Episodic Disabilities and Insurance: Action Items for Consumers
Are you a person living with HIV, MS, Arthritis, or another health condition that causes you to experience episodic disability (disability that comes and goes)? Are you eligible through your employer for health benefits and Short-Term (STD) or Long-Term Disability (LTD) Insurance? These benefits can assist you in managing your health, but they can also be challenging to access for people with recurring and unpredictable conditions. Here are some helpful suggestions.
Find out what is in your health benefits and STD and/or LTD plans.
Many people don’t find out what is in their plan until they need to access it. Be proactive and ask for a copy of your plan ahead of time, so you’ll be prepared and knowledgeable when you need it.
Engage with your available supports.
If you need more information or advice, ask for help from Human Resources or a similar administrative office. If you are unionized, your union representative is a good place to start with any questions you may have related to health benefits or insurance coverage.
Take a preventative approach.
Some of the things in your plan can help prevent episodes – find out what you are entitled to and use it to help you manage your episodic disability. For example, some health benefit plans allow for visits to massage therapists or mental health specialists. If you are entitled to these benefits and they would be helpful for you in managing your condition, access them. Note, some of these services require a referral from your physician.
Provide feedback to your employer on the usefulness of the plan.
There are some insurance plan elements that can be particularly helpful for people living with episodic disabilities, as they make it easier to transition on and off claim. If you find that you are frequently moving on and off claim, you may want to talk to your employer to see if any of the following could be added to your plan:
A Recurrent Claims Clause
A recurrent claims clause allows for an individual to qualify for STD or LTD based on a reoccurrence of an established and qualified disability taking place within a specified period of time. Recurrent claims clauses are useful in that the new episode is treated as the same as the last episode and the individual is not then required to submit a new claim. There are usually time limits on these clauses; some limit the recurrence period to 6 months.
A Waiver of Elimination Period
In offering LTD, it is possible to request a Waiver of the Elimination Period. This essentially allows for an individual with a recurrent disability to qualify for support during an episode without the requirement of fulfilling a new waiting or elimination period. There are reports of elimination periods that extend for up to 5 years allowing for individuals experiencing recurrent periods of disability to immediately qualify for claim.
Remember, being prepared is an important part of self-advocacy. For more information on episodic disabilities please visit the Realize website.
Disclaimer: This fact sheet is provided for information only. Please consult with your insurance provider directly for details relevant to your unique circumstances.