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2016 Enrollment Frequently Asked Questions

General Open Enrollment and Eligibility Questions

1. When is Open Enrollment for plan year 2016?

October 12-26, 2015

2. Do I have to enroll?

Do you have to enroll? YES, if you want to:

Do you have to enroll? NO, if you:

Change your health insurance plan
Elect or keep the employer-funded General Purpose Waiver Health Reimbursement Arrangement (HRA)
Elect a Healthcare FSA
Elect a Dependent Care FSA
NOTE: If you did not complete your LivingWell Promise for 2015: You must enroll online and select either the Standard PPO or CDHP. If you do not, you will be automatically defaulted to the Standard CDHP, single coverage level for 2016.

Want to keep your current health insurance plan option
Currently have and want to keep your employer-funded Waiver Dental/Vision HRA
Are a KRS, KTRS, or Legislative/Judicial return-to-work retiree, under age 65 and want to keep your current health insurance plan with your active agency

3. How do I enroll if I need to make changes to my plan, elect the Waiver General Purpose HRA, or an FSA?

Online KHRIS ESS: Active employees, KTRS retirees, JRP/LRP and KCTCS retirees may enroll online at openenrolllment.ky.gov. Paper Application: If you are beginning or ending a cross-reference payment option, adding a disabled dependent covered on your plan, or are a KRS retiree who needs to make changes to your plan, you must complete a paper application and submit it through your insurance coordinator or HR department.

Click here for more 2016 how to enroll details. Note: If you have the Waiver General Purpose HRA in 2015 and don’t elect to waive coverage or elect a plan in 2016, you will be automatically defaulted to the Standard CDHP, single coverage level for 2016.

4. Who do I call for assistance?

KEHP Open Enrollment Hotline	Outside Frankfort 888-581-8834 In Frankfort 502-564-6534 The KEHP phone message will prompt you to choose from one of the following three options: Option 1 KHRIS User ID, password, computer & technical assistance Option 2 Benefit questions for Anthem, CVS or WageWorks Option 3 KEHP Member Services and Eligibility ** Telephone service at these numbers is only valid Oct. 12-26, 2015.
Health Insurance Benefits Anthem Customer Service	844-402-KEHP (5347)
Prescription Benefits CVS/caremark Customer Service	866-601-6934
FSA & HRA Benefits WageWorks	877-430-5519
Wellness Information HumanaVitality	855-478-1623
Shopper Discounts Vitals SmartShopper	855-869-2133
LRP & JRP Retiree Questions	502-564-5310
KCTCS Retiree Questions	859-256-3100
KRS Retiree Questions	800-928-4646 502-696-8800 kyret.ky.gov
KTRS Retiree Questions	800-618-1687 502-848-8500 ktrs.ky.gov

5. What are the Open Enrollment customer service hours?

Oct. 12-16/Monday - Friday: 8 a.m. to 6 p.m. ET
Oct. 17 Saturday:                     8 a.m. to 1 p.m. ET
Oct. 19-23/Monday - Friday: 8 a.m. to 8 p.m. ET
Oct. 24 Saturday:                     8 a.m. to 1 p.m. ET
Oct. 26/Monday:                      8 a.m. to 6 p.m. ET

6. When and where are the KEHP Benefit Fairs?

Benefit fairs will be held at 14 locations from Oct. 1 through Oct. 20 with representatives available from KEHP, Anthem, CVS Caremark, WageWorks, HumanaVitality® and Vitals SmartShopper. Free flu shots are available first-come, first-served basis at Franklin, Fayette and Jefferson county benefit fairs. All locations will have online enrollment assistance available for active employees and KTRS retirees under age 65. Click here for a complete list of benefit fairs.

7. What plan option are available?

The LivingWell CDHP and the LivingWell PPO require the planholder to fulfill the LivingWell Promise

8. What changes can I make during Open Enrollment?

You may enroll yourself and your children and/or spouse in a health plan or waive coverage. You may also enroll in a Healthcare or Dependent Care Flexible Spending Account (FSA). You can also change your tobacco use status. NOTE: You may not remove a dependent from your plan if the child is enrolled per an administrative order, including National Medical Support Orders.

9. Who can I cover on my health plan?

You may cover your legal spouse or dependent child under age 26.

10. Can children under age 26 be covered as dependents on their parent’s plan if they are eligible for their own coverage (e.g., at another job)?

Yes, KEHP has expanded dependent eligibility to include dependents under age 26 who may be eligible for health insurance coverage through their full-time employer. This includes children who are eligible for KEHP as an employee.

11. Can disabled dependents be covered beyond age 26?

A dependent child who is totally and permanently disabled may be covered by KEHP beyond the end of the month in which he/she turns 26, provided the disability (a) started before his/her 26th birthday and (b) is medically-certified in writing by a physician. A dependent child who is not already covered by KEHP at the time of his/her 26th birthday may not later be enrolled in KEHP on grounds of total and permanent disability unless and until he/she sustains a loss of other insurance coverage. In such a case, a request to enroll a dependent child in KEHP on grounds of total and permanent disability must be made no later than 35 calendar days following the loss of other insurance coverage.

Anthem will make all dependent child disability determinations. If a dependent child is approved for coverage in KEHP on grounds of total and permanent disability, the planholder will periodically be required to produce written proof of the continuing nature(s) of the child’s dependency and/or disability in order to maintain the child’s KEHP coverage.

12. Can I waive coverage and not elect a KEHP health plan?

Yes, you may waive coverage. When waiving coverage, you have three options:

• Waive coverage and elect the Waiver Health Reimbursement Account (HRA). With this option you will receive $175 per month up to $2,100 annually to pay for qualified medical expenses. NOTE: This option is not available to retirees. If you or your spouse or dependent is contributing funds to a Health Savings Account (HSA), you should consult a tax advisor prior to establishing an HRA or FSA.

