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 with employer money onlyAdministered by Humana and the DEI
Stand alone HRAAvailable only to employees who waive health insuranceFunded with employer money onlyAdministered by Chard-Snyder
(Humana materials may refer to an HRA as a Personal Care Account (PCA)
FSA vs. HRAIn addition to the HRA, an employee may fund a Health Care FSA to reimburse unpaid qualified medical expenses (ex: Deductible, Co-pays, Co-insurance, Dental, Vision, etc.)May fund with employee contributionsIf waiving or have single health coverage, may use all or part of the $50 Benefit for funding
For Commonwealth Maximum Choice Plan participants, when using your HRA, only plan covered expenses will count towards the plan deductible and out-of-pocket maximum (Excludes: Dental, Vision, Over the Counter Medications)
FSA vs. HRAIf you have both a Health Care Flexible Spending Account (FSA) and a Health Reimbursement Account (HRA), reimbursement will come from your FSA account balance first.The FSA balance is forfeited at the end of the plan year (12/31/08) and 2 month grace period (3/15/09).The HRA balance will roll-over from year to year as long as you remain a waiver or enrolled in the Commonwealth Maximum Choice Plan.Will not roll-over if you change your plan selection.NOTE: If you use the Benny PrePaid Benefits Card from Chard-Snyder, reimbursements will automatically be from your FSA first until that annual election amount is depleted. Then, reimbursement will be from your HRA.
Using Benny PrePaid Benefits Card for HRA at Pharmacies Waivers OnlyIf employee is covered under spouses health plan, they would use that health insurance card first.Employee would then use Chard-Snyder Benny card for any copay or coinsurance amounts due.
Save Your Receipts: HRA Reimbursed ExpensesIt is important to save all itemized receiptsThe IRS requires proof (substantiation) that expenses are qualified under your plans benefitsFor the Commonwealth Maximum Choice Plan -Humana automatically verifies transactions, in most cases, as they occur. However, Humana may ask members to submit receipts for verification of an expenseFor Waivers, Chard-Snyder automatically verifies transactions, in most cases, as they occur. However, Chard-Snyder may ask members to submit receipts for verification of an expenseAlways save all receipts and explanation of benefits (EOB) in case you are contacted to verify an expense that could not be matched automaticallyIf a refund is needed:Card should be credited by the providerIf providers refund the member directly the member will be required to refund the card (per IRS guidelines)
Flexible Spending Accounts (FSA)Employee Money OnlyThere are two kinds of FSAsHealth Care Spending Account for medical expenses: Minimum $ 5 per paycheck( including $50 benefit); total annual maximum : $ 5,004 ($208.50 per paycheck)Dependent Day Care Account for Dependent care expensesMinimum $ 5 per paycheck; total annual maximum $4,992Please refer to the FSA booklet for further informationMaximum Contribution based on tax filing status
Flexible Spending AccountsMoney does not roll from year to year; use it or lose it ruleCan either use the Benny card or file a paper claim for reimbursementOver-the-counter expenses can be reimbursedCan be used to get reimbursed for any dependents residing in your householdSubstantiation for Benny card may be required.
Flexible Spending Accounts (FSA)Federal regulations require that employees that wish to enroll in a FSA do so every yearRe-enrollment is necessary to participate in a FSA account either with employee contributions or employer contributions due to the $50 BenefitThe carrier for 2009 will continue to be Chard Snyder and Associates
Flexible Spending AccountGrace PeriodUse left over money from 2008 plan year until March 15, 2009(applies to KCTCS personnel system employees only)
Will also apply to 2009 Plan Year (2 monthly grace period will be January 1 March 15, 2010)Will apply to all enrolled employees regardless of personnel system
Flexible Spending AccountGrace PeriodReminderYou may use your FSA Benny Prepaid Benefits card for grace period expenses. The Reimbursements will automatically be applied to the correct year
Or, you may also pay for these expenses and then file for reimbursement from Chard-Snyder by mail or fax
Dependent Care Flexible Spending AccountRetirees are not eligible to participateAmount that can be contributed is based on your tax filing statusReimbursement by claim formBenny Card is not available for use with the Dependent Care FSA
Web Enrollment: FSAFlexible Spending Account: FSA CoverageKCTCS employees will NOT be able to web-enroll for FSA coverage through the DEI WebsiteA message will appear that states that KCTCS is non-participating and to contact the Insurance Coordinator
Web Enrollment: FSAFSA Coverage:
FSA Enrollment is a separate process. KCTCS employees will be able to web-enroll for FSA Coverage through the Chard-Snyder Website at www.chard-snyder.comIf employees are currently enrolled in FSA, they will use their current password to web-enrollDetailed instructions will be available in the Chard-Snyder material available for distributionYou will be able to sign up for your employee health care and/or dependent care elections and any $50 Benefit allocationsNOTE: If you are signing up for both a FSA and a HRA, you will be able to do both through the same screen
Web Enrollment: HRAHRA Coverage:HRA Enrollment is a separate process. KCTCS employees will be able to web-enroll for HRA Coverage through the Chard-Snyder Website at www.chard-snyder.comIf employees are currently enrolled in FSA, they will use their current password to web-enrollDetailed instructions will be available in the Chard-Snyder material available for distributionNOTE: If you are signing up for both a FSA and a HRA, you will be able to do both through the same screen
$50 Benefit AllowanceEligibility is open to KCTCS personnel system regular, full-time employees who are enrolled in single healthcare coverage or who have waived healthcare coverage.You may use the $50 monthly benefit by electing coverage:To pay for health insuranceTo pay for dental insuranceTo be placed in Healthcare FSA (FSA form must be completed)To purchase voluntary supplemental benefitYou must complete a new $50 Benefit Enrollment Form to participate in 2009You may not use this benefit to purchase Group Life Insurance or Supplemental Long Term Disability
Dental Open EnrollmentDental open enrollment is October 13 through October 24, 2008Dental choices:Dental Care Plus Delta DentalCompdentHealthResourcesDental coverage will rollover from 2008 to 2009If you wish to add or drop family members or change carriers you will need to complete a new dental applicationTo cancel dental coverage, employee must fill out dental application and write Cancel Coverage Effective 1-1-09
Dental Open EnrollmentReminder:If your covered dependent is over age 19, you will need to submit a proof of student status to the dental carrier before claims are paid.Dependents are not covered over the age of 23. They will automatically be dropped from the plan. You will need to notify your college Human Resources Office when this occurs.
2009 Insurance/Benefit CARDSHealth Insurance and Prescription Drugs
New ID cards will be issued on all health enrollmentsDentalYou will only receive a new ID card if you change coverageWaiversYou will receive a Chard-Snyder Benny PrePaid Benefits card for your HRA if you are a new enrollee, If you have a 2008 HRA and Benny card, your new 2009 election will be loaded onto itFSAYou will only receive a Benny Prepaid if you are a new enrolleeIf you have a 2008 FSA and Benny card, your new 2009 election will be loaded onto it
If you have both a HRA and a FSA, you will use the same Benny card
For Active Employees Age 65 and OlderThe KCTCS Health Plan is considered primary over MedicareYou do not need to sign up for Medicare Part B until you cease employment. You will then enroll for this coverage under a Special Enrollment PeriodThe prescription drug plan offered through the KEHP is considered Creditable Coverage. You do NOT need to sign up for a Medicare part D plan
See inside front cover and page 4 of your Selection Guide for DEI/KEHP contact numbers
Phone: 877-KYSPIRIT 877-597-7474Phone: 877-KYSPIRIT 877-597-7474