{ "document_id": 13522, "filename": "KEHP_2025_BSG.pdf", "engine": "paddleocr_vl", "source_run_id": 13633, "generated_at": "2026-11-03T19:19:51+00:00", "page_count": 44, "counts_by_type": { "caption": 4, "figure": 15, "footer": 43, "footnote": 20, "form_field": 4, "header": 5, "heading": 133, "link": 183, "list": 36, "list_item": 152, "table": 17, "table_cell": 541, "text": 327, "title": 11 }, "timings": { "total_ms": 27955, "structure_ms": 3667, "text_layer_ms": 168, "build_ms": 275 }, "pages": [ { "document_id": 13522, "page": 1, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 8, "counts_by_type": { "figure": 1, "footer": 4, "heading": 2, "text": 1 }, "build_ms": 0, "items": [ { "id": "p1.1", "order": 1, "type": "figure", "bbox": { "l": 0.96, "t": 612, "r": 792, "b": 217.68 }, "text": "", "attrs": { "block_label": "image" }, "reading_order": 0 }, { "id": "p1.2", "order": 2, "type": "heading", "bbox": { "l": 35.28, "t": 322.8, "r": 332.64, "b": 226.08 }, "text": "Your 2025 Benefits Selection Guide from the Personnel Cabinet", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 1 }, { "id": "p1.3", "order": 3, "type": "heading", "bbox": { "l": 32.88, "t": 158.88, "r": 355.44, "b": 140.4 }, "text": "Open enrollment is October 7 – October 25, 2024", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 2 }, { "id": "p1.4", "order": 4, "type": "text", "bbox": { "l": 42, "t": 113.04, "r": 497.04, "b": 59.28 }, "text": "LivingWell Promise for 2025:\nAll planholders must take the Castlight Health Assessment.\nThis Benefits Selection Guide is published annually, before Open Enrollment, to help you make benefit choices.\nThis guide can be used throughout 2025 for new employees and when there is a qualifying event that permits a benefit change.", "reading_order": 3 }, { "id": "p1.5", 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20\nSurgical Care and Support 20\nCarrum Health 20\nTelehealth and Phone Support 20\nTelehealth through the LivingWell Health Clinic 20\nTelehealth through LiveHealth Online 20\nTelehealth through providers other than mentioned above 21\n24/7 NurseLine 21\nTobacco Cessation 21\nOver the Counter and Prescription Medications 21\nFreedom from Smoking 21\nQuit Now Kentucky 21", "attrs": { "block_label": "content" }, "children": [ { "id": "p2.2.1", "order": 3, "type": "link", "bbox": { "l": 36, "t": 523.628, "r": 77.8106, "b": 510.571 }, "text": "Welcome", "attrs": { "action_type": "/Named" }, "reading_order": 0 }, { "id": "p2.2.2", "order": 4, "type": "link", "bbox": { "l": 36, "t": 507.128, "r": 159.968, "b": 494.071 }, "text": "Open Enrollment Highlights", "attrs": { "action_type": "/Named" }, "reading_order": 1 }, { "id": "p2.2.3", "order": 5, "type": "link", "bbox": { "l": 36, "t": 490.628, "r": 190.866, "b": 477.571 }, "text": "What’s New or Changing for 2025!", "attrs": { 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"37", "attrs": { "action_type": "/Named" }, "reading_order": 55 }, { "id": "p2.3.57", "order": 117, "type": "link", "bbox": { "l": 744.239, "t": 64.6279, "r": 756.162, "b": 51.571 }, "text": "38", "attrs": { "action_type": "/Named" }, "reading_order": 56 } ], "reading_order": 2 }, { "id": "p2.4", "order": 118, "type": "link", "bbox": { "l": 376.74, "t": 160.628, "r": 376.74, "b": 147.571 }, "text": "", "attrs": { "action_type": "/Named" }, "reading_order": 3 }, { "id": "p2.5", "order": 119, "type": "footer", "bbox": { "l": 34.56, "t": 29.76, "r": 42.96, "b": 19.2 }, "text": "2", "attrs": { "block_label": "number" }, "reading_order": 4 } ] }, { "document_id": 13522, "page": 3, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 