Health Policy Provisions, Disability Income, and Government Programs
Mandatory uniform provisions
Policies must include: entire contract; time limit on certain defenses (two years); grace period (7 days weekly, 10 days monthly, 31 days otherwise); reinstatement; notice of claim (20 days); claim forms (15 days); proof of loss (90 days); time of payment of claims (immediately, or 45 days); payment of claims; physical exam and autopsy; legal actions (three years); change of beneficiary. Optional provisions cover change of occupation, misstatement of age, other insurance with this insurer, unpaid premium, and cancellation on five days' notice.
Disability income
The center of DI is the definition of disability: "own occupation" is more favorable than "any occupation." Know the elimination period (a time deductible), benefit period, residual or partial benefits, recurrent disability (a relapse within a set window continues the prior claim), and offsets such as Social Security or workers' compensation. Benefits are a percentage of income, commonly 60-70%. Employer-paid premiums make benefits taxable to the employee; employee-paid premiums make them tax free.
Government programs
Social Security disability requires a five-month waiting period after onset. Medicare begins at 65 or after 24 months of SSDI, with Part A hospital, Part B medical, Part C Advantage, and Part D drugs. Medicaid is needs based. Workers' compensation is no-fault and the exclusive remedy for work injuries. COBRA continues group coverage 18 months (29 if disabled, 36 for dependents after death, divorce, or Medicare eligibility).
Rule of thumb: match the trigger to the program - work injury means workers' comp; disability means SSDI; age 65 means Medicare; low income means Medicaid.