RELATES TO:
KRS
16.505,
61.505,
61.510,
61.701,
61.702,
78.510,
78.5536,
26 U.S.C.
105,
106,
42 U.S.C.
1395y(b)
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
61.505(1)(g) authorizes the
Kentucky Public Pensions Authority to promulgate administrative regulations on
behalf of the Kentucky Retirement Systems and the County Employees Retirement
System that are consistent with
KRS
16.505 to
16.652,
61.510 to
61.705, and
78.510 to
78.852.
KRS
61.702 and
78.5536 provide for the systems
operated by the Kentucky Public Pensions Authority to offer group hospital and
medical insurance coverage to retired members and some spouses and dependents.
This administrative regulation establishes eligibility requirements,
procedures, and necessary documentation and forms for the reimbursement of
hospital and medical insurance benefit premiums paid by Medicare eligible
retired members who were reemployed in a position with a participating employer
and were informed by the Kentucky Retirement Systems or the Kentucky Public
Pensions Authority that they were not eligible for enrollment in an existing
group hospital and medical insurance plan through the Kentucky Public Pensions
Authority from January 1, 2009 through September 30, 2022.
Section 1. Definitions.
(1) "Agency" means:
(a) Prior to April 1, 2021, the Kentucky
Retirement Systems, which administered the State Police Retirement System, the
Kentucky Employees Retirement System, and the County Employees Retirement
System; and
(b) Beginning April 1,
2021, the Kentucky Public Pensions Authority, which is authorized to carry out
the day-to-day administrative needs of the Kentucky Retirement Systems
(comprised of the State Police Retirement System and the Kentucky Employees
Retirement System) and the County Employees Retirement System.
(2) "Boards" means the Board of
Trustees of the Kentucky Retirement Systems and the Board of Trustees of the
County Employees Retirement System.
(3) "Complete" means all required sections of
a form are filled out, the form has been fully executed by the recipient or the
recipient's legal representative, and all supporting documentation required by
the form is included with the form.
(4) "Eligible spouse and dependents" means
spouses and dependent children of MEMs who are eligible to receive all or a
portion of their premiums paid for by the Boards in accordance with
KRS
61.702 and
78.5536.
(5) "Employee" is defined by
KRS
61.510(5) and
78.510(6).
(6) "Employer" is defined by
KRS
16.505(3),
61.510(6), and
78.510(7).
(7) "File" means a form or document has been
received at the retirement office by mail, fax, secure email, in-person
delivery, or via Self Service on the Web site maintained by the agency (if
available).
(8) "KEHP" means the
Kentucky Employees' Health Plan as established in
101 KAR 2:210.
(9) "MEM" means:
(a) A Medicare eligible member who is retired
and reemployed in a position:
1. With a
participating employer that offers or offered the member a hospital and medical
insurance benefit; or
2. By a
participating employer which is or was prevented from offering a hospital and
medical benefit to the member as a condition of reemployment under
KRS
70.293,
95.022, or
164.952; and
(b) A Medicare eligible member who
is retired and whose spouse meets the following criteria:
1. The spouse is also a member.
2. The spouse is reemployed with a
participating employer that offers the spouse a hospital and medical insurance
benefit, or by a participating employer that is prevented from offering a
hospital and medical benefit to the spouse as a condition of reemployment under
KRS
70.293,
95.022, or
164.952.
3. The spouse's hospital and medical
insurance plan coverage is provided by the retired member's benefits pursuant
to KRS
61.702(2) and
78.5536(2).
(10) "Member" is
defined by KRS
16.505(21),
61.510(8), and
78.510(8).
(11) "Month" is defined by
KRS
16.505(34),
61.510(35), and
78.510(32).
(12) "Monthly contribution rate" means:
(a) The amount determined by the boards as
the maximum contribution the systems will pay toward the premium of a retired
member who began participating in the systems on or before June 30, 2003;
or
(b) For a retired member who
began participating in the system on or after July 1, 2003, the amount per
month earned by the retired member based on years of service as provided in
KRS
61.702(4)(e) and
78.5536(4)(e).
(13) "Premium" means the monthly
dollar amount required to provide hospital and medical insurance plan coverage
for a recipient, spouse of a retired member, or dependent child.
(14) "Provide", when used in reference to a
form or other document, means the agency makes a form or document available on
its Web site (if appropriate) or makes a form or document available to a person
by mail, fax, secure email, or via Self Service on the Web site maintained by
the agency (if available).
(15)
"Recipient" is defined by
KRS
16.505(26),
61.510(27), and
78.510(26).
(16) "Retired member" is defined by
KRS
16.505(11),
61.510(24), and
78.510(23).
(17) "Retirement allowance" is defined by
KRS
16.505(12),
61.510(16), and
78.510(16).
(18) "Retirement office" is defined by
KRS
16.505(28),
61.510(31), and
78.510(29).
(19) "Participating" is defined by
KRS
16.505(33),
61.510(34), and
78.510(31).
(20) "Service" is defined by
KRS
16.505(6),
61.510(9), and
78.510(9).
(21) "Systems" means the State Police
Retirement System, the Kentucky Employees Retirement System, and the County
Employees Retirement System.
Section
2. Group Hospital and Medical Insurance Plans Established for
MEMs. Beginning October 1, 2022, a KEHP group hospital and medical insurance
plan shall be available for MEMs and the eligible spouses and dependents of
MEMs in accordance with
KRS
61.702,
78.5536 and
42 U.S.C.
1395y(b).
Section 3. Eligibility for Reimbursement.
(1) A MEM who was informed by the agency that
he or she was not eligible for group hospital and medical insurance plan
coverage through the systems, and who paid premiums for a group hospital and
medical insurance plan for himself or herself as well as his or her eligible
spouse and dependents may request reimbursement for those premiums paid during
the time period from January 1, 2009 to September 30, 2022 as described in
Section 4 of this administrative regulation.
(a) MEMs shall not be eligible for
reimbursement for any portion of premiums paid for themselves, spouses, and
dependents on or after October 1, 2022, except as indicated in paragraph (b) of
this subsection.
(b) For calendar
year 2022 only, MEMs and eligible spouses and dependents of MEMs already
enrolled in a hospital and medical insurance plan other than a KEHP group
hospital and medical insurance plan may choose to remain on that plan through
December 31, 2022 and have his or her reimbursement eligibility period extended
to December 31, 2022.
(2) Payment of premiums for a group hospital
and medical insurance plan for MEMs and eligible spouses and dependents of MEMs
identified in subsection (1) of this section shall be reimbursed upon
submission of documentation as described in Section 4 of this administrative
regulation if all or a portion of the MEM, MEM's eligible spouse's or
dependent's group hospital and medical insurance coverage would have been paid
for by the Boards pursuant to
KRS
61.702 and
78.5536.
(3) A MEM shall not be eligible for
reimbursement of premiums paid by or on behalf of the MEM or his or her
eligible spouse or dependent if:
(a) The MEM
was not notified by the agency that he or she was ineligible for group hospital
and medical insurance plan coverage through the agency; and
(b) The MEM voluntarily chose to purchase or
enroll in a hospital and medical insurance plan not offered by the
agency.
Section
4. Request for Reimbursement.
(1)
The agency shall provide the Form 6260, Medicare Secondary Payer Application
for Medical Insurance Reimbursement, to eligible MEMs.
(2) A MEM may request reimbursement for
himself or herself, and any eligible spouse and dependents by filing Form 6260,
Medicare Secondary Payer Application for Medical Insurance Reimbursement, which
shall include all premiums for the entire time period for which the MEM is
requesting reimbursement.
(a) MEMs may begin
filing Form 6260, Medicare Secondary Payer Application for Medical Insurance
Reimbursement, on August 1, 2022.
(b) MEMs shall only file one (1) Form 6260,
Medicare Secondary Payer Application for Medical Insurance Reimbursement, for
each entity that provided hospital and medical insurance coverage for the MEM
and his or her eligible spouses and dependents.
(c) Form 6260, Medicare Secondary Payer
Application for Medical Insurance Reimbursement shall only be filed once MEMs
and MEM's eligible spouse or dependents are no longer paying premiums eligible
for reimbursement.
(3)
(a) In order to receive the applicable
reimbursement, MEMs shall file the completed Form 6260, Medicare Secondary
Payer Application for Medical Insurance Reimbursement, with one (1) or more of
the following proof of payment of premiums for hospital and medical insurance
coverage that covers the entire time period for the requested reimbursement:
1. The employer certification of health
insurance for medical reimbursement section of Form 6260, Medicare Secondary
Payer Application for Medical Insurance Reimbursement, completed by an employer
to certify premiums paid by the MEM;
2. The insurance agent certification of
health insurance for medical reimbursement section of Form 6260, Medicare
Secondary Payer Application for Medical Insurance Reimbursement, completed by
an insurance agency or company to certify the premiums paid by or on behalf of
the MEM;
3. A signed statement from
the MEM's employer listing dates of hospital and medical insurance coverage
amount of premiums deducted from wages and the cost of the single coverage;
or
4. A signed statement or invoice
from the MEM's insurance company listing the dates and cost of single hospital
and medical insurance coverage, along with proof of payment such as a receipt
or bank statement clearly indicating payment for the statement or invoice
provided.
(b) If any
provided documentation is deemed insufficient by the agency, the agency may
request additional proof of medical and hospital insurance coverage or
payment.
(4)
(a) A completed Form 6260, Medicare Secondary
Payer Application for Medical Insurance Reimbursement, shall be filed no later
than June 30, 2023.
(b) MEMs and
eligible spouses or dependents of MEMs for whom a completed Form 6260, Medicare
Secondary Payer Application for Medical Insurance Reimbursement, is not on file
on or before June 30, 2023 shall not be eligible for reimbursement, except as
provided by subsection (5) of this section.
(5)
(a) If
a MEM submits a Form 6260, Medicare Secondary Payer Application for Medical
Insurance Reimbursement, by the deadline indicated in subsection (4) of this
section that is not complete, then the MEM shall have until December 31, 2023
to file a completed Form 6260, including any documentation or proof of payments
for the time period the MEM is requesting reimbursement that were missing from
the initial incomplete Form 6260.
