Disability Terms and Definitions

PD Presumptive Disability. Only for SSI claims. Enables an early (presumptive) allowance of benefits for 6 months based on a substantial probability of a final allowance when all required documentation is obtained. A PD can be reversed to a denial, but the claimant does not return the PD benefits. Benefit Percentage The benefit payable is usually determined as a percentage of the insured's pre-disability income up to an overall maximum benefit amount. 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. 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. Conversion Privilege If included, this option allows employees who are terminating employment to continue some or all of their LTD coverage at their own expense without submitting evidence of insurability. 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. 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. Optional Supplementation The payments made by States to help persons meet needs not fully covered by Federal SSI benefits. The State determines whether it will make a payment, to whom, and in what amount. Substantial Gainful Activity (SGA) The level of work activity used to establish disability. A finding of disability requires that a person be unable to engage in 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.

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	Did You Know?
	EPSDT stands for Early and Periodic Screening, Diagnosis, and Treatment Program A program mandated by law as part of the Medicaid program. The law requires that all states have in effect a program for eligible children under age 21 to ascretain their physical or mental defects and to provide such health care treatments and other measures to correct or ameliorate defects and chronic conditions discovered. The state programs also have active outreach components to inform eligible persons of the benefits available to them, to provide screening, and if necessary, to assist in obtaining appropriate treatment.