• Waive coverage and elect the Dental/Vision Only HRA. With this option you will receive $175 per month up to $2,100 annually to pay for qualified dental and vision only expenses. NOTE: This option is not available to retirees.

• Waive coverage with no HRA. With this option you do not receive any employer funds.

13. What is the cross-reference payment option?

The cross-reference payment option is a legislatively mandated payment option that offers lower employee premiums which are deducted from both employees’ paychecks. Employees must satisfy all requirements to elect the cross-reference payment option.

Requirements:

• The employees must be legally married with at least one eligible dependent;

• The employees must be eligible employees or retirees* of a group participating in KEHP;

• The employees must elect the same coverage option.

Failure to meet any one of the above requirements will make the employees ineligible for the cross-reference payment option.

*Per the Judicial and Legislators Retirement System, retirees of the Judicial Retirement Plan (JRP) and the Legislators’ Retirement Plan (LRP) are not eligible to elect the cross-reference payment option.

14. May I drop a dependent from coverage in the middle of the plan year?

Coverage may only be dropped during the annual open enrollment period or if a member has a qualifying event. A list of qualifying events is included on the KEHP Enrollment or Change Coverage website

LivingWell Promise

1. What is a LivingWell Promise plan?

The two LivingWell plan options available in 2016 are a part of KEHP’s overall wellness program. By completing the steps of the LivingWell Promise, you can begin to:

• Access the best benefit options;

• Learn about your health status and history;

• Learn about and understand your health risks; and

• Take action to get and stay healthy.

2. What are the LivingWell Promise requirements for 2016?

The LivingWell plans are very popular and keeping the Promise is easy – more than 97% of planholders completed the LivingWell Promise in 2015!

Electing or keeping a LivingWell Promise plan in 2016 means you are required to complete either the HumanaVitality Health Assessment (HA) or Vitality Check biometric screening from January 1, 2016 through May 1, 2016.

Both screenings only take a few minutes to complete and give you a better understanding of your health status, access to the best benefit plan options, and information to help you stay healthy. If you have a cross-reference payment option, you and your spouse both must complete the HA or the Vitality Check biometric screening. If you elect a LivingWell plan option for 2016 and do not complete the LivingWell Promise, you will only be eligible for the Standard plan options in 2017. If you are unable to fulfill the LivingWell Promise because of a physical or mental health condition, KEHP will work with you to develop an alternative way to qualify for either LivingWell plan option.

3. If I am a new employee and choose a LivingWell plan after open enrollment, how long do I have to complete the LivingWell Promise?

New employees who elect a LivingWell plan after open enrollment must complete the Health Assessment within 90 days of the effective date of their coverage.

4. What is the HumanaVitality^® Health Assessment?

More than 137,000 KEHP planholders have already taken their HumanaVitality Health Assessment (HA) as part of their 2016 LivingWell Promise! The Health Assessment (HA) is a series of questions about your current physical and mental well-being, your day-to-day lifestyle, and how you feel about your current health levels. It takes about 10-15 minutes and will tell you your Vitality Age.

Visit LivingWell.ky.gov and click on the HumanaVitality login.

First time users

Click on “Register Now” and complete the required fields. You will be issued a HumanaVitality ID card and you will enter the number found on your HumanaVitality ID card or enter your social security number. Check the box agreeing to the terms, and click “Continue.” Verify the member found is you. Create a username and password. After completing the registration process, return to HumanaVitality to sign in using the username and password you just created.

Returning users

Sign in using your username and password. After you sign in, click on the alert to “Take the Health Assessment” or look for the “Health Assessment” link under the “Get Healthy” tab. If you know your medical history and key measurements, have them ready to help you complete your HA. If you don’t have your key measurements, don’t worry, you’ll still be able to complete the HA. If you had a Vitality Check (biometric screening) within the last 18 months, you will see those results have pre-populated into your HA. The results cannot be updated until a new Vitality Check is submitted. To find a Vitality Check location near you, visit LivingWell.ky.gov. Receive your Vitality Age based on your HA responses. HumanaVitality will then recommend goals. If you choose, you may select goals and discover activities that will allow you to commit to a healthier lifestyle, improve your Vitality Age, and earn Vitality Points™ and rewards along the way.

5. What is a Vitality Check (biometric screening)?

A Vitality Check is a biometric screening that consists of: lab work to test your cholesterol and blood glucose; a blood pressure check; height, weight and waist circumference to learn your Body Mass Index (BMI). For more accurate results, fast for at least nine hours prior to the test. You will earn 400 Vitality Points for taking each test (cholesterol, blood glucose, blood pressure). You’ll earn more HumanaVitality points for completing a Vitality Check than you will by taking just a Health Assessment. If you choose, you may take both and earn more points! A Vitality Check will give you more accurate and recent results to use when populating your Health Assessment. And in turn, you will have a more accurate Vitality Age.

6. Where can I get a Vitality Check (biometeric screening)?

Location	Cost
1. At a KEHP scheduled, select, onsite location-to be announced at a later date.	No cost to the member. The Vitality location will submit the results to HumanaVitality.
2. Through the local health department	No cost to the member. The health department will submit the results to HumanaVitality.
3. At a retail clinic (e.g. Kroger Little Clinic, Walgreens, Take Care Clinics, Concentra) Go to livingwell.ky.gov Click on the Get a Vitality Check box Choose from the locations listed Print the associated Vitality Check voucher Present the voucher and your HumanaVitality ID card at the retail clinic	No cost to the member. The retail clinic location will submit your results to HumanaVitality.
4. At your primary care physician (PCP) Go to livingwell.ky.gov Click on the Get a Vitality Check box Click on the “primary care physician” tab Print a copy of the "PCP Vitality Check Voucher."; Fax the completed form to HumanaVitality at 1-877-250-7814 or mail to P.O. Box 14613, Lexington KY 40512-4613.	Preventive Services are at no cost to the member if an in-network provider is used; however, there may be a charge if the provider submits the claim other than as preventive.

