SOCIAL SECURITY BENEFITS FOR HIV INFECTED
PERSONS
What Benefits Are You Eligible For?
Disability benefits are provided under two programs:
Social Security Disability Insurance, sometimes
referred to as SSDI, and Supplemental Security Income,
often called SSI. The medical requirements are the same for both
programs, and your disability is determined by the same process.
For more information, check out the Social Security Administration's Publication No. 05-10020,
May 1997, Guide to Social Security and SSI Disability Benefits for
People with HIV Infection.
How do people qualify for Social Security Disablity Insurance?
Most people qualify for Social Security disability by working, paying Social Security taxes, and in turn, earning "credits" toward eventual benefits. The maximum number of credits you can earn each year is four. The number of credits you need to qualify for disability depends on your age when you become disabled. Nobody needs more then 40 credits and younger people can qualify with as few as six credits.
Disabled children age 18 or older could be eligible
for dependent's benefits on the Social Security record of a parent
who is getting retirement or disability benefits or on the record
of a parent who has died. The disability must have started before
age 22
Children under the age of 18 qualify for dependents
benefits on the record of a parent who is getting retirement or
disability benefits or on the record of a parent who has died,
merely because they are under age 18.
How much will your Social Security benefit be?
This will depend on your earnings history. Generally, higher earnings translate into higher Social Security benefits. You can find out how much you will get by contacting Social Security and asking for an estimate of your benefits. Social Security will give you a form you can use to send for a free statement that contains a record of your earnings and an estimate of your benefits.
In addition to checking your benefit, Social Security
encourages you to use this statement to verify that your earnings
have been properly recorded in their files. It's important that
you do this because any missing or unreported wages could lower
your Social Security benefit or even prevent you from qualifying
for disability benefits. If you find a problem, contact
your local Social Security office right away, show them proof
of your actual wages, and the record will be corrected.
This can be particularly important
for people who have tested positive for HIV but have not developed
symptoms, so that any potential benefits will not be delayed by
wage correction efforts.
What is Supplemental Security Income?
SSI is a program that pays monthly benefits to people
with low incomes and limited assets who are 65 or older, or blind
or disabled.
What does Supplemental Security Income Do?
As its name implies, Supplemental Security Income
supplements a person's income up to a certain level that can go
up every year based on cost-of-living adjustments. The level
varies from one state to another, so check with your local Social Security office
to find out more about SSI benefit levels in your state.
Is all your income counted to determine if you qualify for SSI?
Social Security doesn't count all the income you
have when they figure out if you qualify for SSI. And if you work,
there are special rules we use for counting your wages. Again,check with Social Security to find out if you can get SSI.
What other factors are considered in making a determination
as to SSI coverage?
In addition to rules about income, people on SSI
must have limited assets. Generally, individuals with assets under
$2,000, or couples with assets under $3,000, can qualify for SSI.
However, when Social Security figures your assets, they don't
count such items as your home, your car (unless it's an expensive
one) and most of your personal belongings.
Your Social Security office can tell you more
about the income and asset limits. For more general information,
ask for a copy of the booklet SSI (Publication No. 05-11000).
How Does Social Security Define Disability?
Disability under Social Security is based on your
inability to work because of a medical condition. You will be
considered disabled if you are unable to do any kind of "substantial"
work for which you are suited. (Usually, monthly earnings of $500 or more
are considered substantial.) Your inability to work must be expected
to last at least a year. Or, the condition that keeps you from
working must be so severe that you are not expected to live.
How This Definition Of Disability Applies To People With HIV
Infection?
A person with symptomatic HIV infection is often
severely limited in his or her ability to work. In other words,
if the evidence shows that you have symptomatic HIV infection
that severely limits your ability to work, and if you meet the other eligibility factors,
the chances are very good that you will be able to receive Social
Security or SSI benefits.
On the other hand, some people with HIV infection
may be less impaired and able to work, so they may not be eligible
for disability.
How Does Social Security Evaluate Your Disability?
Social Security works with an agency in each state,
usually called a Disability Determination Service (DDS), to evaluate
disability claims. At the DDS, a disability evaluation specialist
and a doctor follow a step-by-step process that applies to all disability
claims, thus assuring a consistent national approach to evaluating
disability.
First, the DDS specialists decide whether your impairment
is "severe." This simply means the evidence must show
that your disability interferes with your ability to work.
The next step in the process is deciding whether
the disability is included in a list of impairments. This list
describes, for each of the major body systems, impairments that
are considered severe enough to prevent an adult from doing any substantial work.
