Disability Terms and Definitions

Own Occupation (Own Occ) Under this definition, an insured will be considered disabled only if he or she is unable to perform the duties of his or her occupation. ADA Americans with Disabilities Act The ADA prohibits discrimination on the basis of disability in employment, State and local government, public accommodations, commercial facilities, transportation, and telecommunications. It also applies to the United States Congress. Maximum Benefit Period (Benefit Duration) This is the maximum length of time for which benefits are payable under the plan as long as the employee remains continuously disabled. Unincurred Business Expenses Self-employment business support given to you by someone else without cost. If you are self-employed, we deduct unincurred business expenses from earnings when we determine SGA. Plan for Achieving Self-Support (PASS) Under an approved PASS, recipients of federal SSI may set aside income and/or resources over a period of time to reach a goal to become financially self supporting. The income and resources set aside may later be used to obtain occupational training or education, purchase occupational equipment, establish a business, etc. Family and Medical Leave Act The Family and Medical Leave Act of 1993 To grant family and temporary medical leave under certain circumstances Continuation of Medicare Coverage (SSDI) You can receive at least 93 consecutive months of hospital and medical insurance after the trial work period. This provision allows health insurance to continue when you go to work and are engaging in SGA. Outcome Payment System The system providing a payments under the Ticket to Work program to an employment network for each month, up to a total of 60 months, during which Social Security disability benefits and Federal SSI cash benefits are not payable to a beneficiary because of the performance of substantial gainful activity (SGA) or by reason of earnings from work. Ticket to Work program The Ticket to Work program provides disabled beneficiaries with expanded options for access to employment services, vocational rehabilitation services, or other support services. DHO Disability Hearing Officer. Conducts in person hearings. Next appeal is to a federal Administrative Law Judge (ALJ).

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	Did You Know?
	Ambulatory Care is all types of health services which are provided on an outpatient basis All types of health services which are provided on an outpatient basis, in contrast to services provided in the home or to persons who are inpatients. While many inpatients may be ambulatory, the term ambulatory care usually implies that the patient must travel to a location to receive services which do not require an overnight stay.