7. Who must complete the LivingWell Promise?

Only the planholder is required to complete the LivingWell Promise. Non-employee spouses and dependents covered under your plan will not be required to complete the Health Assessment. If you have the cross-reference payment option, both you and your spouse must complete the Health Assessment.

8. Are spouses or adult children (age 18 and up) required to fulfill the LivingWell Promise?

No. Only you, the planholder, are required to complete the LivingWell Promise. The only exception to this requirement is if you have elected a cross-reference payment option, in which case both planholders must fulfill the Promise.

9. When do I have to take the Health Assessment?

If you make the LivingWell Promise during Open Enrollment you must take your Health Assessment between January 1, 2016 and May 1, 2016. New employees who elect a LivingWell plan option after Open Enrollment must complete the Health Assessment within 90 days of the effective date of their coverage.

10. What happens with the information collected through the Health Assessment?

KEHP takes your personal health information seriously and has measures in place to protect this information. All responses to your HA are strictly confidential and protected under HIPAA. KEHP will not collect, or access, or retain your personal health information, nor will KEHP share your personal health information with your employer. Only HumanaVitality will have access to and be able to view your HA responses. KEHP may receive aggregate information from HumanaVitality that does not identify any individual in order to design and offer health programs aimed at improving the health of KEHP members.

11. Is the information collected through the Health Assessment protected?

Yes. KEHP takes your personal health information seriously and has measures in place to protect this information. All responses to your HA are strictly confidential and protected under HIPAA. KEHP will not collect, or access, or retain your personal health information, nor will KEHP share your personal health information with your employer. Only HumanaVitality will have access to and be able to view your HA responses. KEHP may receive aggregate information from HumanaVitality that does not identify any individual in order to design and offer health programs aimed at improving the health of KEHP members.

12. Can I take the Health Assessment or VitalityCheck biometric screening if I don’t choose a LivingWell plan?

Yes, if you participate in one of the four health plan options, you are automatically enrolled in HumanaVitality®. Once you log in and activate your account you begin earning Vitality Points toward movie tickets, hotel stays, and other reward. You can also take the Health Assessment which gives you your Vitality Age and helps you set goals for a healthy lifestyle.

13. If I can’t take the Health Assessment due to medical or mental health conditions, can I still choose a LivingWell plan?

Yes, if it is unreasonably difficult because of a medical or mental health condition for you to complete the Health Assessment you also have the option of completing the Vitality Check (biometric screening). If it is unreasonably difficult for you to complete either one, call customer service at 855-478-1623, and we will work with you to develop an alternative solution.

14. If I do not fulfill the LivingWell Promise, will my health insurance claims still be paid?

Yes. The plan will continue to pay eligible claims for the plan year, even if you do not fulfill the LivingWell Promise. However, you will not be able to elect a LivingWell plan option for 2017 if you do not fulfill your 2016 LivingWell Promise. The Standard plans will still be available to you.

15. What happens if I fail to complete the LivingWell Promise from January 1 through May 1, 2016?

If you elect a LivingWell plan option and fail to fulfill the LivingWell Promise, you will not be eligible to participate in the LivingWell Promise and choose a LivingWell plan option for the next plan year (2017). Stated another way, if you fail to fulfill the LivingWell Promise, you will only be eligible for the Standard plan options the next plan year.

16. If I choose a LivingWell plan option and take the Health Assessment or VitalityCheck may I change my plan option mid-year?

Mid-year plan changes can only be made if you experience a life event referred to as a qualifying event. If you experience a qualifying event that allows you to change your plan, you can elect another LivingWell plan option or a Standard plan option. If you take the Health Assessment or VitalityCheck from January 1 through May 1, 2016, and complete your original LivingWell Promise, you can enroll in a LivingWell plan option for 2017.

If you experience a qualifying event during the 2016 plan year and elect a LivingWell plan option for the first time as a result of the qualifying event you have 90 days from the effective date of the LivingWell plan to complete the LivingWell Promise. The primary rule for completion of the LivingWell Promise is that the first, or original, election of the LivingWell plan option is the controlling factor for whether you are eligible for a LivingWell plan option the following plan year. If you change plans during the 2016 plan year, whether that change is because of retirement, a qualifying event or a break in service, the first, or original, election of the LivingWell plan follows you throughout the plan year. The same rule would apply to newly eligible members.

For example, at open enrollment you elect a LivingWell plan option. You experience a qualifying event in June and change to a Standard plan option. Your election of the LivingWell plan option, and whether you completed your LivingWell Promise, will be tracked regardless of the mid-year change to a Standard plan option. If you did not complete the LivingWell Promise from Jan. 1 through May 1, 2016, you will not be eligible for a LivingWell plan option for 2017.

17. How does the LivingWell Promise apply to new hires eligible for KEHP coverage?

New employees who elect a LivingWell plan option after Open Enrollment must complete the Health Assessment within 90 days of the effective date of their coverage.

18. How does electing a LivingWell plan option for 2016 and making the LivingWell Promise impact my plan selections for future years?

Please review the following for specific information:

What happens if I terminate employment and am hired at another KEHP participating agency three months later?

The first/original election of a LivingWell plan option will follow you throughout the plan year. The first/original election of a plan requiring the LivingWell Promise is the controlling element. You don’t have to complete the promise twice in the event of a qualifying event, termination, re-hire, etc.

What happens if I elect a LivingWell plan option at Open Enrollment, fulfill the LivingWell Promise, then retire or have a qualifying event in 2016 and continue with my LivingWell plan – do I have to fulfill the LivingWell Promise again to be eligible for a LivingWell plan in 2017?

