KCTCS2009 Employee Open EnrollmentOctober 13th 24th, 2008
Health Insurance HighlightsMandatory Enrollment No ExceptionsIDS and Passwords were mailed to employees at their home addressThe New Benefits Selections Guides will be provided to employeesThe larger KEHP Handbook is available on the DEI web-site http://www.personnel.ky.gov/dei/09OE/Benefits Selection Guides will include a paper application for active employees
New for 2009Mandatory, Active EnrollmentWeb Enrollment or paper applicationDefault to waiver with no HRA money if employees do not enrollPremium Holiday December 2008No health insurance premiums deducted for DecemberPre-Pay to current pay effective January 1, 2009Virgin HealthMilesInternet based activity programEarn cash and gift cards by earning HealthMilesWill not be implemented until after January 1st for KCTCS. A separate roll-out will occur
New for 2009Carena In-home Urgent CareCarenas modern-day, physician house-call serviceGreater Louisville area & Franklin CountyOption for non-emergency conditionsCall HumanFirst Nurse Advice Line24 hour toll free number (800) 622-9529
New for 2009Coverage for Dependents to Age 25Smoking Status change outside Open Enrollment may be requested with proper documentation. Change will be limited to the smoker contributions and will not allow other changes to plan.Single plans pay 1 times the smoker amount. Parent Plus plans by 2 times the smoker amount. Family and family cross-reference will pay 2 times the smoker amount (1/2 from each employee on x-ref).Qualifying events that require an employee to sign and date their form or application within 30 days of the event will now change to 35 days beginning January 1, 2009.
New for 2009A family cross-reference plan will automatically drop to a parent plus if one spouse terms employment. The termed spouse may be added back on as a qualifying event if add form is signed and dated within 35 days of the qualifying event.
New for 2009Due to the change to Current Deductions:Terminations of plans will end on the 15th of the month if an employee loses employment between the 1st and the 15th of the month.Terminations of plans will end on the last day of the month if the employee loses employment between the 16th and the last day of the month.Returning from LWOP will follow the same rule as above in that the reinstatement will occur either on the 16th or 1st day of the following month depending on the employees return date.
Web EnrollmentYour KEHP Online Access will be available for fast accurate and secure enrollment at http://kehp.ky.gov beginning October 13, 2008.Employees will need their ID and Password to enroll on the web.
Web EnrollmentOnce you complete the enrollment process online, you will see a confirmation number screen. This page will need to be printed out and kept as proof of your enrollment.A copy of this confirmation MUST be submitted to your college HR DepartmentIf an e-mail address is entered during the enrollment process, you will receive a confirmation message.
Web EnrollmentFor assistance with employee ID# and Password contact (866)302-5632 or (502)564-3116For computer or technical assistance contact (866)746-1613 or (502)564-4708For information about current benefits for 2009 Open Enrollment benefits (877)597-7474For other information relating to Open Enrollment contact (888)581-8834 or (502)564-6534Hours for Open Enrollment Assistance 10/13/2008 10/24/2008Monday through Friday 8:00 am 8:00 pmSaturday and Sunday 8:00 am 12:00 pm
Enrollment Paper ApplicationsA paper application will need to be completed on the following scenarios:A retireePaying by cross-reference with a retireeA new employee who has not yet enrolled for 2008Switching the primary plan holder on a cross-reference payment optionCurrent cross-reference payment option that two spouses want to stopAll these applications will need to be submitted to college HR Departments or System Office employee benefits for processing
Dependent AuditKEHP will be conducting a dependent audit during the 2009 plan year.Purposes of audit is to verify that each dependent listed on plans is actually eligible for coverage.Each employee should review the dependent eligibility section for the 2009 Plan Year KEHP Handbook to determine if their dependents are eligible.If dependents do not meet the eligibility guidelines, employees should remove the ineligible dependents during Open Enrollment.
Dependent EligibilityUnder a new option for 2009, employees will be able to cover their unmarried dependent children up to the end of the month in which the dependent turns 25.Choosing this new option for unmarried dependent child(ren) may subject the employee contributions to a different tax treatment
Dependent EligibilityDependent Child EligibilityUnmarriedFamily-type relationship to the plan holderChild plan holderStepchildAdopted/placed childFoster childGrandchild
Plan holder is primarily responsible for dependents maintenance and supportUnder age 25Any person who knowingly with intent to defraud any insurance company by filing an insurance application containing false information or conceals for the purpose of misleading information would be committing fraud which is a crime. This includes adding a dependent to the plan that does not meet the KEHP eligibility guidelines.
