††††† 105 KAR 1:290. Medical insurance reimbursement plan.

 

††††† RELATES TO: KRS 61.702, 26 U.S.C. 105(b), 213(d)

††††† STATUTORY AUTHORITY: KRS 61.645(9)(g), 61.702(7)

††††† NECESSITY, FUNCTION, AND CONFORMITY: KRS 61.702(7) requires the Board of Trustees of the Kentucky Retirement Systems to promulgate an administrative regulation to establish a medical insurance reimbursement plan to reimburse hospital and medical insurance premiums of retirement allowance recipients living outside of Kentucky, who are not eligible for the same level of hospital and medical benefits as recipients living in Kentucky and having the same Medicare hospital and medical insurance eligibility status. This administrative regulation establishes eligibility requirements, necessary documentation for proof of insurance, deadlines for filing for reimbursement, and forms.

 

††††† Section 1. (1) The medical insurance reimbursement plan shall be available to a recipient who is:

††††† (a) Residing in another state; and

††††† (b) A retired member of the:

††††† 1. Kentucky Employees Retirement System;

††††† 2. County Employees Retirement System;

††††† 3. State Police Retirement System; or

††††† (c) The beneficiary of a retired member of the:

††††† 1. State Police Retirement System;

††††† 2. Kentucky Employees Retirement System hazardous member;

††††† 3. County Employees Retirement System hazardous member; or

††††† 4. General Assembly who had General Assembly service in a retirement system at Kentucky Retirement Systems; and

††††† (d) Not covered by a medical insurance for Medicare-eligible individuals while Kentucky Retirement Systems offers coverage for Medicare-eligible individuals with the same benefits as for those retired members living in Kentucky.

††††† (2) The reimbursement plan shall be available in any month the recipient is not eligible for:

††††† (a) Coverage at age sixty-five (65) under the contract for medical insurance for Medicare-eligible individuals maintained by the Board of Trustees, unless the individual has insurance coverage through a current employer or through a spouse's current employer;

††††† (b) In-network benefits through a health provider offered through the state group medical insurance administered by the Commonwealth of Kentucky; or

††††† (c) Coverage under an indemnity plan offered to and providing the same payments for medical services to retired members residing in Kentucky.

 

††††† Section 2. (1) The maximum monthly reimbursement rates for the following coverages shall be set by the board in accordance with KRS 61.702:

††††† (a) Coverage for one (1) individual;

††††† (b) Coverage for the recipient and one (1) or more dependents;

††††† (c) Coverage for the recipient and spouse; or

††††† (d) Coverage for the recipient, spouse and dependents.

††††† (2) The monthly reimbursement rate shall be reduced by the amount contributed by an employer or agency toward the recipientís medical insurance premium.

 

††††† Section 3. The retirement system shall notify recipients of their eligibility to participate in the medical insurance reimbursement plan:

††††† (1) Prior to initial payment of the retirement allowance;

††††† (2) When notified of a change of residence to another state in an area not covered by the state group medical insurance administered by the Commonwealth of Kentucky; and

††††† (3) Each open enrollment period for medical insurance coverage effective the following calendar year.

 

††††† Section 4. An eligible recipient shall file an Application for Medical Insurance Reimbursement, Form 6240, at the retirement office at least annually and when changing medical insurance company along with one (1) or more of the following as proof of payment for hospital and medical insurance premiums:

††††† (1) A copy of the invoice from the insurance company and copy of the receipt for payment;

††††† (2) A copy of the invoice from the insurance company and copy of the front and back of the cancelled check made out to the insurance company;

††††† (3) A copy of a pay stub if the pay stub clearly shows a deduction for hospital and medical insurance;

††††† (4) A statement from the employer listing dates and amounts of premiums deducted from wages;

††††† (5) A copy of a bank statement showing deductions for hospital and medical insurance if the statement clearly indicates payment to a company that provides only hospital and medical insurance;

††††† (6) A copy of a bank statement showing deductions to an insurance company along with a statement from the insurance company listing dates and amounts of premiums; or

††††† (7) Other documentation which the retirement system determines is sufficient to prove payment for hospital or medical insurance.

 

††††† Section 5. (1) Medical insurance premiums eligible for reimbursement shall be the premiums for hospital and medical coverage paid for by the eligible recipient.

††††† (2) The retirement office shall reimburse eligible recipients once each calendar year quarter. Eligible recipients shall submit proof of payment for hospital and medical insurance by the following dates for payment in the following month:

††††† (a) By April 20, for reimbursement in May;

††††† (b) By July 20, for reimbursement in August;

††††† (c) By October 20, for reimbursement in November; or

††††† (d) By January 20, for reimbursement in February.

††††† (3) The retirement system shall not reimburse eligible recipients for premiums paid in a calendar year if the Form 6240, Application for Medical Insurance Reimbursement and proof of payment for hospital and medical insurance premiums is received in the retirement office after March 20 of the following year.

 

††††† Section 6. The retirement system may verify the recipientís eligibility for reimbursement for hospital and medical insurance by requesting verification of coverage and payments directly from the insurance company indicated on the Form 6240, Application for Medical Insurance Reimbursement.

 

††††† Section 7. (1) If a recipient receives a payment from the retirement system which does not qualify as a medical insurance premium reimbursement, the recipient shall return the payment to the retirement system.

††††† (2) If the recipient fails to return the payment within thirty (30) days of notification by the retirement office, the retirement office shall deduct the amount from the recipientís future monthly retirement allowance or medical insurance premium reimbursements due from the retirement system.

 

††††† Section 8. Incorporation by Reference. (1) The Application for Medical Insurance Reimbursement, Form 6240 (Rev. 8/01), is incorporated by reference.

††††† (2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Kentucky Retirement Systems, Perimeter Park West, 1260 Louisville Road, Frankfort, Kentucky 40601-6124, Monday through Friday, 8 a.m. to 4:30 p.m. (27 Ky.R. 1113; Am. 1447; eff. 12-21-2000; 28 Ky.R. 914; 1352; eff. 12-19-2001; 29 Ky.R. 774; eff. 11-12-02.)