Relations field office nearest you. You have 20 calendar days from the mailing date of the denial notice to appeal.
You may also submit your written appeal to the Honolulu office or the Department of Labor and Industrial Relations District Office nearest you if you disagree with the amount of benefits paid you by your employer or the TDI insurance carrier. Bring evidence such as pay slips or check stubs to prove you are entitled to more benefits. This Division will notify you of the time and place of the appeal hearing. An impartial referee will hear your case.
The Hawaii TDI law does not specifically indicate that it is unlawful to suspend any employee solely because that employee has suffered a nonwork-related disability. However, you may contact the Civil Rights Commission at (808) 586-8636 for more information.
The sick leave provided by the employer is the TDI benefits for a state or county employee. However, if your combined total of used and unused sick leave credits within a benefit year is less than three weeks prior to the disability, you may be entitled to additional TDI benefits. Contact your personnel office to file a claim.
Every TDI policy issued by an authorized TDI insurance carrier covers the entire liability of the employer to its employees. The classes of employees covered must be specifically indicated in the policy and the Certification of Issuance (Form TDI-62) shall contain the following information:
The Certification of Issuance must be submitted to this Division within thirty days after purchase of insurance. It must signed by an officer of the insurance carrier or its authorized representative. The carrier will be notified if the Certificate of Issuance is accepted.
Social Security Disability Income (SSDI) provides income replacement if an individual meets federally determined disability eligibility standards, usually that the individual is not able to do any job as a result of the disability. SSDI is a federal government program which pays standard benefits to SSDI eligible persons who are unable to work in any job. Everyone who is eligible for federal Social Security is eligible for benefits under this program.
There are two types of disability insurance, short-term and long-term. The main difference between STD and LTD is the period of time the consumer receives benefits if he or she is unable to work. This period is called the benefit period. Short-term will typically replace a portion of the policyholder's salary for three to six months. Long-term will generally begin six months after the disability and can last years or even until retirement age.
DI is a medically underwritten product. If an insurance company believes your risk is too high, they can choose not to provide you individual coverage as long as that denial is not based on any prohibited factors.
Massachusetts law, M.G.L. c. 175 110F, does not allow for benefits due under a DI policy to be reduced by an future increases in federal social security benefits once payment of disability benefits has commenced. However, this only applies to STD policies.
What would an income loss mean for you It would probably be stressful, frustrating, and even a little scary. The good news is, you can patch up this hole in your financial safety net with long-term disability insurance.
Employer sponsored disability insurance is an important employee benefit, but on its own it may not offer you the protection you need as a resident physician. Most employer sponsored coverage offers a monthly disability benefit that would fall well below the amount you may need for ongoing living expenses should you become disabled and are unable to work. On top of that, depending on how the premiums for your employer sponsored disability income insurance are paid, your disability benefit may be taxable. This may leave you with less monthly income. 59ce067264