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Medicare - Plan Year 2019

Humana 2019 Open Enrollment Seminars
2019 KRS Medicare Advantage Benefits Presentation

Humana 2019 KRS Comprehensive Drug Lists

Insurance Information for Percentage Contribution (participation prior to 7/1/2003)

At the September 13, 2018 KRS Board of Trustees meeting, the KRS Board of Trustees approved the contribution plan and the contribution rates for the Medicare KRS retiree health plans. The board chose the Humana Medicare Advantage Premium plan as the contribution plan with a maximum contribution rate of $252.51 for those retirees with 240 or more months of service. (Note-Premium calculation for percentage contribution is based on service credit for Hazardous Duty or Non-Hazardous Duty retirees or beneficiaries who began participation prior to 7/1/2003). 

The information on this page will help guide you in making a sound decision on what your insurance premium will cost you in 2019. 

WHERE CAN I FIND MORE INFORMATION?

Open Enrollment starts October 22 - November 30

Plan Year 2019 Open Enrollment information will be available on Humana's website humana.com/krs after November 6, 2018.  

Humana Open Enrollment Materials will be mailed October 12th to arrive in your home prior to Medicare Eligible Open Enrollment starting.

Humana 2019 KRS Comprehensive Drug Lists

2019 Changes

  • Medical Only Premium has increased to $175.22 per month (see table below)
  • Primary Care Physician Visits require a $15.00 co-pay for 2019 (this co-pay applies to the Max Out of Pocket, it does not apply to the deductible)
  • Specialist Physician Visits require a $25.00 co-pay for 2019  (this co-pay applies to the Max Out of Pocket, it does not apply to the deductible)

Note: Specialists co-payment applies to Medical Specialists, Chiropractic, Podiatry, Mental Health, Therapy In-Office and Advanced Imaging In-Office.  See your Medicare Eligible Open Enrollment Materials for more information. All member cost share (deductible, co-payments, and co-insurance) contribute to the Maximum Out of Pocket.

 

Hazardous Duty Retiree:

Yearly Requirement Due 11/30/2018 for Plan Year 2019

Hazardous duty retirees MUST submit a Form 6256  - Designation of Spouse and/or Dependent Child for Health Insurance Contribution. See FAQ's.  If you fail to submit the form by 12/31/2018 YOU WILL NOT RECEIVE PREMIUM CONTRIBUTIONS for your legal spouse or eligible dependents If you submit the form after Jan 1, you will only receive reimbursement of premiums for the 90 days prior to the receipt of the Form 6256  in Plan Year 2019. 

Example: If you submit the form June 3, 2019, you will receive reimbursement for March - May 2019

Note: The Humana Medicare Employer PPO plans (Essential, Premium) are Medicare Advantage plans.  You must have Medicare Parts A and B.  If you do not have Part B, your premium amount may be higher.  Please contact KRS if you have ​questions about this.  For example if you have 240 months (100%) of Service Credit-Contribution, elect the KRS Premium Plan, and do not have Medicare Part B, you would still have an additional premium payment of $62.78.​​​

 

2019 Medicare Plan/ Premiums Contributions
Available PlansMonthly Premium
Medical Only$175.22
KRS Essential$75.56
KRS Premium$252.51
2019 What KRS Pays Towards Your Premiums/Percentage Contribution
Service Credit% of Contributions Rate Paid by KRSAmound Paid by KRS
240 months or more100%$252.51
180-239 months75%$189.38
120-179 months50%$126.26
48-119 months25%$63.13
0-47 months0%$0

 

Dollar Contribution Rates Plan Year 2019

Is your Participation Date After July 1, 2003? 

See the Dollar Contribution Rates Below. 

If you began participating on or after July 1, 2003, please read the information below. If you have additional questions call KRS at 1-800-928-4646(Toll Free) or 502-696-8800(Frankfort). 

Use this guide if you are receiving benefits, were Hired July 1, 2003 or later, and began Participating with KRS between August 1, 2004 and August 31, 2008.* Or began Participating with KRS on or after September 1, 2008.**

*In order to be eligible for health insurance benefits, you must have 120 months of service upon retirement.

**In order to be eligible for health insurance benefits, you must have 180 months of service upon retirement.

For service in a non-hazardous position, you will receive a monthly dollar contribution of $13.38 for each year of service per month. The Dollar Contribution will increase by 1.5% on July 1st.

i.e. if you began participating September 1, 2003 in a nonhazardous position, and retired effective October 1, 2013, you would receive $133.80 per month towards health insurance premiums.

For service in a hazardous position, you will receive a monthly contribution of $20.07 for each year of service per month. The Dollar Contribution will increase by 1.5% on July 1st.

i.e. if you began participating September 1, 2003 in a hazardous position, and retired effective October 1, 2013 you would receive $200.70 per month towards health insurance premiums. 

