Medicare - Plan Year 2025

​Effective January 1, 2025​​, individuals with the Dollar Contribution benefit for health insurance (retirees hired on or after July 1, 2003), are allowed to seek reimbursement from KPPA for health insurance coverage outside of KPPA insurance plans.

Example: ​You would be required to submit the Form 6280 - Application for Dollar Contribution Reimbursement for Medical Insurance​​ and either Form 6281 - ​Employer Certification of Health Insurance​for Dollar Contribution Reimbursement Plan​​​ ​or Form 6242 - Insurance Agent/Company Certification of Health Insurance for Health Insurance Reimbursement Plan. These forms, in addition to any required documentation, should be submitted ​in April 2025 for the months of January 1, 2025 - March 31, 2025. Review the Form 6280 instructions carefully to determine what forms and documentation are required for your situation.​​​

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 KPPA 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 KPPA between August 1, 2004 and August 31, 2008.* Or began participating with KPPA 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 nonhazardous position, you will receive a monthly dollar contribution of $14.63 for each year of service per month. The Dollar Contribution increased by 1.5% on July 1.

i.e. if you began participating September 1, 2003 in a nonhazardous position, and retired effective October 1, 2013, you would receive $146.30 per month towards health insurance premiums.

For service in a hazardous position, you will receive a monthly contribution of $21.94 for each year of service per month. The Dollar Contribution increased by 1.5% on July 1.

i.e. if you began participating September 1, 2003 in a hazardous position, and retired effective October 1, 2013 you would receive $219.40 per month towards health insurance premiums. 

If you have hazardous and nonhazardous 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 nonhazardous position until September 30, 2008 (5 years x $14.63 = $73.15), and then began participating October 1, 2008 in a hazardous position, and retired effective November 1, 2013 (5 years x $21.94= $109.70​​), you will receive $182.85 per month towards health insurance premiums ($73.15 + $109.70 = $182.85).

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

Please be advised that under the Medicare Secondary Payer Act (MSPA), in certain circumstances, a Medicare-eligible retiree's reemployment with a participating agency of the systems operated by the Kentucky Public Pensions Authority (KPPA) will prevent KPPA from offering enrollment into the KPPA Medicare Advantage Plan. However, Medicare-eligible retirees who are not able to enroll in the KPPA Medicare Advantage Plan may be eligible for enrollment in a plan designed for retirees affected by the MSPA effective October 1, 2022. If you have any questions about the health insurance options offered for retired members who are reemployed full-time with a participating employer, you may submit your questions in writing via email at kppa.mail@kyret.ky.gov. For questions about that, and all other questions about health insurance coverage offered through KPPA, you may also contact our office at (502) 696-8800 or 1-800-928-4646.

Children Eligible for Coverage and Premium Contributions: 

For ​Plan Year 2025​, 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 Kentucky Revised Statute 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 Kentucky Revised Statute 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 1:411). 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 2025​, 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 Kentucky Revised Statute 16.505(17), the contribution will be made for the applicable plan year. Additionally, you must certify that you will immediately provide KPPA written notification when your child no longer qualifies. You will be required to reimburse KPPA 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 KPPA 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.)