Because you completed the LivingWell Promise with your first/original election of a LivingWell plan option in 2016, you are eligible for a LivingWell plan option in 2017. You do not have to take the Health Assessment again in the same plan year to meet the LivingWell Promise requirement.

Would I be able to elect a LivingWell plan option during Open Enrollment, NOT fulfill my LivingWell Promise from January 1 through May 1, then retire (or have a qualifying event) after May 1, 2016 and continue to elect a LivingWell plan option when I retire?

Yes. Despite not completing the Health Assessment, you could elect a LivingWell plan option upon retirement or with a qualifying event, during the same plan year. The fact that you didn’t complete the Health Assessment or VitalityCheck will result in losing the ability to elect a LivingWell plan option and only having Standard plan options in 2017. Again, the first/original election requiring the LivingWell Promise was not fulfilled and impacts the next plan year.

Would I be able to elect the LivingWell plan option during Open Enrollment, retire or have qualifying event, and change to a Standard plan at retirement and then elect a LivingWell plan option the next plan year?

Yes. So long as you fulfilled the promise from the original LivingWell plan election you would be able to choose from all plan options in 2017. Switching to a Standard plan option mid-year wouldn’t penalize you for 2017.

19. If I didn’t choose a LivingWell plan option for 2015, will I be able to choose a LivingWell plan option in 2016?

Yes. If you selected a Standard plan option in 2015 you will be able to select a Standard or LivingWell plan option for 2016. The LivingWell plan options also require a LivingWell Promise in 2016.

20. If I don’t choose a LivingWell plan option for 2016, will I be able to choose a LivingWell plan option in 2017?

Yes. If you select a Standard plan option in 2016 you will be able to select a Standard or LivingWell plan option for 2017. The LivingWell plan options also require a LivingWell Promise in 2017.

21. If I chose a LivingWell plan option but failed to fulfill the LivingWell Promise in 2015, and have to take a Standard (non-LivingWell) plan option in 2016, when is the next time I can enroll in a LivingWell Promise plan option?

If you do not fulfill the LivingWell Promise, you must wait one full plan year before you are eligible to enroll in a LivingWell plan option again. As a result, if you did not fulfill the LivingWell Promise in 2015, you would not be eligible for a LivingWell plan option until plan year 2017.

22. If I elect a LivingWell plan option and agree to the LivingWell Promise, am I required to participate if I’m contacted by a nurse with one of the Anthem Personal Health Nurse Programs?

No, electing a LivingWell plan option only requires you to complete the HumanaVitality® Health Assessment or the Vitality Check (biometric screening). However, the Personal Health Nurse Programs are free to KEHP members and provide valuable services such as personalized support for reaching healthy living goals or managing complex medical conditions .

Plan Information

1. How do the medical and pharmacy benefits work for the 2016?

Click on the plan name to see specific information for each plan.

2. What is a Consumer Driven Health Plan (CDHP)?

CDHPs put you, the consumer, in more control of managing your healthcare expenses. CDHPs feature lower premiums and include an employer-funded, pre-loaded Health Reimbursement Account (HRA) to help reduce your deductible and maximum out-of-pocket expenses. With a higher deductible, the employer-funded HRA, and lower co-insurance amounts, a CDHP engages members in their healthcare decisions and makes them more aware of the cost and utilization of healthcare services. Like a PPO, members in a CDHP have flexibility when choosing healthcare from in-network providers and members must pay more for healthcare from out-of-network providers. Unused dollars in the HRA can accumulate year to year if a member continues to elect a CDHP.

3. What is a Preferred Provider Organization Plan (PPO)?

PPOs are a type of insurance plan with which most people are familiar. Usually PPOs have higher premiums, low deductibles and require you to pay co-pays and co-insurance. The insurance plan is responsible for the remainder. In addition, PPOs allow flexibility when choosing healthcare from in-network providers and members must pay more for healthcare from out-of-network providers.

4. What is a deductible?

A deductible is the amount you have to pay out-of-pocket before the plan begins to pay expenses. Deductibles are generally calculated per calendar year and most plans have individual and family deductible amounts.

5. What is co-insurance?

Co-insurance refers to a shared payment between the health plan and you, described in percentages (e.g. 80%/20%).

6. What is out-of-pocket maximum?

This is the most money in a plan year that you can expect to pay for covered medical and pharmacy services.

7. What is a co-pay?

A co-pay is your portion of the cost for a health care service (e.g. You may pay $25 per office visit or $10 to get a prescription filled.) Your insurance plan pays the difference.

Health Reimbursement and Flexible Spending Accounts

1. What is a Health Reimbursement Account (HRA)?

An HRA is an employer-funded account that you can use to cover qualified expenses. The KEHP has multiple types of HRAs: embedded HRAs that are part of the CDHP plan options; and a Waiver General Purpose (health) HRA and a Waiver Dental/Vision Only HRA that can be selected when you choose to waive your health coverage. HRA funds can roll over to the next calendar year, as long as you continue to elect the same type of HRA; i.e. CDHP to CDHP, Waiver General Purpose HRA to Waiver General Purpose HRA or Waiver Dental/Vision Only HRA to Waiver Dental/Vision Only HRA.

Funds in the LivingWell CDHP HRA, Standard CDHP HRA, and the Waiver (health) HRA can be used to pay for:

• Medical and prescription deductibles, co-payments and co-insurance

• Certain dental fees such as cleanings, fillings and crowns

• Orthodontic treatment

• Vision fees including contacts, eyeglasses and laser vision correction

• Medical supplies such as wheelchairs, crutches and walkers

NOTE: If you use your CDHP HRA funds for dental and vision expenses, these funds will not apply to your deductible and out-of-pocket maximum.

