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Insurance, Finance, Employment, and Maximizing Benefits

Understanding and Maximizing Your Benefits

If you as a family caregiver, or the patient you are caring for, are employed by an organization that offers benefits, below is a list of common benefit definitions and questions to ask your human resources professional. As all plans and circumstances are different, it is important to collaborate with your human resources team to understand what is available and applicable to your and/or the patient’s situation.

The US Department of Labor (DOL) is also helpful in providing information about your rights in regard to benefits-related topics such as filing health claims, HIPAA, COBRA laws, life changes, and tips for making your benefits work for you. Click to view the DOL resources available to you.

Types of Benefits to Inquire About

Short-term disability insurance pays a portion of an employee’s salary for a specified time due to illness or a non-work-related accident.

Long-term disability insurance usually begins after the short-term disability coverage period ends. It covers a portion of salary and can continue up to age 65 or the maximum benefit period specified by the policy. The insurance company will transition an employee from short-term to long-term disability if applicable.

Family Medical Leave Act (FMLA) is a United States federal law that entitles qualified employees to job-protected unpaid leave from work for up to 12 weeks (consecutive or nonconsecutive) in any 12-month period for the following reasons:

  • The care of a child after birth or adoption or placement of a child
  • The serious health condition of the employee
  • The serious health condition of a child, spouse, domestic partner, or parent

FMLA also requires that the employee’s group health benefits be maintained during the leave.

Both the employer and the employee must be eligible for FMLA protection. If eligible, the employee must apply for FMLA coverage and certify eligibility. Visit the Department of Labor's website for complete information on the FMLA.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost.

Employee Assistance Programs (EAPs), which are typically designed to help employees lead happier and more productive lives at home and at work, are offered by some employers. Depending on your plan, most initial service fees are usually partially or fully covered by your employer and services are typically 100% confidential. Please check with your employer on the fees and confidentiality of your specific plan.

In many EAPs, a professional counselor will answer your call, listen to your issue or concern, and (1) help define the problem clearly, (2) assess the type of help needed, and (3) either provide the recommended help or make the most appropriate, cost-effective referral for you.

Examples of reasons to call:

  • Stress, depression, anxiety
  • Marital relationship problems
  • Family and parenting issues
  • Anger, grief, and loss
  • Drug and alcohol abuse
  • Childcare and eldercare services
  • Identity theft
  • Financial issues and legal concerns
  • Time management

Benefits-Related Questions to Ask Your Human Resources Professional

  • Who will be my primary contact in HR for questions during this time?
  • Will I be sent reminders before important deadlines that may affect my benefits coverage?
  • Can I be assigned a direct contact at the health insurance agency to help me through claims, billing, and statement questions?
    • How do I file health insurance claims?
    • How can I appeal health insurance claims?
  • What is the company’s disability benefits program?
    • Are there pre-existing condition limitations to the benefits program?
    • Is a state disability plan offered (programs can vary by state)?
      • If yes, must it be used in place of the company disability plans or can it be supplemental?
    • Under what time frames and conditions does the program start to pay out?
    • What percentage of salary is paid out for my circumstances and for how long?
    • What is the timing and method of payment (every two weeks via direct deposit, monthly checks)?
      • If via check, ensure that the address information on file is up to date.
  • Under the disability plan, what do I need to consider regarding:
    • Filing a claim
      • When should the claim be filed?
      • Who should the claim be filed with?
      • When and how should I except to receive confirmation?
    • Returning to work full time?
    • Returning to work part time?
    • Is there a return to work incentive?
    • What happens to incentive and bonus payments when out on disability leave?
  • For FMLA benefits, can my remaining sick time or paid time off be used in conjunction with the FMLA?
  • For long-term disability benefits, what happens to my other company benefits, and am I still considered an employee during this time?
  • How does the transition between short-term and long-term disability work, and under what circumstances does the transition take place?