Dependent EligibilityAn employee will not be able to pay dependent premiums on a pre-tax basis if the employees /plan holders dependent(s) CANNOT MEET ONE of these definitions:
Qualifying ChildQualifying Relative
Dependent EligibilityQualifying Child is a child who is unmarried and:Family-type relationship to the plan holderLives with the plan holder in his/her household for more than half of the tax year (exceptions such a temporary absences if a full-time student)Under age 19 and not a full-time student (or under age 24 if a full-time student) as of the end of the calendar year in which the members taxable year begins. A student means an individual who, during each of the five (5) calendar months during the calendar year in which the employees taxable year begins, is a full-time student at an educational organization.
Dependent EligibilityQualifying Child (continued)There is no age requirement if a child is permanently and totally disabledIndividual must not provide more than half of his or her own support for calendar year in which the taxable year of the employee begins.
Dependent EligibilityQualifying Relative is a child or other individual who:Family-type relationship to the member taxpayer (a child of the employeeetc.) and is someone who resides with the employee in his/her household for the members taxable yearA person cannot be a qualifying relative of the member if at any time during the taxable year the relationship between the member and the person violates federal, state or local lawReceives over half of his/her support from the member taxpayer. (Support includes food, shelter, clothing, medical and dental care education and the like.)Is not anyones (including the members) qualifying child
Dependent EligibilityAll dependents on the plan age 19-23 to be considered a qualifying child MUST be a full-time student. If they are not, they MUST meet the qualifying relative definitionEmployees who choose to add a dependent on their plan year who will turn 24 or 25 during the 2009 plan year will pay their total premiums post tax unless they can show proof that they are eligible for pre-tax.
Dependent EligibilityTax ConsequencesPaying dependent premiums on a pre-tax basis for an individual who does not meet the definition of qualifying child or qualifying relative may be in violation of federal tax lawHowever, if a dependent child fails to meet the requirements of qualifying child or qualifying relative he or she may be eligible to be covered as a dependent on a post-tax basis pursuant to KEPH plan eligibility defined in KRS 304.17A-256. If you are electing to cover a dependent on a post-tax basis then you must acknowledge the post-tax status.
2009 Health Plan ChoicesCommonwealth Optimum PPOCommonwealth Maximum Choice*Commonwealth Capitol Choice*Commonwealth Standard PPO*
*Three of the Four plan choices have no employee contribution for single coverage!
Health PlansCommonwealth Optimum PPOResult of combining Enhanced and Premier85%-15% co-insurance in-network 70%-30% out-of-networkSingle deductible $250, Family $500Single Out-of-pocket maximum $1125, Family $2250$10 co-pay for office visitsPrescriptions $5.00, $20.00 & $40.00
Prescription DrugsFor the Commonwealth Optimum PPO and the Commonwealth Capitol Choice Plans the Prescription copays are different in 2009:200820091st Tier$5$52nd Tier$15$203rd Tier$30$40
Health PlansCommonwealth Maximum ChoiceReplaces the Commonwealth Select PlanEmployees with the 2008 Select Plan who pick the Commonwealth Maximum Choice for 2009 will roll over any unused 2008 HRA funds into the HRA attached to the Commonwealth Maximum Choice PlanRetirees are NOT eligible to take the Commonwealth Maximum Choice
Commonwealth Maximum Choice HRAThe KEHP funds the Health Reimbursement Account (HRA) based on level of coverage (these funds are available first day of the plan year):Single$1,000Couple$1,500Parent Plus $1,500Family$2,000
When these funds are used to pay for medical and prescription services they reduce the deductible. You are responsible for all costs between the HRA funding, and the total deductible. Example: Single coverage has a $2000 deductible, HRA funds are $1000. The $1000 difference between the two, is members responsibility. Once the deductible has been met the plan pays 90%, member coinsurance is 10%. Because this plan has no co-pays, once the out of pocket maximum has been reached services are paid at 100%
Example: How the HRA Plan WorksKelly has the Commonwealth Maximum Choice PPO Plan with a $1000 Health Reimbursement Account (HRA), Kellys deductible is $2000:She has minor surgery at an in-network facilityHumana calculates the provider discount and then Kellys doctor sends her a bill for $375Kelly writes her HumanaAcccess card number on the bill and sends it back to her doctorThe $375 she paid with her HRA also applies to her deductibleKellys doctor prescribes a prescription drug that costs $125:Kelly swipes her HumanaAccess card to cover the prescription cost at the pharmacy, paid out of her HRA funds.The prescription cost also reduces Kellys deductibleKellys out-of-pocket costs total is $0 (she used her HRA funds to pay for her services)Kelly still has $500 left in her HRAKelly has now met $500 of her $2000 deductible
HRA/FSA Integration: Commonwealth Maximum Choice PlanA Health Care Flexible Spending Account (FSA) may be used to fund member responsibility expenses on a tax free basisPremium savings from selection of the Commonwealth Maximum Choice plan versus other selections may fund or assist in funding a FSA
Health PlansCommonwealth Capitol ChoiceBrand New Plan$500 per family member benefit allowance that provides 100% coverage (subject to co-pays) for many in-network services before you start paying towards the deductibleBenefit Allowance is use it or lose it Does not roll Co-pays on office visits and prescriptionsAfter payment of $100 per admission co-pay and $500 annual deductible, you pay nothing for additional hospital facility charges.
