Glossary Section 7-Understanding Work, Disability and Income Support

Navigating the healthcare system can feel like learning a new language. Knowing the right terms matters. It can help you

• Understand what your insurance will and won't cover.
• Know what questions to ask about your health insurance, financial assistance, or income.
• Avoid unexpected costs.
• Get financial help.
• Advocate for yourself or your patients when insurance companies deny coverage or when bills don't add up.

This glossary is a tool you can use whenever you aren't sure about a word or term. It covers health insurance basics, prescription drug coverage, billing, the approvals and appeals process, financial assistance, and income support.

Remember, health policy, program eligibility, and insurance rules change all the time. It is a good idea to check with your insurance company, job, healthcare providers, or other federal/state agencies about your specific needs or questions about your coverage.

Key Terms

Americans with Disabilities Act (ADA) Accommodations: Changes or adjustments that your employer makes to help people with disabilities do their jobs. These accommodations are part of the Americans with Disabilities Act. This act protects people with disabilities by doing things like offering changes to your work schedule or job duties, letting you work from home, or providing you with special equipment. The accommodation must be reasonable for your employer to make. It can’t put the employer at risk financially or cause changes that disrupt your coworkers. By law, employers must work with you to find a reasonable solution. Talk with your employer about options if you think a reasonable accommodation will help you keep working.

Disability: A physical or mental condition that limits your ability to do daily activities or work. Your employer, insurance company, state, and federal government may define disability in different ways. For example, the Social Security Administration (SSA) defines disability as something that will keep you from doing substantial work and is expected to last at least 12 months or result in your death. The ADA defines disability as a physical or mental condition that limits one or more life activities—things like walking, standing, lifting, or concentrating. It is important to know the differences to help guide what benefits you may be eligible for.

Family and Medical Leave Act (FMLA): A federal law that lets eligible workers take up to 12 weeks of unpaid leave every year for certain medical or family caregiving needs. FMLA protects your job if you need to take leave for a serious health condition or to care for a family member with a serious health condition. It also provides job protection for the birth or adoption of a child. To be eligible, you need to have worked at your job for 12 months and work for an employer with more than 50 workers. You can take FMLA all at once or intermittently. Intermittent FMLA lets you take leave in smaller pieces or chunks of time. For example, if you need to get to medical appointments, you can take two full days a week of leave, or take just the mornings off for 5 weeks. You also keep your health insurance while on FMLA.

Long-Term Disability (LTD): A type of income insurance that replaces part of your income if you cannot work for a longer period of time due to serious injury or illness. There may be a waiting period after signing up for LTD before you can begin to collect these benefits. LTD can come from your job, or you can purchase an LTD policy on your own. It is important to remember these payments only replace a portion of your income.

Paid Leave: Time away from work that your employer pays you for. It can include different types of paid time off, including sick time, vacation time, or personal time. Some employers also offer paid family and medical leave. Leave policies vary by employer. Start with your Human Resources department to see what options for paid leave you have.

Some states also have paid family and medical leave. There is no federal law for paid family and medical leave. You can learn more about state-paid leave through the National Partnership for Women and Families (link: https://nationalpartnership.org/wp-content/uploads/paid-leave-victories-2020-to-today.pdf)

Service-Connected Disability: A disability related to military service. It can include illnesses or injuries that started during service, were made worse by service, or can be linked to military service. Many cancers are service-connected disabilities. If the Department of Veterans Affairs (VA) decides your injury or illness is related to your military service, you may be eligible for disability income. If you are a veteran with cancer, it is worth exploring if your cancer may be service-connected. A VA social worker or Veterans Service Organization (VSO) can help you with the claims process.

Short-Term Disability (STD): A type of income insurance that replaces your income if you can’t work for a short period of time because of injury or illness. There may be a waiting period after signing up for STD before you can start to collect benefits. STD usually lasts 3-6 months. It can be through your employer, or you can buy a policy on your own. STD can also be a bridge while you are waiting for LTD benefits to start.

Social Security Disability Insurance (SSDI): A program run by the SSA that pays you monthly if you have a serious disability and are unable to work. It is directly tied to how much you have worked and the Social Security taxes that you have paid over time. You must meet the SSA definition of disability, have earned enough work credits, and your work credits must meet a “recency requirement.” This means you need to have work credits earned in 5 of the last 10 years. There is also a 5-month waiting period before you begin collecting benefits. After you have been on SSDI for 2 years, you become eligible for Medicare.

Substantial Gainful Activity (SGA): SGA is how the Social Security Administration (SSA) describes your level of work activity and earnings. If you earn more than a certain amount every month, you do not qualify for SSDI benefits. The earnings threshold changes every year, so it’s good to check with SSA regularly to see if your earnings may be in line with your disability claim.

Supplemental Security Income (SSI): A program run by the SSA that gives money to people who are aged, blind, or disabled and have limited household income and resources. It is not tied to your work history. It is a needs-based program. This means your eligibility is based on your income and resources. In most states, if you get SSI, you also get Medicaid.

Ticket to Work: A program from SSA that helps people on SSDI or SSI go back to work. It lets you test your ability to work without losing your disability benefits. If you try working and can’t continue, you don’t have to reapply for benefits. The program also connects you with job training, career counseling, and job placement help.

Trial Work Period: A program that lets people on SSDI test their ability to work, while they are still getting their full benefits. During this trial, you can work up to 9 months within 60 months. You won’t lose your SSDI, regardless of how much income you make. After your trial work period is over, SSA will review how much you are working and earning to see if you are above the SGA level. The trial work period earnings threshold changes every year, so check with SSA about current amounts. It’s a good idea to talk with SSA about the trial work period before you go back to work.

Unemployment Compensation: A program that provides temporary (short-term) income if you have lost your job through no fault of your own. It is run jointly by the federal government and each state. How much and how long you can collect benefits is different in each state. It is not the same as disability. You must actively be looking for work to qualify for unemployment compensation.

Workers' Compensation: A program that helps workers who are injured or become sick because of their job. It can cover things like medical expenses, lost wages, and rehabilitation. The laws for this program vary by state. You should let your employer know right away if you are injured at work or develop an illness related to your job. It is not the same as disability; it only covers workplace-related injuries or illnesses.