Funds in the Waiver Dental/Vision Only HRA can be used to pay for:

• Certain dental fees such as cleanings, fillings and crowns

• Orthodontic treatment

• Vision fees including contacts, eyeglasses and laser vision correction

NOTES: a. Retirees are not eligible for either Waiver HRA or the Dental/Vision Only HRA. b. If you or your spouse or dependent is contributing funds to a Health Savings Account (HSA), you should consult a tax advisor prior to establishing an HRA or FSA.

2. What is a Flexible Spending Account (FSA)?

FSAs let you set money aside from your paycheck before taxes to pay for certain healthcare and dependent care (child or adult day care services) expenses. This results in you paying less income and Social Security taxes. Starting in 2015, you can carry over up to $500 of unused funds in your Healthcare FSA to the next calendar year.

Note: If you have an FSA and carry over funds into a subsequent plan year, you will not be eligible to participate in a Health Savings Account (HSA) in the subsequent plan year. You will be ineligible to participate in an HSA even if you do not elect an FSA for the subsequent plan year and even after your FSA carry over funds are spent. You should consult a tax advisor for more information on how an FSA and the FSA carry over impacts your eligibility to participate in an HSA.

3. What is a Healthcare Flexible Spending Account (FSA)?

A Healthcare FSA is an account funded by you for healthcare services such as prescription co-payments, deductibles, and doctor’s office co-payments with pre-tax money. The amount you contribute will be payroll deducted. Make sure to set aside only as much as you will use during the current calendar year – you can carry over up to $500 of unused funds in your Healthcare FSA to the next calendar year, but anything above that will be forfeited. You can use your FSA for family members who are considered a tax dependent. The 2016 limit for contributions to a Healthcare FSA is $2,500 per employee. FSA funds can be used to pay for:

• Medical and prescription co-payments and co-insurance

• Certain dental fees such as cleanings, fillings and crowns

• Orthodontic treatment

• Vision fees including contacts, eyeglasses and laser vision correction

• Medical supplies such as wheelchairs, crutches and walkers

4. What is a Dependent Care Flexible Spending Account (FSA)?

A Dependent Care FSA allows you to pay for dependent care expenses such as a daycare or after-school programs for dependents up to age 13, or an adult day care. The maximum that you can contribute per year is based on your tax filing status: $5,000 for married, filing a joint return; $5,000 filing as head-of-household; or $2,500 married, filing separate returns. Make sure to set aside only as much as you will use. You can use the money only for eligible expenses paid for during the current calendar year. Remember: Use it or lose it.

5. How do I receive reimbursement for my HRA or FSA account?

WageWorks offers a variety of methods to pay for and verify your eligible expenses.

Swipe and Go: Use your WageWorks Healthcare Card, a convenient payment method tied to WageWorks healthcare FSA and HRAs to make healthcare purchases at the doctor’s office, pharmacy, optician, dentist, and other healthcare providers. You can not use the WageWorks Healthcare Card with Dependent Care FSA services.

Online: Reimbursement forms are readily available online. You can upload your receipt directly to your account. When accessing your account online, you can also setup the Pay My Provider service to pay many of your eligible healthcare and dependent care expenses directly from your spending account (similar to online banking).

Mobile App: WageWorks offers a mobile app that allows you to take a picture of your claim receipt or Explanation of Benefits (EOB) and send it to your WageWorks online account. They will use the receipt to validate any receipts needing verification. The mobile app enables you to log in to your account and check your balances, submit claims, snap photos of receipts, get alerts by text or email — all on the go!

Fax/Mail: You can also print the needed forms from the WageWorks website and submit via fax or mail. Claims Administrator P.O. Box 14053, Lexington, KY 40512 Fax 877-353-9236

6. What is substantiation?

Substantiation is required by the IRS to verify that an HRA or FSA claim is an eligible expense. If you have a health insurance plan with KEHP, as well has a Healthcare FSA, then most of your HRA or FSA expenses paid with WageWorks Healthcare Card will be verified through Anthem’s medical claims system. If you choose a Waiver HRA, your primary health insurance plan is not through KEHP. You will need to keep your receipts and submit them for your expenses, even if you use your WageWorks Healthcare Card. You can submit receipts and verify expenses online or use the EZ Receipts Mobile App.

7. Who is eligible for an FSA?

Employees of state agencies, schools boards, and certain quasi-agencies are eligible. Contact your insurance coordinator or HR department for details.

8. Can I have an HRA and a Healthcare FSA?

Yes, you can elect both. Because HRAs are employer-funded and FSAs are employee-funded, you could choose to have both to cover your out-of-pocket expenses. For example, you elect the LivingWell CDHP, family coverage level, and have $1,000 in an employer-funded HRA that can be used toward your deductible. You could also elect to have $1,500 of your money added to a Healthcare FSA and use those pre-tax dollars to help meet your deductible or to use for vision and dental expenses.

9. How long do I have to spend FSA and/or HRA money?

FSA and/or HRA funds may only be used to pay for eligible expenses incurred during the coverage plan year. However, you have until March 31, 2017 to submit reimbursement requests for HRA expenses incurred during your 2014 coverage period.

Waiving Health Insurance Coverage

1. Who is eligible for the Waiver HRA?

• Any active employee of a state agency, school board, or certain quasi-agencies who is eligible for state-sponsored health insurance coverage (see new requirements below)

• A retiree who has returned to work

Attestation of other group health plan coverage required

NOTE: Due to changes in federal law, since 2015, employees who are eligible to waive KEHP health insurance coverage and choose a Waiver (general purpose) HRA may do so only if the employee has other group health plan coverage that provides minimum value and the employee declares, in writing, that the employee has such other coverage. Please refer to the questions and answers below for more information on whether you are eligible to waive KEHP health insurance coverage for 2016 and enroll in a Waiver (general purpose) HRA.

What is “other group health plan” coverage?