Social Security recently published a list of impairments
for HIV infections. In this list, they included many conditions
associated with symptomatic HIV infection, including some that
specifically apply to women and children with HIV infection.
Some of the HIV-related conditions included in the
HIV list of impairments are shown below. The level of severity
that an impairment must meet to be found disabling are also specified
in the regulations.
Pulmonary tuberculosis resistant to treatment Kaposi's
sarcoma Pneumocystis carinii pneumonia (PCP) Carcinoma of the
cervix Herpes Simplex Hodgkin's disease and all lymphomas HIV
Wasting Syndrome Syphilis and Neurosyphilis Candidiasis Histoplasmosis
Remember: these are just a few examples. You
can see a complete list of HIV-related impairments at any Social
Security office. The complete list will also include the findings
necessary for listed impairments to be considered disabling by
Social Security.
How are women with HIV Infection evaluated?
Statistics show that there is an increasing number
of women with HIV diseases. Social Security's guidelines for the
immune system recognize that HIV infection can show up differently
in women than in men. In addition to following the criteria outlined
in the previous section, DDS disability evaluators consider specific
criteria for diseases common -in women. These include: vulvovaginal
candidiasis (yeast infection); genital herpes; pelvic inflammatory
disease (PID); invasive cervical cancer; genital ulcerative disease;
and condyloma (genital warts caused by the human papillomavirus).
Again, the level of severity necessary for these impairments to
be considered disabling is included in the list of impairments.
How Do You File For Disability Benefits?
You apply for Social Security and SSI disability
benefits by calling or visiting any Social Security office. All
Social Security files are kept strictly confidential. It would
help if you have certain documents with you when you apply. But don't delay filing because
you don't have all the information you need. Social Security will
help you get the rest of it after you sign up.
The information you'll need may include: your Social
Security number and birth certificate; the Social Security numbers
and birth certificates for family members signing up on your record;
and a copy of your most recent W-2 form (or your tax return if
you're self-employed).
If you're signing up for SSI, you will need to provide
records that show that your income and assets are below the SSI
limits. This might include such things as bank statements, rent
receipts, car registration, etc. You'll also need to give them
information about how your condition affects your daily activities,
the names and addresses of your doctors and clinics where you've
received treatment and a summary of the kind of work you've done
in the last 15 years. If you have medical evidence such as reports
of blood tests, laboratory work or a physical, it would be helpful
if you brought them with you.
What Steps Has Social Security Taken To Ensure Prompt Processing
And Payment Of Disability Benefits related to HIV claims?
All HIV infection claims are given prompt attention
and priority handling. For many people applying for SSI with a
medical diagnosis of symptomatic HIV infection, the law allows
Social Security to presume they are disabled. This permits them
to pay up to six months of benefits pending a final decision on
the claim. You will qualify for this immediate payment if: a
medical source confirms that the HIV infection is severe enough
to meet SSA's criteria; you meet the other SSI nonmedical eligibility
requirements; and you are not doing "substantial" work.
If you have symptomatic HIV infection but the local
Social Security office cannot provide immediate payment, a disability
evaluation specialist at the DDS may still make a "presumptive"
disability decision at any point in the process where the evidence suggests
a high likelihood that your claim will be approved. (If they later
decide you are not disabled, you will not have to pay back the
money you received.)
Special arrangements have been made with a number
of AIDS service organizations, advocacy groups and medical facilities
to help Social Security get the evidence they need to streamline
the claims process. Many DDS's have Medical/Professional Relations
Officers who work directly with these organizations to make this
process work smoothly.
What You Can Do To Expedite The Processing Of Your Claim?
You can play an active and important role in ensuring
that your claim is processed accurately and quickly. The best
advice is to keep thorough records that document the symptoms
of your illness and how it affects your daily activities, and then to provide
all of this information to Social Security when you file your
claim.
What happens if you return to work?
If you return to work, Social Security has a number
of special rules, called "work incentives," that provide
cash benefits and continued Medicare or Medicaid coverage while
you work. They are particularly important to people with HIV disease who, because
of the recurrent nature of HIV-related illnesses, may be able
to return to work following periods of disability.
Work incentives are explained in detail in the publication Working While Disabled...How We Can Help (Publication
No. 05-10095). For a free copy, just call or visit your nearest Social Security office.
What Do you need to know about Medicaid and Medicare?
Medicaid and Medicare are our country's two major
government-run health insurance programs. Generally, people on
SSI and other people with low incomes qualify for Medicaid, while
Medicare coverage is earned by working in jobs covered by Social
Security, for a railroad or for the federal government. Many people
qualify for both Medicare and Medicaid.