12, "counts_by_type": { "figure": 1, "footer": 1, "heading": 1, "link": 1, "text": 8 }, "build_ms": 1, "items": [ { "id": "p3.1", "order": 1, "type": "heading", "bbox": { "l": 34.32, "t": 495.12, "r": 164.16, "b": 467.28 }, "text": "Welcome", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p3.2", "order": 2, "type": "text", "bbox": { "l": 33.36, "t": 403.44, "r": 378.48, "b": 325.44 }, "text": "This Benefits Selection Guide (BSG) is available to review when making benefit\nselections for you and your family. It is published annually, to help you make\nbenefit choices during Open Enrollment. You can also use this guide to select\nbenefits as a new employee or if you experience a qualifying event during the year.\nIt is very important that you thoroughly read this guide, so you are aware of the\nmany benefits that are available to you.", "reading_order": 1 }, { "id": "p3.3", "order": 3, "type": "text", "bbox": { "l": 33.84, "t": 313.44, "r": 356.64, "b": 288.48 }, "text": "Pay close attention to the important information you will need to review while making your benefit elections:", "reading_order": 2 }, { "id": "p3.4", "order": 4, "type": "text", "bbox": { "l": 42, "t": 283.92, "r": 269.52, "b": 272.64 }, "text": "• Health, dental, vision, and life insurance plan options", "reading_order": 3 }, { "id": "p3.5", "order": 5, "type": "text", "bbox": { "l": 43.2, "t": 267.36, "r": 97.44, "b": 256.08 }, "text": "Premiums", "reading_order": 4 }, { "id": "p3.6", "order": 6, "type": "text", "bbox": { "l": 42.96, "t": 250.56, "r": 107.52, "b": 239.04 }, "text": "Benefit grids", "reading_order": 5 }, { "id": "p3.7", "order": 7, "type": "text", "bbox": { "l": 42.72, "t": 233.76, "r": 189.6, "b": 221.76 }, "text": "• Flexible Spending Accounts (FSA)", "reading_order": 6 }, { "id": "p3.8", "order": 8, "type": "text", "bbox": { "l": 42.96, "t": 216.24, "r": 157.2, "b": 204.48 }, "text": "Waiving health insurance", "reading_order": 7 }, { "id": "p3.9", "order": 9, "type": "text", "bbox": { "l": 33.6, "t": 190.32, "r": 373.92, "b": 138.96 }, "text": "It's your choice to select the benefits that are best for you. Neither the Kentucky Employees' Health Plan (KEHP) nor your employer can make this decision for you. If you have questions, refer to the Contact Information on page 33 to find who can best answer your question.", "children": [ { "id": "p3.9.1", "order": 10, "type": "link", "bbox": { "l": 273.527, "t": 164.3, "r": 306.756, "b": 152.79 }, "text": "page 33", "attrs": { "action_type": "/Named" }, "reading_order": 0 } ], "reading_order": 8 }, { "id": "p3.10", "order": 11, "type": "figure", "bbox": { "l": 395.28, "t": 611.28, "r": 790.56, "b": 0 }, "text": "", "attrs": { "block_label": "image", "embedded_text": "3" }, "reading_order": 9 }, { "id": "p3.11", "order": 12, "type": "footer", "bbox": { "l": 749.28, "t": 30.24, "r": 756.48, "b": 19.68 }, "text": "3", "attrs": { "block_label": "number" }, "reading_order": 10 } ] }, { "document_id": 13522, "page": 4, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 35, "counts_by_type": { "footer": 1, "heading": 8, "link": 1, "list": 3, "list_item": 11, "text": 11 }, "build_ms": 4, "items": [ { "id": "p4.1", "order": 1, "type": "heading", "bbox": { "l": 34.32, "t": 577.44, "r": 321.6, "b": 552 }, "text": "Open Enrollment Highlights", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p4.2", "order": 2, "type": "heading", "bbox": { "l": 33.6, "t": 536.4, "r": 279.36, "b": 523.2 }, "text": "Health Insurance Premiums and Benefits", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 1 }, { "id": "p4.3", "order": 3, "type": "text", "bbox": { "l": 42.96, "t": 521.04, "r": 