The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 18: Legal and Financial Issuesemployer to employer and not all employers have disability coverage for their employees. Even ifa disabled individual is no longer employed, it is important to investigate whether or not she waspart of an employer program. Often, individuals have coverage, leave their job because ofdisability, and never realize that they are entitled to monthly income from a disability insurancepolicy. If an individual has left her employment as a result of disability she may still be coveredunder the group plan if she was qualified for the coverage at the time she was an employee.Coverage will in part depend upon whether or not the policy contains a requirement that anapplication take place within a specified timeframe after the onset of disability.Group programs are disability insurance policies provided through various professional, industry,fraternal, and other affiliation groups. Individual policies are purchased directly by an individual.In most cases, an individual will know if she purchased a group or individual policy as an individualtends to pay her own premiums and receives statements under these plans.5. Life Insurance: Accelerated Benefits and ViaticationWhile life insurance polices are generally designed to provide income support to the survivorsof a deceased life insurance policy holder, they can also provide much-needed income support toa person living with HIV. Many life insurance policies include an accelerated benefits provisionthat allows a terminally ill person with HIV to obtain a portion of the life insurance proceedsthat would normally be reserved for the surviving beneficiaries. The remaining proceeds go tothe surviving beneficiaries upon the terminally ill person’s death. In general, in acceleratedbenefits provisions, the definition of terminally ill is defined strictly as a life expectancy of1 year or less.In addition, private viatical settlement companies are often willing to purchase the life insuranceof a person living with HIV and pay a percentage of the value of the policy. The standard of whatconstitutes terminal illness is more flexible in viatication, but it is important to note that if aperson’s life expectancy is greater than 2 years the proceeds received will be taxable for Federaltax purposes. With viatication, the policyholder sells the policy to the viatical settlement companyand upon the policyholder’s death all of the life insurance proceeds are distributed to the company.An individual considering either an accelerated benefit or viatication should consult with anattorney or benefits expert. The viatical settlement industry, in particular, is largely unregulatedand the transaction requires oversight to ensure that a person living with HIV receives satisfactoryterms of sale.B. HEALTH CARE ACCESS SUPPORT1. MedicareMedicare is government health insurance covering people over 65, the blind, and the disabled.Since it is a Federally administered program, Medicare rules are consistent throughout thecountry.Medicare coverage consists of two parts: Part A (which is free) covers limited hospital care,skilled nursing care, and hospice care; and Part B (which is optional and requires a monthlypremium) covers doctor’s services, outpatient hospital services, and other medical services. Ifan individual elects Part B coverage a monthly premium is deducted from the SSDI payment,although some States have a program for people living with HIV that covers the cost. Presently,neither Part A nor Part B covers outpatient pharmaceutical drugs.370U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau