Benefits Selection Guide - Kentucky Personnel Cabinet

Waiver Dental/Vision Only HRAIf you are an eligible, active employee and choose to waive coverage and select the Dental/Vision OnlyHealth Reimbursement Account (HRA), your employer will contribute $175 per month, up to $2,100 per year,into your HRA account. You receive a HumanaAccess Visa® debit card pre-loaded to pay for qualified dentaland vision expenses. Any balance remaining in your HRA at the end of the calendar year will roll to the nextcalendar year, as long as you continue to waive your health insurance coverage and elect an HRA.Waiver Dental/Vision Only HRAExamples of covered servicesCertain dental fees such as cleanings, fillings, and crownsOrthodontic treatmentVision fees including contacts, eyeglasses, and laser vision correctionWho is Eligible for the Waiver Dental/ Vision Only HRAAny active employee of a state agency, school board, or certainquasi-agencies who is eligible for state-sponsored health insurance coverageA retiree who has returned to workNOTE: If you choose the Waiver Dental/Vision Only HRA through KEHP, yourMedicare coverage will be your primary health insurance plan.Who is Not EligibleAn employee of an agency that does not participate in KEHP's HRA/FSA programA retiree, under age 65 who has gone back to work and elected coverage under the retirement systemSubstantiating Waiver HRA andWaiver Dental/Vision Only HRA ClaimsHumana will not have access to your health insurance claims as a waiver ofhealth insurance. Therefore, you must submit documentation to verify yourHRA claim is an eligible expense. This documentation, such as an itemizedstatement from your provider or an explanation of benefits, is referred to assubstantiation.Submit the HRA/FSA Verification Form, which is found at kehp.ky.gov andmyhumana.com. You may mail or fax this information to Humana. Forquestions, call Humana Spending Account Administration at 800-604-6228.You have until March 31, 2015, to submit reimbursement requests for HRAexpenses incurred during your 2014 coverage period.19