“Group health plan coverage” means coverage under a plan (including a self-insured plan) maintained by an employer (including a self-employed person) or labor union to provide health care for current or former employees or their families. Group health plan coverage does not include Medicaid, KCHIP, TRICARE, Medicare, veteran’s health coverage, Peace Corp coverage, any other governmental insurance plan, student policies, state high risk pool coverage, or individual market coverage, including individual coverage purchased through the Kentucky Health Benefit Exchange (kynect).

What is “minimum value”?

A group health plan provides “minimum value” if the plan pays at least 60% of the total allowed cost of covered benefits/services and participants or members in the plan are required to pay no more than 40% of the total allowed cost of covered benefits/services.

What is the difference between a Waiver (general purpose) HRA and a Waiver Dental/Vision Only HRA?

A Waiver (general purpose) HRA will reimburse the employee or the employee’s dependents for certain medical expenses such as medical and prescription drug deductibles, co-payments and co-insurance, certain dental and vision services, and medical supplies. The Waiver Dental/Vision ONLY HRA will reimburse the employee or the employee’s dependents only for expenses related to vision and dental services.

Am I eligible to choose a Waiver (general purpose) HRA if I waive KEHP health insurance coverage?

An employee who is eligible for a Waiver HRA may choose a Waiver (general purpose) HRA only if (1) the employee has other group health plan coverage that provides minimum value, and (2) the employee attests or signs a declaration that the employee has other group health plan coverage.

How do I know if my other group health plan coverage provides minimum value?

The employer or the sponsor of the other group health plan coverage can tell you if the group health plan provides minimum value.

What happens if I lose my other group health plan coverage during the year?

If an employee elects a Waiver (general purpose) HRA and ceases to be covered under another group health plan that provides minimum value, the employee must notify KEHP within 35 days after the date that the other group health plan coverage ends. In this event, coverage under the Waiver (general purpose) HRA will be terminated and the employee may elect a KEHP health insurance plan option or the Waiver Dental/Vision ONLY HRA. Any funds remaining in the Waiver (general purpose) HRA after termination may be used to reimburse the employee for eligible expenses incurred prior to termination of the Waiver (general purpose) HRA. The employee is permitted to permanently opt out of and waive future reimbursements from the Waiver HRA at least annually at open enrollment.

What happens if I choose a Waiver (general purpose) HRA but do not have other group health plan coverage that provides minimum value?

You are not eligible for coverage under a Waiver (general purpose) HRA unless you declare, in writing, that you have other group health plan coverage that provides minimum value. If KEHP determines that you have made a false certification, your coverage under the Waiver (general purpose) HRA will be revoked.

Why must the Waiver (general purpose) HRA be integrated with other “group health plan” coverage?

The changes regarding the Waiver (general purpose) HRA are the result of changes in federal law. The Waiver (general purpose) HRA is considered a “group health plan” but it does not comply with certain federal law requirements for group health plans. For instance, the Waiver (general purpose) HRA does not provide preventive care at zero cost sharing for members. Also, the Waiver (general purpose) HRA does not comply with the prohibition against annual limits as it is limited to $2,100 per year. For these reasons, federal law requires the Waiver (general purpose) HRA to be coupled with other “group health plan” coverage that meets all the requirements for health plans imposed by the federal government. This ensures that individuals have the necessary coverage to comply with the federal individual health insurance mandate.

Why isn’t TRICARE considered other “group health plan” coverage?

The federal law requiring the upcoming changes for individuals receiving TRICARE benefits with regard to HRA eligibility begins with guidance issued September 13, 2013, collectively by the US Department of Labor, the US Department of Treasury, and the US Department of Health and Humana Services. As indicated by the guidance, an HRA, like the Commonwealth’s Waiver (general purpose) HRA, must be integrated with other group health plan coverage and that coverage must provide minimum value. In order to elect the Waiver (general purpose) HRA, the employee must be “actually enrolled in a group health plan that provides minimum value.” The term “group health plan” is specifically defined by federal law. With respect to a “group health plan,” the following definition applies: 26 USC 5000(b)(1) - The term “group health plan” means a plan (including a self-insured plan) of, or contributed to by, an employer (including a self-employed person) or employee organization to provide health care (directly or otherwise) to the employees, former employees, the employer, others associated or formerly associated with the employer in a business relationship, or their families. TRICARE is a government-sponsored plan and is not an employer-sponsored or employee organization (e.g. union) – sponsored plan. As such, persons with TRICARE are not able to attest or declare that they are enrolled in a “group health plan” that provides minimum value.

Can I choose a Waiver Dental/Vision ONLY HRA if I do not have other group health plan coverage that provides minimum value?

Yes. You may waive KEHP health insurance coverage and choose a Waiver Dental/Vision ONLY HRA even if you do not have other group health plan coverage that provides minimum value. You are not required to sign a written declaration if you waive KEHP health insurance coverage and choose a Waiver Dental/Vision ONLY HRA. You should bear in mind, however, that you might owe a tax penalty if you do not maintain minimum essential health coverage.

2. Who is not eligible for the Waiver HRA?

If you are a member of an agency that does not participate in KEHP’s HRA/FSA program, a retiree, or a retiree under age 65 who has gone back to work and elected coverage under the retirement system, then you are not eligible for the Waiver HRA. NOTE: If you or your spouse or dependent is contributing funds to a Health Savings Account (HSA), you should consult a tax advisor prior to establishing an HRA.

3. Who is eligible for the Waiver Dental/Vision Only HRA?

Any active employee of a state agency, school board or certain quasi-agencies who is eligible for state-sponsored health insurance coverage may waive health insurance and enroll in the Waiver Dental/Vision Only HRA. Retirees who have returned to work and who are over age 65 may also waive health insurance and enroll in the Waiver Dental/Vision Only HRA.

