Disability

Under the ADA and Rehabilitation Act, a disability is a physical or mental imparement that substantially limits one or more major life activities. Cancer may or may not be a disability depending on how substantially impaired the person is from the cancer; the effects of the treatments and medicines are also to be considered. For Social Security disability, you must have a medical condition that renders you unable to work and is expected to last 12 months or result in death. In many cases, cancer treatments do not render you unable to work or are expected to last for 12 months.

Discrimination

Under the ADA or the Rehabilitation Act, employers cannot discriminate, which means that they can not treat people with disabilities differently from the way they treat other employees as long as they can perform the essential functions of the job.

Excluded Service

This is a medical treatment or service, specifically listed in your health plan that is not covered. Be careful: most plans list at least 20 services they do not cover, including many that cancer patients often need, such as:

►    Treatments for a condition that you had before you were insured (called a “pre-existing condition’);
►    Treatments not approved by the FDA or accepted in the medical community (called ‘investigative” or “experimental treatments”);
►    Procedures for non-medical reasons (called ‘cosmetic procedures”);
►    Services given for convenience or as convalescent care (called “not medically necessary”).

Family Member

For purposes of FMLA leave, this term is narrowly defined to include only a spouse, parent, or child.

FMLA Medical Certification

A physician issues this document. It contains:

►    The date when the condition began;
►    The important medical facts about the condition;
►    An estimate of how long the condition will last; and
►    A statement that:
You are unable to work, or
You have to miss work to receive treatment or to recover or
You are needed to care for a family member

 

Health Plan

This is an agreement whereby an organization agrees to pay for medical services on behalf of an individual. There are three types of health plans: federal (Medicare), state (Medicaid), and private.

 

Medically Necessary Service

This is a treatment covered by your health plan. But beware: just because your doctor prescribes a treatment, it does not mean that your plan will pay for it. It is the administrator of your health plan – not your doctor – who decides what treatments will be paid. In general, health plans define a medically necessary service as:

►    Required to treat your illness or injury;
►    Consistent with the treatment for your medical condition;
►    Generally accepted in the medical community; or
►    Not for your convenience,

 

Pre -Existing Condition

Generally speaking, any condition for which a person is currently receiving treatment, has been advised to receive treatment, or for which a prudent person would seek treatment is a pre-existing condition. In other words, if a person is undergoing treatment for a condition, whether or not an insurance company is paying for the treatment, the person has a pre existing condition.

 

Qualifying Event

As this term is used under COBRA, it means an event which results in the loss of eligibility to participate under the employer’s health plan. The events include voluntary or involuntary termination for any reason other than gross misconduct, reduction in the number of hours of work, the failure to return to work following medical leave, divorce or legal separation, death of the covered employee, covered employee’s eligibility for Medicare, or aging out of coverage under parent’s health plan.