..:: Ontario AIDS Network ::..

If you need to take time off of work because of the effects of HIV on your health, you should learn what health insurance you might be entitled to.

You may work for a company that offers extended health insurance as part of your employment package. Health insurance benefits may include hospital room coverage, medication coverage, dental/vision coverage, life insurance, and professional services such as podiatry, massage therapy, or psychotherapy. Another common benefit of health insurance is wage protection, such as short-term and long-term disability income programs.

Short-term disability programs (STD) cover you if you need a brief medical leave from work, usually up to six months. Your employer holds your position for you during this sick period, as you are expecting to return to work.

You will have to complete an application for STD. You should ask your Human Resources or Personnel department to supply you with an application. Your physician will be required to provide basic documentation to your employer, and more detailed medical documentation to the benefits/insurance company. YOU DO NOT HAVE TO REVEAL YOUR HIV STATUS TO YOUR EMPLOYER! Your doctor may have to, when filling in forms for the insurer. That information should remain confidential

The exact short-term disability benefit that you may be entitled to is based upon a contract that was negotiated between your employer and the benefits/insurance company. Most STD programs will cover up to 26 weeks away from work, and pay between 60% and 100% of your wages. Some plans start immediately; others have a waiting period. Some plans make you exhaust your sick days and vacation time before you are eligible. Some plans start after you have exhausted sickness benefits from Employment Insurance (EI), while others will cover you in place of EI benefits or top-up your EI benefit wage to your pre-illness wage.

Since your STD benefit will depend on the contract between your employer and the insurance company, you will need to review employee handbook to learn about the specific details. You can probably acquire documents from your Human Resources or Personnel department staff. Read the documents carefully to find answers to the following questions:

What forms do you have to complete, and when?
What forms will your doctor need to fill in, and how much medical detail is required? Will your doctor charge a fee for this? Who pays?
Is there a waiting period before benefits start?
How long is the benefit paid for, and how much will you be paid?
Are monies from any other source (i.e. CPP-Disability, EI sickness benefits) deducted from your benefits? If so at what percentages?

The insurance company will have a claims adjudicator or liaison employee who can be contacted for information as well. However, use discretion when giving personal information - you need to be in control of both your medical information and any decisions about a potential leave from your employment.

Living with HIV, sometimes you feel like you need time away from work, but your doctor doesn't agree. You should talk to your doctor first, if you are considering taking STD. Be sure that your doctor supports your decision and is comfortable completing the necessary forms. Medical evidence to support your application is vitally important in order to be eligible for STD. If you don't have specific and detailed medical information, your application for STD may be delayed or rejected.

If it takes a while to get your first STD benefit, you may have to apply for Employment Insurance sickness benefits. It usually takes within four weeks of applying to get your first cheque. It will pay 55% of your insurable earnings, to a maximum of $413 per week. In order to qualify, you must have worked 600 hours in the last 52 weeks or since your last claim. You can call Employment Insurance at your local HRDC office, or see our chapter on Employment Insurance Sickness Benefits.

If you've been away from work more than a few months and/or are expected to be away for more than a few months, you may be entitled to Long-Term Disability benefits. Long-term Disability Programs (LTD) cover employees who have a severe illness or disability that prevents them from doing either their previous occupation or any other occupation. The definition of disability used by LTD programs tends to be similar to the Canada Pension Plan's definition.

To be eligible, you have to submit an extensive application to the insurance company managing the benefit. Your doctor will also have to submit a detailed medical report.

Similar to short-term disability, your LTD benefit is based upon a contract between your employer and insurance company:

Most LTD start between 6 months and 12 months after leaving work due to ill health.
They typically pay between 50% and 90% of your pre-disability wage.
LTD usually requires you to use up any pre-LTD sources of income, such as short-term disability or EI sickness benefits, before you can qualify.
LTD benefits are taxable income. If while you were working you paid a tax premium for an LTD benefit, your LTD will be a tax-free income.
Your LTD provider will want you to apply to any other source of income you're eligible for (i.e. CPP-Disability, Workers Compensation Pension, etc.). Amounts received from these other sources are then deducted dollar for dollar from your total LTD benefit.
Your LTD plan will want to evaluate your work potential based on your own occupation/any occupation criteria. In your first 2 years on LTD, you will be evaluated based on your ability to do your own job (prior to your illness and leaving work). After that you will be evaluated against your ability to do any occupation for which you are reasonably suited by training, education and experience.

