Health Care Plans

Revision date of this archived policy: November 08, 2005

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93.1	Policy
	The University makes various health care plans available to certain regular employees, certain temporary employees, certain retirees, and others as designated by the University Administrative Regulations.
	93.1.1	The University health care plans are self-funded. The plan document, entitled "University of Kentucky Medical Benefits Plan", is available in the Employee Benefits Office and on the Employee Benefits website (https://hr.uky.edu/benefits).
	93.1.2	The University offers several health care plans. All plans are not available in every location. The employee's county of residence normally determines plan availability. The details of each health care plan are contained in a certificate of coverage or summary plan description. Copies of the certificates of coverage are available in the Employee Benefits Office.
	NOTE: Since alternatives, coverage, and administrators of the plans may change from time to time, it is recommended that an employee study and evaluate the certificates of coverage for each plan prior to enrollment.
	93.1.3	The University contributes a health care plan credit amount toward the cost of the monthly health care premium for enrolled regular, full-time employees (see HRP&P 94.0: Health Care Plan Credit).
		93.1.3.1	Additional cost for the health care plan in which the employee enrolls shall be paid by the employee.
	93.1.4	Generally, an eligible employee may enroll in a health care plan available where the employee resides.
		93.1.4.1	An eligible employee may enroll in one of the following levels of coverage: 1) Employee only, 2) Employee + child(ren), 3) Employee + spouse, or 4) Employee + family.
			93.1.4.1.1	Coverage for new enrollment shall be effective on the first day of the month consecutive with or following the date of hire.
			93.1.4.1.2	Enrollment may occur at the following times: 1) within the initial thirty (30) days of employment, 2) during periods of open enrollment, or 3) within thirty (30) days of a qualifying family status change.
	NOTE: A family status change occurs because of one of the following events: a) one gets married or divorced, b) one has a child through birth or adoption, c) one loses coverage under another plan, d) one must comply with a family relations judgment, decree or order, e) one’s employment status (or that of one’s spouse) changes from full-time to part-time or vice versa, f) one (or one’s spouse) ends or begins work, and g) one’s spouse’s coverage changes during his/her open enrollment. An employee has thirty (30) days from the date of the family change of status to return completed enrollment form(s) to the Employee Benefits Office. Any changes made must be consistent with the family status change and will require documentation such as birth, marriage, or death certificates.
			93.1.4.1.3	A change in enrollment will be effective as of the date of the qualifying event.
			93.1.4.1.4	Eligible dependents include spouse, and unmarried children less than twenty-five (25) years of age who continue to be dependents . Eligibility for a spouse or dependent(s) is defined in the plan's certificate of coverage.
			93.1.4.1.5	For active employees who are eligible for Medicare (e.g., age 65 or older), the selected University of Kentucky health care plan provides primary coverage and Medicare is supplemental.
			93.1.4.1.6	Health care plan participants who receive medical benefits through the University’s long-term disability plan and who are eligible for Medicare Part B shall apply for Medicare Part B benefits through the Social Security Administration. Upon approval for Medicare Part B, the participant shall change enrollment from a current health care plan to a carveout plan which provides benefits secondary to Medicare.
	93.1.5	Temporary employee eligibility is contingent upon the following:
		93.1.5.1	The employee shall be at least a .20 full time equivalent (FTE), and
		93.1.5.2	The employee shall have sufficient earnings to pay the monthly premium of the plan in which the employee is enrolled.
	93.1.6	Retiree eligibility for participation is contingent upon the following: Retirement in accordance with University retirement regulations (AR-II-1.6); and A minimum of five (5) years of regular full-time employment or its equivalent at the time of retirement and, at the date of retirement, participation in a plan.
		93.1.6.1	At the time of retirement, and thereafter, the retiree may add dependents to a health care plan when the retiree experiences a qualifying event (i.e., marriage, birth, or adoption of a child). A change of enrollment shall be initiated by the retiree within thirty (30) days of the occurrence of the qualifying event.
		93.1.6.2	A retiree, who is eligible to participate in a University health plan and who has been continuously enrolled in a University health plan since retirement (or who has elected to defer coverage as outlined in 93.1.6.3), may add a spouse after retirement, provided the spouse has had creditable health insurance coverage for twelve (12) months immediately before being covered on the University’s plan and there has not been a break in coverage of more than sixty-three (63) days from the time the prior plan ends and the University coverage begins. Creditable health insurance is defined as any health plan that provides coverage for preventive, diagnostic and catastrophic health services; including, but not limited to primary care physician services, specialty care physician services, inpatient and outpatient services and supplies, lab tests and X-rays and prescription drugs.
