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I’m covered by the group plan of my employer. How do I determine what disability is covered and what the benefits are?
If you have health insurance or a health plan through an employer or group, you usually do not have a copy of the insurance contract or plan agreement, but only a handbook, summary, brochure or other type of evidence of coverage. It is the actual insurance policy or plan agreement that controls what the coverage's and benefits are, with one important exception.
Generally, the law provides that the handbook or other evidence of coverage may operate to expand or increase the coverage or benefits available, but may not operate to decrease or limit the benefits and coverage available below that which is provided in the insurance policy or plan agreement. Therefore, if there is any question about whether a benefit or coverage is available, you, as an insured or plan member, should read and compare the language about the particular benefit or coverage in both the policy or plan and in the related evidence of coverage.
In a disability plan, pay close attention to what is covered as a "disability", how much time lapses between the disability and your first benefit check, how much income you will receive if disabled, how long the payments will last, and any integration with other benefits, such as Social Security or state disability payments.
As all plans are not created equal and don’t serve everyone’s needs, it’s a good idea to find out how much group coverage you have and whether it is possible to buy more to dovetail with the company plan. An individual policy will narrow the gaps in your group plan. |
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