When you are on LTD, you are still an employee of the company. You may be eligible for some of it's other extended health benefits. Some plans may require you to pay some or all of the premium costs for the extended health benefit or life insurance in order to keep this coverage.

Since LTD is a unique contract between your employer and their insurance company, you should carefully read your employee handbook, or speak to a staff person in your Personnel department to learn:

How long do you have to be off work before the benefit starts, and when you should apply?
How much money will you be entitled to?
Are you required to apply for CPP, WCB, or any other income sources? If so, is this income deducted from your LTD?
What is their definition of 'disability'? (Note key phrases like "total", or "permanent", or "previous occupation or any occupation", etc.)
Will you be interviewed and assessed by rehabilitation staff, to evaluate your potential to return to your previous job or another job appropriate to your skills and abilities?

If your LTD does not include drug coverage, you should find an insurer who does. Many people use the Trillium Drug Program, the provincial drug insurance program. To qualify, you have to be a resident of Ontario and have an Ontario Health card. You can pick up a Trillium application at most pharmacies, or visit our chapter on Trillium.

You need to be in control of who knows your private medical information and your consideration to leave employment. Use discretion in giving personal information to your employer or insurance company. YOU DO NOT HAVE TO TELL YOUR EMPLOYER YOUR HIV STATUS, though your doctor may have to inform the insurance company if it's relevant.

Some people, usually the self -employed, contract, or seasonal workers, purchase their own private STD and LTD through insurance companies, alumni associations, business groups or with an investment company. Most of the points mentioned above in the employer-based STD/LTD plans apply to private plans, except that rather than your employer negotiating the contract, either you did it yourself or the association negotiated it on behalf of everyone.

As with the employer-based STD/LTD, review your documents and policy to familiarize yourself with your benefits. Consider contacting the claims adjudicator or insurance provider should you have questions; but again, exercise discretion in disclosing your medical situation without supporting documentation from your physician.

Q: What is a short-term disability?
Often considered to be a disability which prevents you from doing your job; usually lasting not longer than six months.

Q: Does being HIV+ entitle me to short-term disability benefits?
Only if HIV is affecting your health (opportunistic infections, side effects from HIV medications, etc.) in a way that affects your ability to work. Also, some people with HIV have emotional or mental health problems in response to their diagnosis that might affect their ability to work.

Q: Will I have to tell my boss about my HIV status? My company?
No. Your doctor may tell your insurance provider if it's relevant, and that information is confidential.

Q: Can I get STD at the same time as EI benefits?
Maybe. Some STD insurers will provide you with money in addition to EI; some will only start after your EI has run out.

Q: What is a long-term disability?
A significant period of disability which prevents you from doing your job; generally ranging from six months to life.

Q: Am I still an employee if I am on LTD?
Usually, you are still considered an employee while on LTD.

For drug coverage, visit our chapter on the Trillium Drug Program. Should you have further questions about the Trillium Drug Program, you can reach them at 1-800-575-5386 or in Toronto at 326-1558. Information is available through the Internet at www.gov.on.ca

For Employment Insurance sickness benefits, see our chapter on Employment Insurance, or visit www.hrdc.ca and look under Employment Insurance.

For up-to-date information about HIV, disability and the law in Ontario, try contacting the HIV and AIDS Legal Clinic (Ontario), HALCO. HALCO is a not-for-profit, community-based legal clinic serving low income People with HIV and AIDS (PHA's) in Ontario.

We hope this information provided by the Ontario AIDS Network answers all your questions. If the section does not answer all your questions, and you have HIV/AIDS or are an individual or organization supporting someone living with HIV/AIDS, let our Benefits Expert answer your question. All responses are confidential. Click HERE to send your question.