Frequently Asked Questions
Q: Won't Social Security pay if I ever become disabled?
A: 70% of all disability applicants
are rejected by the Social Security Administration. In fact, according
to the 2003 Social Security Handbook, five full calendar months must pass
before any disability benefits begin from the government. To qualify, the
disability must be one that "can be expected to result in death, or which
has lasted or can be expected to last for a continuous period of not less
than 12 months," and the disability must prevent the individual from being
able to perform any type of gainful employment.
Important Definitions
Brand Name Drugs:
Prescription drugs that are manufactured and
marketed under a registered name. They are usually patented and may be
exclusively offered by certain manufacturers.
Business Expenses Protection
Plan:
A business expenses protection disability insurance
plan is designed to help you keep your business running by reimbursing
your monthly business expenses if you were to become sick or hurt and unable
to work.
Coinsurance:
The percentage of the cost of covered services
that you will be responsible for, after your annual deductible is met.
With some plans, you have a choice of coinsurance levels. Much like your
deductible, selecting a higher coinsurance typically lowers your monthly
premium because it increases your share of the cost.
Copayment:
The specific dollar amount you have to pay for
certain covered services.
Cost-Sharing:
The costs of medical care today can be staggering.
Health care coverage can help protect you against these high costs. With
most health care coverage, you pay a monthly premium, then you share some
of the cost of covered medical care with the company that provides your
health coverage. The level of cost-sharing you choose directly impacts
your premium account. The more you are willing to share in the costs, the
lower your premium. You can choose your level of protection and the level
of cost-sharing that works best for your health care needs and budget.
Deductible:
The amount you have to pay each calendar year
for covered services before your health care plan starts paying. For some
services, the plan will even begin to pay before the deductible is met.
Usually, the higher a plan's deductible, the lower the premium. In some
cases, you may also have a separate deductible for certain services such
as prescription drugs.
Formulary:
A list of prescription drugs that health care
plans cover. They include generic and preferred brand name drugs that have
been rigorously reviewed and selected by a committee of practicing doctors
and clinical pharmacists for their quality and effectiveness. Your insurer
has negotiated lower prices on these formulary drugs, so you'll save money when
your doctor prescribes medication from the formularies. There can be different
formularies for different health care plans.
Generic Drugs:
Prescription drugs that typically have been in
use for some time and can be manufactured and distributed by numerous companies,
so their cost is usually much lower. Generic drugs must, by law, contain
the same active ingredients as their brand name equivalent and have the
same clinical benefit.
Health Savings Account (HSA):
A special bank account that can be set up by a
member enrolled in a qualified HSA-compatible high-deductible health plan
if they choose. Contributions to this account can be made with certain
tax advantages and funds from the account can be used for qualified health
care expenses.
Individual Disability Insurance
Plan:
Ask yourself, if you were to become sick or hurt
and unable to work, how long could you survive financially without an
income? Disability insurance plans pay you if you become ill, injured,
or disabled and unable to work. They help you to pay your medical bills
and maintain your standard of living.
Lifetime Maximum:
The lifetime benefit amount that will be paid
under the policy for each member. This includes network and non-network
covered services combined.
Out-Of-Pocket Maximum:
The most that you would pay in a calendar year
for deductible and coinsurance for network covered services. Once you reach
this maximum, the plan pays at 100% for most services for the rest of the
calendar year.
Prescription Drugs:
Medications that must be authorized for use by
your doctor. There are varying levels of prescription drug coverage. Depending
on the plan, you may have coverage for generic drugs or generic and brand
name drugs.
Tiers:
Tiers represent a cost level within the generic and brand
name prescription drug categories. The prescription drug coverage under
your health care plan will differ for each of these tiers. Not all products
have this tiering.
-
Tier 1: These drugs generally include generic
drugs and a few lower cost brand name drugs.
-
Tier 2: These drugs generally include higher
cost generic and brand name drugs.
-
Tier 3 and 4: These drugs include the highest
cost brand name drugs.
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