Your
Legal Rights If You Become Seriously Ill
Your
Legal Rights If You Become Seriously Ill
Knowing these Facts can save you from worry-and even financial
hardship.
Barbara Ullman Scherin, Esql, Loyola Law School
Reprinted with permission from Bottom Line/Health-www.bottomlinesecrets.com
If you or
someone you love is diagnosed with a serious ailment, such as cancer,
heart failure or some other chronic or life-threatening disease,
it's easy to become so consumed with the reality of the medical
condition that you overlook important legal issues that may arise.
Most people know the importance of a will or trust, which provides
for someone's estate after death, and an "advance directive"
that appoints a person to make medical decisions on a patient's
behalf in case the patient becomes unable to do so.However, there
are other important legal concerns for ill people - and often they
are shrouded in myths that create unnecessary worry and confusion.
The most common legal myths facing patients - and the facts you
need to know….
Myth:
You will lose your health insurance if you change employers while
you have a serious illness.
Fact: The federal Health Insurance Portability and
Accountability Act (HIPPA) allows you to move from one health plan
to another without being excluded due to a preexisting medical condition
such as cancer, heart disease, etc.
Medicare, which covers American age 65 or older (as well as people
of any age who meet Social Security disability requirements), cannot
be revoked because of a serious illness. People have the option
of enrolling in traditional Medicare or a Medicare Advantage plan,
which is basically a medical HMO.
The same applies to people who are covered by Medicaid, the federal-state
program for low-income Americans. For more information, contact
the Centers for Medicare and Medicaid, 800-633-4227, www.cms.gov.
Another little-known Fact: Some employers will request
that a representative from your health insurance provider come to
your workplace to explain coverage. This usually happens if an employer
offers more than one health insurance plan - or as a part of the
open enrollment period when employees can change from one plan to
another. In other cases, your company's human resources department
may provide guidance.
Myth:
If you are unable to work because of a serious illness, you will
lose your job.
Fact: The American with Disabilities Act (ADA) is
a federal law that applies to employers with 15 or more employees.
A person is protected by ADA if he/she has a physical or mental
impairment that substantially limits a major life function. To qualify,
a person must be able to perform the essential functions of the
job - with reasonable accommodation, if necessary (which must be
provided by the employer as long as it does not create undue hardship
for the employer). Examples: Extended periods of leave time, job
restructuring and part-time work schedules.
Important: It is your choice whether to disclose your
medical condition to your employer. If you do not require some type
of accommodation, you are not obligated to disclose your illness.
Some employees are concerned that if they tell their employers they
have cancer, they will be treated differently and will face discrimination.
However, you cannot claim discrimination if your employer was never
told about your medical condition.
Another little-known Fact: The Family and Medical Leave
Act is a federal law that allows an employee to take up to 12 weeks
of unpaid medical leave during any 12-month period without losing
his job or health insurance coverage. It applies to employers with
50 or more employees, and the employee must have worked at the company
for at least one year (and at least 1,250 hours in that year).
This type of leave can be tailored to the needs or your treatment.
Example: You can take all 12 weeks at once…or mornings off
for radiation, or Fridays off for chemo. This leave can be used
for an employee's own serious illness or that of a parent, child
or spouse.
When on leave, people are usually looking for ways to cover their
monthly expenses. Some states have a state disability insurance
program that provides a portion of one's salary, usually for a maximum
of one year.
Another option is payments under short-or long-term disability insurance.
Not every employer offers this type of insurance.
Suggestion: If your employer does not offer disability insurance,
you may want to purchase it privately.
Caution: Once you are diagnosed, it may be difficult to purchase
private disability insurance. Contact an insurance agent who can
explore options that might be available.
Myth:
You will lose your health insurance if you change employers while
you have a serious illness.
Fact: The federal Health Insurance Portability and
Accountability Act (HIPPA) allows you to move from one health plan
to another without being excluded due to a preexisting medical condition
such as cancer, heart disease, etc.
Fact:
Many states have a high-risk pool that covers people who can't qualify
for individual insurance and don't have access to group insurance,
Medicare or Medicaid. These offerings vary from state to state,
and premiums my be high. Also, depending on the state where you
live, there may be other options available.
Another little-known Fact: Some states have additional
protections. The Breast and Cervical Cancer Treatment Program, administered
by the states, pays for the treatment of uninsured women with breast
or cervical cancer if they meet certain requirements. Some states
may have coverage for men with prostate cancer.
The specific details of coverage vary from state to state. Check
with the Department of Insurance in your state about all of the
above.
Myth:
If you are unable to work because of a serious illness, you will
lose your job.
Fact: : The short-term disability insurance offered
by some states can help. Social Security benefits may be available
if you can demonstrate that you are disabled by a physical or mental
impairment that is expected to last 12 months or longer.
Social Security Disability Insurance is based on a person's work
history. Supplemental Security Income is based on a person's assets
and resources. For more information, contact the Social Security
Administration, 800-772-1213, www.ssa.gov.
Important: There is a six-month waiting period before
you are eligible to receive Social Security benefits. Apply for
benefits as soon as it is determined that you are going to be disabled
for at least 12 months.
Another little-known fact: Many people know that it's often
possible to save on health insurance by electing coverage under
a spouse's health insurance plan. However, many people don't know
that HIPPA protection also applies to this situation, so a preexisting
medical condition cannot legally preclude you from starting coverage
under your spouse's employer-provided plan.
Also, some people may be eligible for lower utility and telephone
bills, because their income has decreased.
Editor's
Note: Bottom Line/Health interviewed Barbara Ullman Schwerin,
Esq., adjunct professor of law at Loyola Law School, deputy director
of community programs at the Disability Rights Legal Center and
the founding director of the Cancer Legal Resource Center (CLRC),
all in Los Angeles. The CLRC, 866-843-2572, www.disabilityrightslegalcenter.org,
a joint program of Loyola Law School and the Disability Rights
Legal Center, provides information about relevant laws and resources.
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