If you have hazardous and non-hazardous service, you will receive contribution based on the amount of full years of service for each.

i.e. if you began participating September 1, 2003 in a non-hazardous position until September 30, 2008 (5 years x $13.38 = $66.90), and then began participating October 1, 2008 in a hazardous position, and retired effective November 1, 2013 (5 years x $20.07 = $100.35), you will receive $167.25 per month towards health insurance premiums ($66.90 + $100.35 = $167.25).

If you have a partial year of hazardous service and a partial year of non-hazardous service, they can be combined to equal a full year, you will receive 1 year of non-hazardous service.

i.e. if you have 9 years and 6 months of non-hazardous service and 6 months of hazardous service, your insurance contribution will be based on 10 years of non-hazardous service. You will receive $133.80 per month towards health insurance premiums.

If you are receiving a monthly retirement benefit, that qualifies you to receive a Health Insurance Percentage contribution and also receiving a monthly retirement benefit that qualifies you to receive a Health Insurance Dollar contribution, please contact the Retirement office for help calculating your cost.

How to Calculate your insurance cost if your participation date is after 7/1/2003

Hazardous Formula:

Service Credit-Dollar Contribution Level Amount ($20.07*) X Years of Service = Amount KRS Pays

Hazardous Example:

$20.07* X 10 (let's say you have 10 years of service for this example) = $200.70

Non-Hazardous Formula:

Service Credit-Dollar Contribution Level Amount ($13.38**) X Years of Service = Amount KRS Pays

Non-Hazardous Example:

$13.38** X 10 (let's say you have 10 years of service for this example) = $133.80​

Medicare Secondary Payer

Please be advised that under the Medicare Secondary Payer (MSP) Act, in certain circumstances, a Medicare eligible retiree's reemployment with a participating agency of Kentucky Retirement Systems will PROHIBIT Kentucky Retirement Systems from offering or continuing to offer retiree coverage under the Humana Medicare Advantage Plan.  PLease call KRS if you have questions.  You should also contact Medicare if you have questions. Need more details click here

 

Silver Sneakers can help you get fit the way you want by providing you access to fitness locations nationwide. Only retirees enrolled in the Medicare Advantage Essential or Premium plans may take advantage of the Silver Sneakers benefit.

GO365 Wellness and Reward Program        

 

Children Eligible for Coverage and Premium Contributions: 

For Plan Year 2019​, the spouse and each dependent child of retired hazardous members of KERS, CERS, and SPRS, as well as some disabled members, may be eligible to receive an insurance contribution based upon the retired member’s service. Pursuant to KRS 16.505(17), “Dependent child” means Dependent Eligibility & Verification for Health Insurance For Haza​​rdous Duty Retirees with Health Insurance Dependents child in the womb and a natural or legally adopted child of the member who has neither attained age eighteen (18) nor married or who is an unmarried full-time student who has not attained age twenty-two (22). Solely in the case of a member who dies as a direct result of an act in line of duty as defined in this section or who dies as a result of a duty-related injury as defined in KRS 61.621, “dependent child” also means a naturally or legally adopted disabled child of the member, regardless of the child’s age, if the child has been determined to be eligible for federal Social Security disability benefits or is being claimed as a qualifying child for tax purposes due to the child’s total and permanent disability;   (See 105 KAR 1:410). Retired members with children who do not meet this definition may be able to cover their children under the KEHP plan, but will not receive a contribution amount toward the coverage of those children.

Establishing Eligibility: To establish your child’s eligibility for the hazardous contribution toward health insurance for 2019, you must certify the child’s eligibility on a completed Form 6256, Designation of Spouse and/or Dependent Child for Health Insurance. This certification form must be completed annually to receive the contribution. If you submit the required certification and your child is an eligible “dependent child” pursuant to KRS 16.505(17), the contribution will be made for the applicable plan year. Additionally, you must certify that you will immediately provide KRS written notification when your child no longer qualifies. You will be required to reimburse KRS for premiums paid if you make a false or incorrect certification that a child meets the eligibility requirements or if you fail to immediately notify KRS when a child no longer meets the eligibility requirements.

Children Eligible for Coverage: Pursuant to the Affordable Care Act, children are eligible to remain covered by the parent or guardian’s health insurance until the first day of the month following their 26th birthday regardless of marital status. Step-children, foster children, and children for whom you have been named guardian may also remain on the plan until the first day of the month following their 26th birthday. (In some cases, disabled dependents can be carried past their 26th birthday.)

Spousal Coverage: If your spouse has health insurance under your account, a Form 6256, Designation of Spouse and/or Dependent Child for Health Insurance must be completed and submitted to KRS before the beginning of each plan year, or immediately following a qualifying event, for your spouse to receive the hazardous contribution toward health insurance for that plan year. If you divorce a spouse who is covered by health insurance under your KRS account, you must notify our office promptly. An ex-spouse is not eligible to remain on your plan. You must submit a new health insurance application with your ex-spouse removed (or a signed written statement to completely cancel a plan) to this office as soon as the divorce is final. A copy of the Dissolution of Marriage must be provided to KRS as soon as that is available. Without proper notification and documentation, you will be required to reimburse KRS for premiums paid on behalf of an ex-spouse who is no longer eligible for health insurance under your account.


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