		93.1.6.3	Beginning April 1, 2003, any retiree is permitted to “defer” the health benefit from the University at either the time of retirement or at a later date during retirement [before or after age sixty-five (65)].
			93.1.6.3.1	This deferral is a one-time deferral. A retiree who elects to defer the retiree health benefit will be permitted to reactivate the retiree health benefit at any time, but once reactivated, there is no provision for a second deferral.
			93.1.6.3.2	A retiree may elect to cover eligible dependents when the retiree health benefit is reactivated, even if the dependents were not on the plan previously. A deferral document must be signed by the retiree and an Employee Benefits representative to activate the deferral.
			93.1.6.3.4	A retiree (and dependents) reactivating coverage must have had creditable medical coverage during the deferral period [at least twelve (12) months prior to reactivating the University coverage] and may not have more than a sixty-three (63) day break in coverage from the time the prior plan ends and the University coverage begins upon reactivation of coverage. Creditable health insurance is defined as any health plan that provides coverage for preventive, diagnostic and catastrophic health services; including, but not limited to primary care physician services, specialty care physician services, inpatient and outpatient services and supplies, lab tests and X-rays and prescription drugs. A retiree who defers the health benefit must wait a minimum of thirty (30) days before reactivating the retiree health benefit.
	93.1.7	Retiree participants who become eligible for Medicare Part B shall apply for Medicare Part B and upon acceptance into Medicare Part B shall change current coverage to a carveout plan.
		93.1.7.1	Generally, retiree carveout plans are coordinated with Medicare Parts A and B coverage. Medicare is primary coverage and the University’s carveout plan is secondary coverage.
		93.1.7.2	For retirees on the carveout plan who return to University employment through fee schedule employment or on a post-retirement appointment and who are .20 or greater FTE, the University plan is primary and Medicare is supplemental.
		93.1.7.3	Anyone hired prior to March 4, 1997, who has a minimum of fifteen (15) years of regular full-time employment or its equivalent, shall receive a health plan credit as a retiree.
		93.1.7.4	Anyone hired on or after March 4, 1997, who has a minimum of (15) years of continuous regular full-time service, shall receive a health plan credit as a retiree. The fifteen (15) years of continuous regular full-time service shall be immediately prior to the date of retirement.
		93.1.7.5	Retirees under the age of sixty-five (65) who become disabled are eligible for Medicare Part B and shall apply for a carveout plan.
	93.1.8	In the event of the death of an employee who is not eligible for retirement, eligible dependents may continue coverage in the plan in accordance with the federal law, Consolidated Omnibus Reconciliation Budget Act (COBRA).
		93.1.8.1	In the event of death of an employee who is eligible to retire under AR II-1.6 at the time of death, eligible dependents shall be eligible for continued coverage in accordance with the provisions of 93.1.6 and 93.1.7.
			93.1.8.1.1	The spouse and dependents shall have been enrolled in a University health plan at the time of the employee’s death.
93.2	Delegation
	Administration of the University's health care plans is a function of the Employee Benefits Office.
93.3	Procedure
	93.3.1	An employee seeking information about health care plans or desiring to enroll shall refer to current certificates of coverage or contact the Employee Benefits Office. Information is also available on the HR Employee Benefits web site at https://hr.uky.edu/Benefits. Eligible community college employees wishing to enroll in one of the health care plans may obtain current brochures and/or enrollment forms from the business officer or the president's office at the college where they are employed or the KCTCS administrative offices.
		93.3.1.1	All enrollments are processed by the Employee Benefits Office.
	93.3.2	Premium payments for an employee in a pay status shall be made through payroll deductions.
		93.3.2.1	An employee who is going to be in a no pay status and who is enrolled in a health care plan shall make arrangements with the Employee Benefits Office to pay the plan's premiums or coverage terminates.
	93.3.3	Generally, the employee's premium contribution is paid under Internal Revenue Service Code Section 125 on a pre-tax dollar basis.
	93.3.4	An employee who loses eligibility for coverage because of termination of employment is eligible to continue coverage for a period as defined by federal law (Consolidated Omnibus Budget Reconciliation Act or COBRA) at the employee's own expense.
		93.3.4.1	Information explaining the costs, billing procedures, and maximum coverage period shall be sent to persons eligible for COBRA rights by the Employee Benefits Office.

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