Disability
Resources &
Forms
KAISER PERMANENTE SANTA ROSA
DISABILITY BENEFITS FOR PEOPLE WITH CANCER
Information about Disability Benefits, Medi-Cal, FMLA and Financial Assistance
Programs
Three government Disability Insurance programs have very similar names: SDI, SSDI, and SSI.
State Disability Insurance (SDI) is a state program that gives a cash benefit for one year
or less to Californians who are disabled due to significant illness who worked before becoming
disabled. SDI generally pays 55% of your wages for up to 52 weeks of disability.
Social Security Disability Insurance (SSDI) is a federal program that pays monthly
cash benefits to people with long-term disabilities (due to significant illness) who qualify
because
they used to work or have qualifying family members who worked and paid Social
Security
taxes for a long enough time.
Supplemental Security Income (SSI) is a federal program that gives a monthly cash
payment to people older than 18 but younger than 65, who are disabled and are not able to
work. If you cannot work due to a significant illness, have no other sources of income, and
have
limited resources, you may be eligible for SSI. You do not need to have worked in the
past to get SSI. In California, people who qualify for SSI also get Medi-CAL benefits
automatically.
You may be able to qualify for more than one of these programs at the same time. For
example, you might get SDI at first and later start getting SSDI. If you get SSDI and have low
resources, you may qualify for SSI as well. Make sure you know which benefits you get and
which you might qualify for if you applied.
Private Disability Insurance
Short-Term Disability (STD) is private insurance that replaces some of your income in
an illness prevents you from working. While you are away from work it pays you a certain
percentage of your income for a set period. Some employers provide group STD
policies as part of their benefits packages. An STD policy can be purchased individually.
Long-Term Disability (LTD) insurance is private insurance that helps people who
cannot
work because of a disability. If you have LTD insurance, it will replace some of the
income you lose when you can’t work because of a disability or severe illness. Some people
have LTD insurance from their employers. Others purchase it individually.
KAISER PERMANENTE SANTA ROSA
DISABILITY BENEFITS FOR PEOPLE WITH CANCER
Economic Assistance
Medi-Cal is California’s Medicaid program. This is a public health insurance program
which provides needed health care services for low-income individuals and families, seniors,
and persons with disabilities, including low-income people with specific diseases.
In-Home Supportive Services (IHSS) provides caregiving services to low-income
seniors
and people of any age who are disabled (due to significant illness) who need
assistance to safely remain at home. You must be receiving Medi-CAL or SSI to be eligible for
IHSS.
Long-Term Care Medi-CAL (LTC) is a state program that provides for custodial and
skilled nursing care to low-income individuals and to nursing home residents who have used
up their personal resources.
FMLA/PFL
Family and Medical Leave Act (FMLA) provides certain employees with up to 12
weeks of unpaid, job-protected leave per year. It also requires that their group health
benefits be
maintained during the leave of absence. There are no cash benefits associated
with FMLA.
Paid Family Leave (PFL) provides short-term cash benefits to eligible California workers
who have a full or partial loss of wages due to a need to care for a seriously ill family member.
PFL is a component of the SDI program to provide partial wage replacement benefits.
Financial Assistance
Kaiser Permanente Medical Financial Assistance (MFA) Program offers financial help
for medical services and prescriptions to all Kaiser Permanent patients who qualify.
Additional Financial Resources and community grants are available for patients diagnosed
with and undergoing cancer treatment. Please call the Oncology Social Worker for more
information.
This is a benefit through the State of California that will pay you for up to 52 weeks, or 1
year, of disability while you undergo chemotherapy or other treatment for cancer. You can
take part-time or full-time disability, depending on your oncologist’s authorization.
Note: You cannot file for disability until the first day you stop working.
Step 1: Once you and your oncologist decide which date you will start treatment, including chemotherapy
or surgery, request a doctor’s note, i.e. a “Work Activity Status Form (WASF)” from your oncologist. Either
Katrina Ouellette, Medical Assistant, at 707-393-4774 or Zoe Koehler, Oncology Social Worker at 707-393-
3749 will be able to assist you. The date you start treatment will be the first date of your disability.
*It is your responsibility to keep track of the end date of your WASF and call us to request an extension if
needed (Generally our oncologists write WASFs for 6 months at a time).
Step 2: On the first day of your disability, go to http://www.edd.ca.gov/Disability/
and select SDI Online.
Choose SDI Online Registration and complete the questions. Be sure to authorize Kaiser Permanente to
disclose to EDD and not the other way around.
Step 3: You will need the following information to file a claim:
Date your disability began
Sick, vacation, paid time off, annual or ‘other’ pay
provided by your employer (if applicable)
The very last day you worked your regular or
customary hours (full duty)
Driver’s License number
For California State government employees,
bargaining unit number
Last or current employer name, mailing address and
phone number as found on W2 or paycheck stub
Document the receipt number that displays once your claim is submitted.
Step 4: After filing your claim form, please contact Kaiser Permanente Release of Medical Information:
Provide the following information
By one of the methods below
Your Medical Record Number
Receipt Number (“R”+15 digit number)
OR simply provide us your “Claimant’s Statement” created upon online
submission
Fax: 707-571-3767
Phone: 707-571-3770
In Person:
3558 Round Barn Blvd. #112
Santa Rosa, CA 95403
*In the case you have additional questions, you can contact EDD directly at 800-480-3287 or by
going to their office at 606 Healdsburg Ave. Santa Rosa, CA 95401
Santa Rosa Oncology Department
kp.org/santa rosa
How To Apply For State Disability Insurance (SDI)
Through Employment Development Department (EDD)
Save time — manage your
medical records online
On kp.org, it’s easy to access your health information when you need it.
Many records, forms, and certifications are available online — anytime, anywhere.
Whether you’re at home or on the go, it’s easy to:
• Request and view your medical records
• File a disability claim
• Request Family and Medical Leave Act certification
Get started today at kp.org/requestrecords
1. Type kp.org/requestrecords into your web browser.
2. Select an option that fits your needs:
o A copy of your electronic medical records.
o Request for a state disability physician/practitioner certificate.
o Family and Medical Leave Act (FMLA) certification.
o Immunization Records.
3. Log into your KP.org account.
4. Complete your request.
For Any questions please contact our Release of Medical Information Department
at (707) 571-3770 or [email protected]g
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