4. Who is not eligible for the Waiver Dental/Vision Only HRA?

Tobacco Use

1. What is the non-tobacco user discount?

The Commonwealth of Kentucky is committed to fostering and promoting wellness and health in the workforce. As part of the KEHP wellness program, incentives are available for members who do not use tobacco products, including monthly premium discounts for non-tobacco users. You, the primary planholder, are eligible for the monthly non-tobacco user rates if you certify that neither you nor any other person to be covered under your plan has regularly used tobacco within the past six months. Certification of tobacco use or non-use is accomplished by completing a Tobacco Use Declaration Form as part of your application for health insurance coverage through KEHP. Specifically, the question on the Tobacco Use Declaration Form asks: “Within the past six months, have you, or a spouse or dependent to be covered under your insurance plan, used tobacco regularly?  Yes  No.”

2. What does “used tobacco regularly” mean?

“Regularly” means you (or a spouse or dependent 18 years of age or older) has used tobacco four or more times per week on average excluding religious or ceremonial uses.

3. What is considered tobacco?

“Tobacco” means all tobacco products including, but not limited to, cigarettes, pipes, chewing tobacco, snuff, dip, and any other tobacco products regardless of the frequency or method of use. Electronic cigarettes are not considered a form of tobacco.

4. Who is considered a dependent for the Tobacco Use Declaration?

“Dependent” means, for the purpose of the Tobacco Use Declaration, only those dependents who are 18 years of age or older and covered under your plan.

5. When can I qualify for the monthly insurance premium discounts for non-tobacco users?

All KEHP members or prospective KEHP members have the opportunity to qualify for the monthly premium discounts for non-tobacco users upon application (new hires) for insurance coverage through KEHP and once each year at open enrollment (ongoing employees).

6. Can I change the tobacco use status during the plan year if I stop smoking?

Yes, provided all persons covered under your plan are non-tobacco users. KEHP Planholders certifying that there is a tobacco user covered under the Planholder’s insurance plan will be eligible for monthly discounted premium contribution rates provided all persons covered under the plan stop using tobacco products regularly (four or more times per week on average) during the plan year. In order to qualify for the monthly discounted premium contribution rates, the Planholder must sign a Tobacco Use Change Form certifying that neither the Planholder nor the Planholder’s spouse/dependent(s) regularly used tobacco products during the 6 months prior to completion of the Tobacco Use Declaration Form.

To the extent available, proof of completion of a tobacco cessation program or other proof of non-tobacco use will be required (i.e. proof of successful completion of the Cooper-Clayton Smoking Cessation program). The monthly discounted premium contribution rates will be applicable on the first of the month following the signature date on the Tobacco Use Change Form. See the Answer to Question #10 for more information on the tobacco cessations programs offered through KEHP.

7. What is the Tobacco Use Change Form?

The Tobacco Use Change Form is a form used to advise KEHP of any changes in Members’ tobacco use status that occur during the plan year. A member refers to each person covered under a KEHP insurance plan including employees and retirees and their spouses and dependents. Click this link to access the Tobacco Use Declaration Form.

8. What happens if I do not accurately declare the tobacco use for persons covered under my KEHP plan?

KEHP planholders who do not accurately declare the tobacco use for persons covered under their insurance plan will be required to pay the difference between the tobacco-user and the non-tobacco-user premium contribution rates on a retroactive basis for the period during which the planholder falsely certified eligibility for the non-tobacco-user monthly discounted premium contribution rates.

9. How can I get help to quit using tobacco?

KEHP has programs available to help you quit using tobacco such as the Cooper Clayton Smoking Cessation program or the Kentucky Tobacco Quit line. Through these programs, KEHP members can get over-the-counter Nicotine Replacement Therapy, without any cost (beginning 1/1/2014), for the life of the program. After the program is complete, members can continue to receive over-the-counter Nicotine Replacement Therapy without any cost if prescribed by a physician. In addition to the Cooper Clayton and the Quit Line programs, KEHP also offers a coaching program that will assist the member with designing a personal plan to decrease dependency on tobacco products and manage withdrawal and cravings that accompany tobacco use cessation.

10. What are the alternative standards available for those who are unable to meet the non-tobacco use standard?

Members who request a reasonable alternative standard must complete the HumanaVitality^® Health Assessment and enroll in the HumanaHealth Coaching program. Through HumanaHealth Coaching, the member is assigned a “coach” that will assist with designing a personal plan to decrease dependency on tobacco products and manage withdrawal and cravings that accompany tobacco use cessation. The coach will support the member as they go through the steps of ceasing to use tobacco. When the member completes their HumanaVitality^® Health Assessment, they will be given a goal and will have access to the HumanaHealth Coaching program. Members who are unable to satisfy or have completed the Health Assessment and Health Coaching alternative standard will be required to enroll in either the Cooper-Clayton smoking cessation program or the Kentucky Tobacco Quit Line program. Members who are unable to satisfy the Cooper-Clayton or Kentucky’s Tobacco Quit Line alternatives must contact DEI for other reasonable alternatives such as the assignment of a personal nurse for support, advice, and information regarding smoking cessation.

To the extent feasible and to the extent the member’s physician has joined in the request for a reasonable alternative standard, KEHP will provide the member an opportunity to comply with the recommendations of the personal physician as a reasonable alternative standard to meeting the non-tobacco use standard. In any event, each member seeking a reasonable alternative standard must complete the HumanaVitality^® Health Assessment. KEHP will work with you (and, if you wish, with your doctor) to find a wellness program with the same monthly reward that is right for you in light of your health status.

KHRIS ESS - Online Enrollment/Employee Self Service

1. How do I enroll through KHRIS ESS?

If you are an active employee, a KTRS retiree, or a KCTCS retiree, you can go to khris.ky.gov to log in and enroll for benefits. Click here for a quick KHRIS ESS guide.

