Policies

Purpose

The University makes various health care plans available to certain regular and temporary employees, retirees and others as designated by the University Administrative Regulations.

Policy

1) The University health care plans are self-funded. The plan document entitled “University of Kentucky Medical Benefits Plan,” is available in the Human Resources Office of Employee Benefits (Employee Benefits) and on the Employee Benefits website at http://www.uky.edu/hr/benefits/.

2) The University offers several health care plans. All plans are not available in every location. The employee’s county of residence determines plan availability. The details of each health care plan are contained in a certificate of coverage (COC) or summary plan description (SPD). Copies of the certificates of coverage are available in Employee Benefits.

3) The University contributes a health care credit amount toward the cost of the monthly premium for enrolled regular full-time employees. Additional cost for the health plan in which the employee enrolls shall be paid by the employee.

4)An eligible employee may enroll in a health care plan available in the county where the employee resides.  An employee may enroll in one of the following levels of coverage: employee only, employee + child(ren), employee + spouse or sponsored dependent, or or employee + family. Eligible dependents include spouse, sponsored dependent and unmarried children less than 25 years of age who continue to be dependent. Children of a sponsored dependent must reside with the employee.

1. Coverage for new enrollment shall be effective on the first day of the month consecutive with or following the date of hire.
2. Enrollment may occur within the initial 30 days of employment, during periods of open enrollment or within 30 days of a qualifying family status change.
3. A change in enrollment will be effective as of the date of the qualifying event.
4. 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.
5. Participants who receive medical benefits through the University’s Long Term Disability (LTD) Plan and who are eligible for Medicare Part B shall apply for Medicare Part B through the Social Security Administration. Upon approval for Medicare Part B, the participant shall change enrollment from an active employee  health care plan to a supplemental plan which provides benefits secondary to Medicare.
6. Employees with sponsored dependent coverage must provide documentation of twelve months of residency with the employee for the sponsored dependent and the children of a sponsored dependent prior to enrolling in the plan.

5) Temporary employee eligibility is contingent upon the employee

1. Being at least a 0.2 full time equivalent (FTE), and
2. Having sufficient earnings to pay the monthly premium.

6) Retiree eligibility for participation is contingent upon the following:

1. Retirement in compliance with retirement regulations (AR-II-1.6); and
2. A minimum of five years of regular full-time employment, or its equivalent, and participation in a plan on the date of retirement.
1. Upon retirement and thereafter, the retiree may add dependents to a health care plan when the retiree experiences a qualifying event. A change of enrollment shall be initiated by the retiree within 30 days of the qualifying event.
2. A retiree who has been continuously enrolled in a health plan since retirement (or who has chosen to defer coverage), may add a spouse or sponsored dependent after retirement, provided the spouse or sponsored dependent had creditable health insurance coverage for 12 months immediately before being covered on the University’s plan and there has not been a break in coverage of more than 63 days preceding coverage by the University’s plan.
3. A retiree spouse or sponsored dependent may cancel coverage at any time and be reinstated with proof of creditable health coverage for 12 months immediately before being covered on the University’s plan and there has not been a break in coverage of more than 63 days preceding coverage by the University’s plan.

Note: Creditable health insurance is defined as any health plan that provides coverage for preventative, diagnostic and catastrophic health services; including, but not limited to, primary or specialty care physician services, inpatient and outpatient services and supplies, lab tests, x-rays and prescription drugs.

7) Beginning April 1, 2003, a retiree is permitted to “defer” the health benefit from the University at either the time of retirement or at a later date.

1. This is a one-time deferral. A retiree who chooses to defer, will be permitted to reactivate the health benefit at any time, but once reactivated, there is no provision for a second deferral.
2. A retiree may choose to cover eligible dependents when the benefit is reactivated.
3. A retiree, and dependents, must have had creditable medical coverage during the deferral period, at least 12 months prior to reactivating University coverage and with no more than a 63 day break in coverage prior to reactivation.

8)  Upon approval for Medicare Part B retirees shall change current coverage to a supplemental retirement health plan (to be called supplemental plan).

1. Generally, supplemental plans are coordinated with Medicare Parts A and B. 
2. For retirees on the supplemental plan who return to University employment through fee schedule or post-retirement employment/appointment and who are 0.2 or greater FTE, the University plan is primary and Medicare is supplemental.
3. Anyone hired prior to March 4, 1997, with a minimum of 15 years of regular full-time employment, or its equivalent, shall receive a health plan credit as a retiree.
4. Anyone hired on or after March 4, 1997, but prior to January 1, 2006, with a minimum of 15 years of continuous regular full-time service, shall receive a health plan credit as a retiree. The 15 years of service shall be immediately prior to the date of retirement.
5. Anyone hired after January 1, 2006 will not receive the health credit.  They will have "access only."
6. Retirees under the age of 65 who become disabled are eligible for Medicare part B and shall apply for a supplemental plan.

9) In the event of the death of an employee who is not eligible for retirement, and who has a spouse and dependents and sponsored dependents enrolled in a University health plan, eligible dependents may continue coverage in the plan in accordance with the federal law, Consolidated Omnibus Reconciliation Budget Act (COBRA). In the event of the death of an employee who is eligible to retire under AR II-1.6, qualified dependents shall be eligible for continued coverage as outlined in numbers seven and eight of this policy.

10)  The University has three separate groups for determining health plan premiums:  active employees; pre-65 retirees and post-65 retirees (eligible for Medicare).  Health plan premiums will be determined based on the actual claims experience within each group.

Process

Administration of the University’s health care plan is a function of Employee Benefits.

1) Premium payments for an employee in a pay status shall be made through payroll deductions.

2) An employee going into a no pay status and who is enrolled in a health plan shall make arrangements with Employee Benefits to pay the plan’s premiums, or coverage terminates.

3) Generally, the employee’s premium contribution is paid under the Internal Revenue Service Code Section 125 on a pre-tax basis. Sponsored dependent deductions will be on an after-tax basis unless the sponsored dependent and dependents on the plan meet the pre-tax requirements of the IRS. Employer contributions to the plan will be “taxable benefits” for sponsored dependent coverage that is not eligible for pre-tax benefits.

4) An employee who loses eligibility for coverage because of termination of employment is eligible to continue coverage for a period as defined by COBRA at the employee’s expense.

5) Information explaining the costs, billing procedures and maximum coverage period shall be sent to persons eligible for COBRA by Employee Benefits.