2005 Active Employee Health Insurance Handbook - Enrollment & Eligibility
Full-time employees - Regular full-time employees of the following agencies who contribute to one of the
state-sponsored retirement systems are eligible to participate:
- State Agencies
- Boards of Education
- Health Departments
- Members of additional groups whose employers pay into a state-sponsored retirement system and have
elected to participate in the Public Employee Health Insurance Program.
Retirees - Retirees under age 65 who draw a monthly retirement
check from any of the following retirement systems, are eligible to participate:
- Kentucky Judicial Retirement Plan
- Kentucky Legislators Retirement Plan
- Kentucky Retirement Systems (KRS)
- Kentucky Teacher' Retirement System (KTRS)
Other eligible participants - Eligible COBRA participants.
Limitations - Employees, retirees, COBRA participants and their
dependents may only be covered under one state-sponsored plan.
A dependent is:
- A member's spouse under an existing legal marriage;
- A member's unmarried child from birth to age twenty-four
(24) who resides with the member in a parent-child
relationship and who is dependent on the member for
more than 50% of his/her maintenance and support. For
purposes of determining eligibility, the term "child"
includes a (1) natural child, (2) stepchild by an existing
legal marriage, (3) child legally placed for adoption with,
or legally adopted by, the member, (4) foster child, and
(5) grandchild and/or a child for whom full legal
guardianship has been awarded;
- A member's unmarried child who does not reside with the
member in a parent-child relationship, but for whom the
member or his/her spouse has a legal obligation under a
divorce decree, court order or administrative order to
provide for the health care expenses of the child.
Dependents may only be covered under one (1) state
sponsored plan. Unless both employees agree in writing,
the employee with custody shall have first option to cover
the dependent child.
An eligible dependent child is covered to the end of the
month in which he/she turns twenty-four (24).
For purposes of this definition, a divorced dependent is not
an "unmarried" dependent.
Eligibility may continue past the age limit for an unmarried
child covered under the Plan who is totally disabled and
unable to work to support himself/herself due to a mental or
physical disability that started before the age limit and is
medically certified by a physician. The carrier may require
proof of the dependent's disability no more than once per
A total disability is defined as the condition that results
when any medically determinable physical or mental
condition prevents a dependent from engaging in
substantial gainful activity and can be expected to result
in death or to be of continuous or indefinite duration. The
carrier must approve total disability.
||Levels of Coverage
Participants in the Program are eligible to enroll in the following levels of coverage:
- Single - Covers the employee/retiree ONLY
- Parent Plus - Covers a married or single employee/retiree and one or more children, but does not cover the spouse
- Couple - Covers an employee/retiree and his/her legal spouse
- Family - Covers an employee/retiree, his/her legal spouse and one or more children