How Commonwealth Capitol Choice WorksSteve has the Commonwealth Capitol Choice PPO plan with the $500 benefit allowance, a $500 deductible, office visit co-pay $15 and a 20% co-insuranceSteves first claim is for a routine care (annual exam) office visit.Total charge, after provider discount is $125Steve pays his $15 office visit co-payThe plan pays 100% of the approved balance ($110). The benefit allowance is still $500Steves second claim is for strep throat, he has an office visit and receives a prescriptionTotal charge, after provider discount is $85.Steve pays his $15 office visit co-pay.The plan pays for the approved balance of $70 from the benefit allowance. The benefit allowance is reduced to $430.Steve pays his $20 co-pay and picks up his prescription at the pharmacy.The cost of this prescription does not affect the benefit allowance.
How Commonwealth Capitol Choice WorksSteve has physical therapy following minor surgery, the physical therapy benefit is subject to the deductible then 20% coinsurance.Total cost of the service after provider discount is $1500The Benefit Allowance covers the first $430 ($70 was used on previous service)Steve is responsible for his $500 deductible, this reduces the claim balance to $570.Steve is also responsible for $114, which is his 20% coinsurance amount.
Steve has now used all of his benefit allowance and has met his $500 deductibleIf Steve had chosen a plan without the benefit allowance, his total member responsibility for this claim would have been $700 ($500 deductible and $200 coinsurance).
Total Bill1500Minus benefit allowance 430 Plan pays 1070Minus Steves deductible 500 Steve pays 570 Steves 20% coinsurance 114 Steve paysBalance 456 Plan pays
Health PlansCommonwealth Standard PPOReplaces the Commonwealth Essential PlanHigher member deductiblesHigher member co-insuranceHigher annual maximum out-of-pocketLower premiumsNEW: A single coverage option is now available
Health Plan Comparisons
Health Plan ComparisonsBenefit Allowance /HRA AmountDeductibleOut of Pocket Maximum (includes Deductible-excludes Office & RX co -pays)Office Visit Co-PayBenefit Payments (hospital, surgery, etc)Your Co-Insurance (payment amount)RX Co - paysStandard (formerly Essential)N/A$ 750 Ind $1,500 Fam$3,500 Ind $7,000 FamN/A75%25%Min Max$10 $25$20 $50$25 $100Optimum (formerly Enhanced/ Premier)N/A$250 Ind $500 Fam$1,125 Ind $2,250 Fam$1085%15%$5$20$40Capitol choice$500$ 500 Ind $1,500 Fam$2,000 Ind $6,000 Fam$1580%20%$5$20$40Maximum Choice (formerly Select)$1,000 single$1,500 Parent & Couple$2,000 Family$2,000 Ind $3,000 Fam$3,000 Ind $4,500 FamN/A90%10%Deductible then 10%
Waiving Health Insurance If you waive health insurance coverage, the employer contribution towards a HRA will be $175 per month for a total of $2100 for the yearIf employee is hired with an effective date later that January 1, 2009, the $175 per month for the waiver will be prorated.Example: Employee is hired on March 1st, with an effective date of May 1st on their waiver with an HRA. The employee would receive $175 per month beginning with the month of May
Health Reimbursement Accounts (HRAs)Who is NOT eligible for HRAsIf employee or spouse has a Health Savings Account (HSA), you are NOT allowed to have an HRA. If you have an HSA and elect our HRA, you will be in violation of federal tax law.A retiree who has gone back to work and elects coverage under the retirement systemRetireesSpouse of a hazardous duty retiree
HRATwo Separate Health Reimbursement Accounts
Embedded HRAOffered in conjunction with Commonwealth Maximum ChoiceFunded wi...