(b) MEMs and eligible spouses or dependents
of MEMs for whom a completed Form 6260, Medicare Secondary Payer Application
for Medical Insurance Reimbursement, is not on file on or before December 31,
2023 shall not be eligible for reimbursement.
(6)
(a) If
a MEM is deceased, the executor, administrator, or other representative of the
MEM's estate may request reimbursement for the MEM, and any eligible spouse or
dependents, by filing a Form 6260, Medicare Secondary Payer Application for
Medical Insurance Reimbursement, and all other required documentation at the
retirement office in compliance with this section.
(b) The executor, administrator, or other
representative of the MEM's estate shall also file an order appointing the
executor, administrator, or other representative of the MEM's estate from a
court with jurisdiction that has been entered by the Clerk of the Court or
certified by the Clerk of the Court.
(7) If the last day to file a completed Form
6260, Medicare Secondary Payer Application for Medical Insurance Reimbursement,
under this section is a Saturday, Sunday, a public holiday listed in
KRS
2.110, a day on which the retirement office
is actually and legally closed, or any other state or federal holiday that
disrupts mail service, then the deadline shall be satisfied if the completed
Form 6260 is on file by the end of the next business day.
Section 5. Funding. Pursuant to
KRS
61.701, fund assets shall be dedicated for
use toward health benefits, as provided in
KRS
61.702 and
78.5536, and as permitted under
26 U.S.C.
105 and
106 of the United States Internal
Revenue Code, to retired recipients and employees of employers participating in
the systems, including MEMs. Fund assets shall also be dedicated for use toward
eligible spouses and dependents of MEMs health benefits as provided in
KRS
61.702 and
78.5536. Fund assets shall be
used to reimburse eligible MEMs and eligible spouses and dependents of the
MEM.
Section 6. Authorized
Payments.
(1) The agency shall reimburse
premiums paid by a MEM or the spouse of a MEM for a MEM who meets the
eligibility requirements of Section 3 of this administrative regulation and the
MEM's eligible spouse and dependents for each month between January 1, 2009 and
September 30, 2022, except as provided in subsection (2) of this section:
(a) That are included on a timely-submitted,
completed Form 6260, Medicare Secondary Payer Application for Medical Insurance
Reimbursement, in compliance with Section 4 of this administrative regulation;
and
(b) Where documented proof of
payment of premiums was filed in compliance with Section 4 of this
administrative regulation.
(2) In the case of MEMs who choose to remain
on their current hospital and medical insurance plan through December 31, 2022
in accordance with paragraph (1)(b) of Section 3 of this administrative
regulation, the agency shall reimburse premiums paid by a MEM or the spouse of
a MEM for a MEM who meets the eligibility requirements of Section 3 of this
administrative regulation and the MEM's eligible spouse and dependents for each
month between January 1, 2009 and December 31, 2022:
(a) That are included on a timely-submitted,
completed Form 6260, Medicare Secondary Payer Application for Medical Insurance
Reimbursement, in compliance with Section 4 of this administrative regulation;
and
(b) Where documented proof of
payment of premiums was filed in compliance with Section 4 of this
administrative regulation.
(3) The amount the MEM or the estate of the
MEM shall receive for each month of premium reimbursements authorized by
subsection (1) or (2) of this section shall be the lesser of:
(a) The monthly contribution rate in effect
during the calendar year in which the premiums authorized for reimbursement
were paid by the MEM or the spouse of the MEM had the MEM been eligible to
enroll in the non-Medicare eligible group hospital and medical insurance plan
established in accordance with
KRS
61.702 and
78.5536; or
(b) The premiums paid by the MEM or the
spouse of the MEM for hospital and medical insurance coverage for the MEM and
his or her eligible spouse and dependents.
(4)
(a) The
applicable monthly contribution rate referenced in paragraph (3)(a) of this
section shall be based on the MEM's hazardous and nonhazardous
service.
(b) The applicable monthly
contribution rate referenced in paragraph (3)(a) of this section shall not
include the tobacco usage fee for the non-Medicare eligible group hospital and
medical insurance plan.
(5)
(a) If
a MEM or an estate of a MEM receives a payment from the agency that does not
qualify for reimbursement in accordance with this administrative regulation,
the MEM shall return the payment to the agency at the retirement
office.
(b) If the MEM or an estate
of a MEM fails to return the payment, the agency may withhold payment from the
MEM's monthly retirement allowance payment or take other action to collect on
the payment received in error.
Section 7. Incorporation by Reference.
(1) Form 6260, "Medicare Secondary Payer
Application for Medical Insurance Reimbursement", November 2022, is
incorporated by reference.
(2) This
material may be inspected, copied, or obtained, subject to applicable copyright
law, at the Kentucky Public Pensions Authority, 1260 Louisville Road,
Frankfort, Kentucky 40601, Monday through Friday, from 8:00 a.m. to 4:30 p.m.
This material is also available on the agency's Web site at
kyret.ky.gov.