368.88, "b": 486 }, "text": "There are four health plan options to choose from for 2025. The new plan is a High Deductible Health Plan (HDHP). More information about this new plan is on page 8.", "children": [ { "id": "p4.3.1", "order": 4, "type": "link", "bbox": { "l": 66.7098, "t": 497.737, "r": 93.9998, "b": 486.707 }, "text": "page 8.", "attrs": { "action_type": "/Named" }, "reading_order": 0 } ], "reading_order": 2 }, { "id": "p4.4", "order": 5, "type": "text", "bbox": { "l": 42.72, "t": 482.4, "r": 374.88, "b": 459.84 }, "text": "There will be no employee increase in health insurance premium contributions for 2025.", "reading_order": 3 }, { "id": "p4.5", "order": 6, "type": "text", "bbox": { "l": 42.72, "t": 455.52, "r": 365.52, "b": 432.24 }, "text": "There will be no changes to co-pays, co-insurance, deductibles, or maximum out-of-pocket amounts.", "reading_order": 4 }, { "id": "p4.6", "order": 7, "type": "heading", "bbox": { "l": 34.32, "t": 422.4, "r": 176.4, "b": 409.2 }, "text": "Dental and Vision Plans", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 5 }, { "id": "p4.7", "order": 8, "type": "text", "bbox": { "l": 41.76, "t": 406.8, "r": 309.12, "b": 395.04 }, "text": "There will be no increase in dental or vision premiums in 2025.", "reading_order": 6 }, { "id": "p4.8", "order": 9, "type": "heading", "bbox": { "l": 34.32, "t": 385.44, "r": 120.96, "b": 372.72 }, "text": "Life Insurance", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 7 }, { "id": "p4.9", "order": 10, "type": "text", "bbox": { "l": 41.76, "t": 369.84, "r": 337.92, "b": 358.08 }, "text": "There will be no changes to optional life insurance premiums in 2025.", "reading_order": 8 }, { "id": "p4.10", "order": 11, "type": "text", "bbox": { "l": 42.48, "t": 354.48, "r": 359.76, "b": 330.48 }, "text": "During Open Enrollment you can add or increase optional life insurance for yourself or your spouse without a Statement of Health.", "reading_order": 9 }, { "id": "p4.11", "order": 12, "type": "text", "bbox": { "l": 33.6, "t": 323.52, "r": 356.88, "b": 273.12 }, "text": "Although you can make changes to life insurance on your dependent children (under age 26) at any time during the year, Open Enrollment is a good time to evaluate your insurance needs and whether you need to add or increase life insurance on your dependents.", "reading_order": 10 }, { "id": "p4.12", "order": 13, "type": "text", "bbox": { "l": 33.84, "t": 267.84, "r": 345.12, "b": 229.68 }, "text": "You can also enroll in life insurance if you are a new employee or if you have a life-changing event, such as gaining a new child, getting married, or getting divorced.", "reading_order": 11 }, { "id": "p4.13", "order": 14, "type": "heading", "bbox": { "l": 407.52, "t": 536.64, "r": 502.32, "b": 523.44 }, "text": "Don't Miss Out!", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 12 }, { "id": "p4.14", "order": 15, "type": "text", "bbox": { "l": 406.08, "t": 521.28, "r": 735.84, "b": 493.2 }, "text": "You must take action to take advantage of certain benefits available to you. Mandatory enrollment is required if you want:", "reading_order": 13 }, { "id": "p4.15", "order": 16, "type": "list", "bbox": { "l": 415.44, "t": 489.84, "r": 635.76, "b": 446.64 }, "text": "", "attrs": { "item_count": 3 }, "children": [ { "id": "p4.15.1", "order": 17, "type": "list_item", "bbox": { "l": 416.4, "t": 489.84, "r": 563.04, "b": 478.32 }, "text": "the Waiver General Purpose HRA,", "reading_order": 0 }, { "id": "p4.15.2", "order": 18, "type": "list_item", "bbox": { "l": 415.92, "t": 474.48, "r": 604.32, "b": 462.48 }, "text": "a Healthcare Flexible Spending