Benefits Selection Guide - Kentucky Personnel Cabinet

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Changing or Canceling <strong>Benefits</strong>When You Need to Change or Cancel <strong>Benefits</strong>KEHP is operated as a federally regulated, Section 125 Cafeteria Plan which enables you to pay your healthinsurance premiums and your Flexible Spending Account contributions with pre-tax dollars. In exchange forthis benefit, there are only three times you can change or cancel your benefitelections during the plan year.During the enrollment period when you first becomeeligible for benefitsDuring the annual Open Enrollment periodIf you experience a life event, referred to as aQualifying EventWhat is a Qualifying Event?MarriageHaving or adopting a childDivorceLoss of other health insuranceLegal guardianship or court orderWhen you have a Qualifying EventIn all cases, any change in your plan option or coverage level must be consistent with the qualifying event.For most events, you must complete an Enrollment/Change Application and submit it to your InsuranceCoordinator or Human Resource Generalist within 35 calendar days. If you have a baby or adopt a child, youhave 60 calendar days unless adding additional dependents and then you have 35 days.Qualifying events are complicated and, at times, difficult to understand. There are restrictions on the typesof changes you may make due to federal qualifying event rules. A change in a life event or status may notentitle you to change the amount you contribute to a Flexible Spending Account. If you do not sign and datethe required form in a timely manner, you will not be permitted to revise your coverage election until thenext Open Enrollment period. For additional information about qualifying events, contact your InsuranceCoordinator or Human Resource Generalist.22
Flu ShotsAgain this year, KEHP is helping members live well through flu season by offering free flu shots from Sept. 1through Nov. 30, 2013.Free flu shots are available at all benefit fair locations on a first-come, first-served basis and at participatingprovider locations including some doctors’ offices, health clinics, retail pharmacies, local health departments,and other participating providers.Earn Vitality PointsEarn 200 Vitality Points for every KEHP member, 18 years of age and older, who gets a flu shot! Members0-17 years old who receive a flu shot will earn 100 Vitality Points.QuestionsCheck out the free flu shot FAQs and how to receive Vitality Points atLivingWell.ky.gov. If you have questions about HumanaVitality® or Vitality Points, call877-597-7474.Your prescription coverage is administered by Express Scripts Inc. and is included with all KEHP plan options.The amount you pay will depend on the plan option you select, and whether the prescribed drug is a tier 1generic, tier 2 formulary brand, or tier 3 non-formulary brand.Maintenance Drug BenefitPrescriptionsPurchasing a 90-day supply of maintenance drugs allows you to pay at a reduced cost. You may receive a90-day supply through Express Scripts mail order or through participating local retail pharmacies. A list oflocal participating pharmacies can be found at kehp.ky.gov. To qualify for this benefit, the drug must belisted on Express Scripts’ maintenance drug list. For more information, call Express Scripts at 877-597-7474.Formulary and Additional Pharmacy Coverage InformationYou may view the Express Scripts National Preferred Formulary for KEHP at kehp.ky.gov. The website alsoincludes the Pharmacy Summary Plan Descriptions, which provides additional information about priorauthorization, step therapy, quantity level limit programs, inherited metabolic diseases, CuraScript specialtypharmacy, and other pharmacy issues.23
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Benefits Selection Guide - Kentucky Personnel Cabinet

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