For more information about Medicaid, contact
your local Medicaid agency.
For more information about Medicare, call or
visit your local Social Security office to ask for the booklet
Medicare (Publication No. 05-10043).
When a Social Security beneficiary dies, does the funeral home
notify Social Security or is notification up to the family?
Many funeral directors voluntarily provide death
information directly to Social Security. But, family members of
a deceased individual still have the legal responsibility to notify
Social Security.
For More Information...
You can get recorded information about Social Security
coverage 24 hours a day, including weekends and holidays, by calling
Social Security's toll-free number, 1-800-772-1213. You can speak
to a service representative between the hours of 7 a.m. and 7
p.m. on business days. Their lines are busiest early in the week
and early in the month so, if your business can wait, it's best
to call at other times. Whenever you call, have your Social Security number handy.
People who are deaf or hard of hearing may call their
toll-free "TTY" number, 1-800-325-0778, between 7 a.m.
and 7 p.m. on business days.
Social Security information also is available to
users of the Internet. Type http://www.ssa.gov to access Social
Security information.
The Social Security Administration treats all calls
confidentially- whether they're made to our toll-free numbers
or to one of our local offices.
THRIFT SAVINGS PLAN
Does my participation in the TSP affect my IRA?
Participation in the TSP does not affect your ability
to contribute to an IRA. Because you are a Federal employee covered
by a Government retirement plan, your ability to make tax-deductible
contributions to an IRA depends upon your income and that of your
spouse. When you separate, you can transfer your TSP account into
your IRA or roll it over without regard to the annual limits that
the IRS imposes on IRAs. However, you cannot roll your IRA or
a payment from another retirement plan into the TSP. For more
information, ask your personnel office for the Fact Sheet "The
Thrift Savings Plan and IRAs."
How do other legal requirements affect my TSP account?
Your TSP account is not subject to bankruptcy proceedings
and cannot be garnished for payment of debts.
HOW CAN THE GLBT FEDERAL EMPLOYEE PROTECT
THEIR DOMESTIC PARTNER OR SIGNIFICANT OTHER?
Life Insurance
You can designate your partner or significant
other as your beneficiary under the Federal
Employee Life Insurance Program. You can do this by completing
Designation of Beneficiary Form, Standard Form 2823. These forms
should be checked periodically in order to ensure that they reflect
your desires. A CHANGE OF BENEFICIARY MAY BE MADE AT ANY TIME
WITHOUT THE KNOWLEDGE OR CONSENT OF THE PREVIOUS BENEFICIARY.
NOTE:
Unpaid Compensation
You may designate your partner or significant other
as your Beneficiary for any Unpaid Compensation. To do so, you
must complete Standard Form 1152, which can be obtained from your
personnel office. This designation will remain valid until expressly
changed or revoked, until the employee transfers to another agency,
or until reemployed by the same or another department or agency
of the Government. In case of separation and reemployment,
or transfer to another agency, a new Designation of Beneficiary
should be executed.
Thrift Savings Plan
You can designate your partner or significant other as your beneficiary under the Thrift
Savings Plan. You can do this by completing Designation of Beneficiary
Form, TSP-3. These forms should be checked periodically in order to ensure that they reflect your desires. A CHANGE OF BENEFICIARY
MAY BE MADE AT ANY TIME.
NOTE:
A will is not valid for the disposition of a TSP account.
Retirement Funds
You may designate your partner or significant other
as your Beneficiary for your contributions to the Civil Service
Retirement System (CSRS), by completing Standard Form No. 2808 or
to the Federal Employees Retirement System (FERS) by completing Standard Form 3102.
This lump sum benefit does NOT affect the right of any person who qualifies to receive survivor annuity benefits retirement.
To do so, you must complete Standard Form 1152, which can be
obtained from your personnel office.
Note: By law, no change or cancellation of beneficiary
in a last will or testament, or in any other document not witnessed
and filed as required by CSRS regulations will have no force or
effect on this designation.
Always consult your agency human resources/personnel
office or, if you are retired, your retirement system before taking
action.
A change or cancellation of beneficiary in a last
will or testament, or in any other document not witnessed and
filed as required by the Federal Employee Group Life Insurance
Progam shall not have any force or effect on this designation.
A witness to a Designation of Beneficiary is NOT
eligible to receive payment as a beneficiary.
Always consult your agency human resources/personnel
office or, if you are retired, your retirement system before taking
action.
Completion of TSP-3 does NOT effect your FERS Basic Annuity, your CSRS annuity, or any other benefits.