Account, or", "marker": "•", "reading_order": 1 }, { "id": "p4.15.3", "order": 19, "type": "list_item", "bbox": { "l": 415.44, "t": 458.88, "r": 635.76, "b": 446.64 }, "text": "a Child & Adult Daycare Flexible Spending Account.", "marker": "•", "reading_order": 2 } ], "reading_order": 14 }, { "id": "p4.16", "order": 20, "type": "text", "bbox": { "l": 407.04, "t": 438.96, "r": 721.2, "b": 403.2 }, "text": "Your failure to affirmatively enroll in these benefits will result in the loss of benefits and carryover funds, see sections on these benefits for additional information.", "reading_order": 15 }, { "id": "p4.17", "order": 21, "type": "heading", "bbox": { "l": 407.52, "t": 396.48, "r": 570.72, "b": 383.76 }, "text": "Other Enrollment Circumstances", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 16 }, { "id": "p4.18", "order": 22, "type": "heading", "bbox": { "l": 408.24, "t": 379.68, "r": 492, "b": 367.44 }, "text": "You MUST enroll if:", "level": 3, "reading_order": 17 }, { "id": "p4.19", "order": 23, "type": "list", "bbox": { "l": 415.68, "t": 363.84, "r": 707.76, "b": 293.76 }, "text": "", "attrs": { "item_count": 4 }, "children": [ { "id": "p4.19.1", "order": 24, "type": "list_item", "bbox": { "l": 415.68, "t": 363.84, "r": 621.12, "b": 351.84 }, "text": "You want to change your health insurance plan.", "reading_order": 0 }, { "id": "p4.19.2", "order": 25, "type": "list_item", "bbox": { "l": 415.92, "t": 348.24, "r": 577.92, "b": 336.48 }, "text": "You want to add or drop dependents.", "reading_order": 1 }, { "id": "p4.19.3", "order": 26, "type": "list_item", "bbox": { "l": 415.92, "t": 332.64, "r": 634.56, "b": 320.88 }, "text": "You want to change or elect a dental or vision plan.", "reading_order": 2 }, { "id": "p4.19.4", "order": 27, "type": "list_item", "bbox": { "l": 416.64, "t": 317.52, "r": 707.76, "b": 293.76 }, "text": "You want to change or elect an optional life insurance plan for you or your dependents.", "reading_order": 3 } ], "reading_order": 18 }, { "id": "p4.20", "order": 28, "type": "text", "bbox": { "l": 407.04, "t": 285.6, "r": 738.96, "b": 261.36 }, "text": "Although you may not be required to re-enroll, we encourage you to review your plan options and ensure that the plan you currently have still meets your needs.", "reading_order": 19 }, { "id": "p4.21", "order": 29, "type": "heading", "bbox": { "l": 408, "t": 253.68, "r": 523.44, "b": 241.92 }, "text": "You don't have to enroll if:", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 20 }, { "id": "p4.22", "order": 30, "type": "list", "bbox": { "l": 415.68, "t": 238.08, "r": 753.36, "b": 154.8 }, "text": "", "attrs": { "item_count": 4 }, "children": [ { "id": "p4.22.1", "order": 31, "type": "list_item", "bbox": { "l": 415.68, "t": 238.08, "r": 642.96, "b": 226.08 }, "text": "You want to keep your current health insurance plan.", "reading_order": 0 }, { "id": "p4.22.2", "order": 32, "type": "list_item", "bbox": { "l": 416.16, "t": 222, "r": 726.96, "b": 209.76 }, "text": "You currently have a Waiver Limited Purpose HRA and you want to keep it.", "marker": "•", "reading_order": 1 }, { "id": "p4.22.3", "order": 33, "type": "list_item", "bbox": { "l": 415.92, "t": 206.16, "r": 753.36, "b": 170.16 }, "text": "You are a Kentucky Public Pension Authority (KPPA) or Teachers' Retirement System (TRS) retiree under the age of 65 who returned to work and want to keep your current health insurance plan with your active employer.", "marker": "•", "reading_order": 2 }, { "id": "p4.22.4", "order": 34, "type": "list_item", "bbox": { "l": 416.4, "t": 167.04, "r": 686.64, "b": 154.8 }, "text": "You want to keep your current dental