2. What is my KHRIS user ID?

Your KHRIS user ID is a six-character identification provided to you in the KEHP Open Enrollment packet you should receive in late September. If you do not know your KHRIS ID, you can retrieve it by clicking “Forgot KHRIS User ID?” on the KHRIS login page at khris.ky.gov

3. How do I find my password?

You can go to khris.ky.gov and follow these steps:

• Click the “Forgot/Reset Password or New User” link.

• Enter your KHRIS user ID and click “Validate.” For security purposes, you must provide the following information: Last Name, Zip Code, Date of Birth, and Social Security Number. Click “Authenticate.” If your information has been validated, a temporary password displays. Write this down or copy it.

• Click “Exit.” Back at the main page khris.ky.gov, type your KHRIS user ID and temporary password.

• Click “Log On.” You will now be prompted to change the temporary password. Type your temporary password created above, create a new password, and confirm your new password by typing it again. Click “Change.”

4. I’m having trouble with KHRIS ESS after I have logged into the site. What do I need to do?

You can review the KHRIS technical requirements and make any necessary changes. Keep in mind these tips for accessing the Open Enrollment portion of KHRIS ESS:

• If your resolution is below 1280 X 960, some items may not fir on the screen

• It is not recommended for mobile devices (iPads, tablets, phones etc.)

• Install the most recent version of Adobe Reader to correctly view/display forms

• Please disable all pop-up blockers

• Please use the logout button at the top right to fully logout before closing the browser window with the X

KEHP Health and Wellness Programs

1. Where can I learn more about KEHP’s health and wellness programs?

Go to LivingWell.ky.gov to learn more about the many programs offered through KEHP. You can access information on HumanaVitality^®, Health Coaching, Healthy Kids, Mental and Stress Management, Nurse Support, Quitting Tobacco, Weight Management, Worksite Wellness and other programs.

2.What is HumanaVitality^®?

HumanaVitality^® is KEHP’s incentivized wellness program that allows you to earn points for rewards such as movie tickets, hotel stays, sports equipment and other items. Go to LivingWell.ky.gov for more details.

Affordable Care Act, kynect, Preventive Care and other Questions

1. What is the “Marketplace”?

In an effort to give individuals access to affordable, comprehensive health insurance coverage, the ACA established the Health Benefit Exchange or the “Marketplace.” The Marketplace offers one-stop-shopping for health insurance coverage. Through the Marketplace, individuals can shop, compare, and apply for coverage. They can also apply for premium tax credits that can be used to reduce the cost of coverage.

2. Is there a Marketplace in Kentucky?

Yes. Each state has a Marketplace. In Kentucky, the Marketplace is called kynect.

3. How can I contact kynect?

You may visit kynect for more information or contact kynect by phone at 1-855-4kynect.

4. Will employees eligible for coverage through KEHP be eligible for premium tax credits through the Marketplace?

No. If an employee has an offer of health coverage from their employer that meets certain affordability and minimum value standards, the employee will not be eligible for a tax credit through the Marketplace. KEHP will ensure that plan(s) available for participating groups will meet the affordability and the minimum value tests. It is likely that not all plans offered through KEHP will meet the test for every employee, but at least one plan that meets both tests will be available for every employee.

No employer action is required to ensure the coverage offered through KEHP meets the affordability and minimum value tests, provided the employer does not make any changes to the employer or employee contributions established by KEHP. If an employer group participating in KEHP offers employer or employee contributions different than those established by KEHP, the employer will need to conduct its own analysis to determine if the minimum essential coverage is affordable.

5. As a KEHP member, are my dependents or spouse eligible for a premium tax credits through the Marketplace?

No. If an employee has an offer of health coverage from their employer that meets certain affordability and minimum value standards, the employee’s dependents or spouse will not be eligible for a premium tax credit through the Marketplace.

6. Can I waive health insurance and buy coverage from the Marketplace?

Yes. However, if an employee has an offer of health coverage through KEHP from their employer, the employee will not be eligible for a tax credit through the Marketplace. Also, the employer premium contribution as well as the employee’s premium contribution is excluded from income for federal and state income tax purposes. Payments for coverage through the Marketplace are made on an after-tax basis.

Additionally, if you decide to waive KEHP coverage and purchase coverage through the Marketplace, you may not be eligible to enroll in the General Purpose Waiver HRA. In order to enroll in the General Purpose Waiver HRA, an employee must be enrolled in a group health plan that provides minimum value. Individual insurance coverage purchased through kynect is not “group health plan” coverage. For more information on your eligibility to enroll in the General Purpose Waiver HRA, please see the FAQs under “Waiving Health Insurance Coverage.”

7. What is preventive care and what is covered under the preventive care benefits?

Preventive care helps you stay healthy - it includes annual exams for children and adults, immunizations, and screenings such as mammograms and colonoscopies. In 2016, all four KEHP health plans will provide members with extensive preventive care benefits.

Coverage for children’s preventive health services will include autism screening, blood pressure screening, developmental screening, hearing and vision screening, immunization vaccines, and many other tests and screenings. For women, preventive services will include contraception, breastfeeding supplies and counseling, well-woman visits, breast cancer mammography screening, and many other tests, counseling, and screening services. For adults, preventive services include cholesterol screening, diabetes screening, depression screening, immunizations, obesity screening, diet counseling, and many other tests and preventive services. For a full listing of preventive services covered under the KEHP plans in 2016, please click here

8. Will I have to pay a co-payment, co-insurance, or deductible for preventive care?

No, in 2016, preventive care will be paid for under all four KEHP health plan options without any member cost sharing. That means KEHP members will be able to get preventive care without paying a co-payment, co-insurance, or a deductible for those services. To take advantage of the preventive care without cost-sharing, in-network providers must provide the preventive services.