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
• KCTCS
• 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)
• KCTCS

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 year.

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.

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