and vision insurance plan.", "reading_order": 3 } ], "reading_order": 21 }, { "id": "p4.23", "order": 35, "type": "footer", "bbox": { "l": 35.04, "t": 29.52, "r": 43.44, "b": 19.44 }, "text": "4", "attrs": { "block_label": "number" }, "reading_order": 22 } ] }, { "document_id": 13522, "page": 5, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 18, "counts_by_type": { "figure": 2, "footer": 1, "heading": 2, "table": 1, "table_cell": 10, "text": 2 }, "build_ms": 1, "items": [ { "id": "p5.1", "order": 1, "type": "heading", "bbox": { "l": 33.6, "t": 577.68, "r": 322.08, "b": 552 }, "text": "Open Enrollment Highlights", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p5.2", "order": 2, "type": "heading", "bbox": { "l": 33.6, "t": 536.88, "r": 113.04, "b": 523.44 }, "text": "Benefit Fairs", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 1 }, { "id": "p5.3", "order": 3, "type": "text", "bbox": { "l": 32.88, "t": 522, "r": 456, "b": 509.04 }, "text": "You can choose to attend one of the five in-person benefit fairs below, or view pre-recorded webinars.", "reading_order": 2 }, { "id": "p5.4", "order": 4, "type": "figure", "bbox": { "l": 545.04, "t": 558.24, "r": 588.24, "b": 516.72 }, "text": "", "attrs": { "block_label": "image" }, "reading_order": 3 }, { "id": "p5.5", "order": 5, "type": "text", "bbox": { "l": 600.48, "t": 555.36, "r": 739.68, "b": 515.76 }, "text": "Scan the QR code to be directed to the Open Enrollment information site.", "reading_order": 4 }, { "id": 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"id": "p5.6.5", "order": 11, "type": "table_cell", "bbox": { "l": 616.468, "t": 485.3175, "r": 654.2079, "b": 472.2605 }, "text": "Tuesday", "attrs": { "row": 0, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "reading_order": 4 }, { "id": "p5.6.6", "order": 12, "type": "table_cell", "bbox": { "l": 36, "t": 409.56, "r": 178.8, "b": 330.24 }, "text": "October 1Russell CountyRussell County AuditoriumNataratorium Complex2167 US 127Russell Springs, KY 426422:00 p.m. to 6:00 p.m. CST", "attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1 }, "reading_order": 5 }, { "id": "p5.6.7", "order": 13, "type": "table_cell", "bbox": { "l": 178.8, "t": 409.56, "r": 321.6, "b": 330.24 }, "text": "October 2Franklin CountyKY State Office Building Auditorium501 High StreetFrankfort, KY 406018:00 a.m. to 6:00 p.m. EST", "attrs": { "row": 1, "col": 1, "rowspan": 1, "colspan": 1 }, "reading_order": 6 }, { "id": "p5.6.8", "order": 14, "type": "table_cell", "bbox": { "l": 321.6, "t": 409.56, "r": 464.4, "b": 330.24 }, "text": "October 3Daviess CountyOwensboro Board Of Education450 Griffith AvenueOwensboro, KY 423012:00 p.m. to 6:00 p.m. CST", "attrs": { "row": 1, "col": 2, "rowspan": 1, "colspan": 1 }, "reading_order": 7 }, { "id": "p5.6.9", "order": 15, "type": "table_cell", "bbox": { "l": 464.4, "t": 409.56, "r": 607.2, "b": 330.24 }, "text": "October 4Hopkins CountyHopkins County Career & Tech Center1775 Patriot DriveMadisonville, KY 424312:00 p.m. to 6:00 p.m. CST", "attrs": { "row": 1, "col": 3, "rowspan": 1, "colspan": 1 }, "reading_order": 8 }, { "id": "p5.6.10", "order": 16, "type": "table_cell", "bbox": { "l": 607.2, "t": 409.56, "r": 750, "b": 330.24 }, "text": "October 8Pike CountyPike County Central High School Cafeteria100 Winners Circle DrivePikeville, KY 415012:00 p.m. to 6:00 p.m. EST", "attrs": { "row": 1, "col": 4, "rowspan": 1, "colspan": 1 }, "reading_order": 9 } ], "reading_order": 5 }, { "id": "p5.7", "order": 17, "type": "figure", "bbox": { "l": 34.32, "t": 301.68, "r": 757.2, "b": 36 }, "text": "", "attrs": { "block_label": "image" }, "reading_order": 6 }, { "id": "p5.8", "order": 18, "type": "footer", "bbox": { "l": 748.32, "t": 30.72, "r": 757.68, "b": 19.68 }, "text": "5", "attrs": { "block_label": "number" }, "reading_order": 7 } ] }, { "document_id": 13522, "page": 6, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 16, "counts_by_type": { "figure": 1, "footer": 1, "heading": 5, "link": 3, "text": 5, "title": 1 }, "build_ms": 1, "items": [ { "id": "p6.1", "order": 1, "type": "title", "bbox": { "l": 33.36, "t": 577.92, "r": 395.76, "b": 553.44 }, "text": "What's New or Changing for 2025!", "attrs": { "block_label": "doc_title" }, "level": 2, "reading_order": 0 }, { "id": "p6.2", "order": 2, "type": "heading", "bbox": { "l": 33.6, "t": 536.64, "r": 128.4, "b": 523.68 }, "text": "New Plan Option", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 1 }, { "id": "p6.3", "order": 3, "type": "text", "bbox": { "l": 32.64, "t": 521.52, "r": 379.92, "b": 473.52 }, "text": "The LivingWell High Deductible Health Plan (HDHP) is the new Plan Option for 2025. This is a catastrophic-type of coverage. You may benefit from this Plan if you have a Health Savings Account (HSA) not from KEHP. Read more information under Health Insurance on page 8.", "children": [ { "id": "p6.3.1", "order": 4, "type": "link", "bbox": { "l": 224.277, "t": 497.5, "r": 378.445, "b": 485.99 }, "text": "Read more information under Health", "attrs": { "action_type": "/Named" }, "reading_order": 0 }, { "id": "p6.3.2", "order": 5, "type": "link", "bbox": { "l": 36, "t": 486.17, "r": 92.1891, "b": 474.3 }, "text": "Insurance on", "attrs": { "action_type": "/Named" }, "reading_order": 1 }, { "id": "p6.3.3", "order": 6, "type": "link", "bbox": { "l": 92.1891, "t": 486.17, "r": 121.149, "b": 474.3 }, "text": "page 8.", "attrs": { "action_type": "/Named" }, "reading_order": 2 } ], "reading_order": 2 }, { "id": "p6.4", "order": 7, "type": "heading", "bbox": { "l": 33.12, "t": 456.24, "r": 289.44, "b": 442.8 }, "text": "Fill Specialty Drugs at any Specialty Pharmacy", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 3 }, { "id": "p6.5", "order": 8, "type": "text", "bbox": { "l": 32.88, "t": 440.64, "r": 381.84, "b": 380.64 }, "text": "Specialty drugs are no longer required to be filled through CVS Specialty Pharmacy. Members can obtain specialty drugs at any in-network specialty pharmacy, including CVS Specialty Pharmacy. The same cost share (either a copay or deductible/coinsurance depending on plan option) will apply at either CVS or non-CVS Specialty pharmacies.", "reading_order": 4 }, { "id": "p6.6", "order": 9, "type": "heading", "bbox": { "l": 407.04, "t": 536.4, "r": 469.2, "b": 524.16 }, "text": "PrudentRx", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 5 }, { "id": "p6.7", "order": 10, "type": "text", "bbox": { "l": 405.6, "t": 521.28, "r": 738.72, "b": 484.8 }, "text": "The PrudentRx program is no longer available to KEHP members due to recent changes to law. Members are encouraged to research and apply copay cards or drug cost assistance cards when they pick up covered drugs at the pharmacy.", "reading_order": 6 }, { "id": "p6.8", "order": 11, "type": "heading", "bbox": { "l": 407.04, "t": 467.52, "r": 544.32, "b": 455.28 }, "text": "Default Plan - New Hires", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 7 }, { "id": "p6.9", "order": 12, "type": "text", "bbox": { "l": 405.84, "t": 452.16, "r": 746.64, "b": 427.92 }, "text": "New employees who fail to enroll in a health plan within 30 days of their hire date will be automatically enrolled in the Waiver without HRA.", "reading_order": 8 }, { "id": "p6.10", "order": 13, "type": "heading", "bbox": { "l": 406.8, "t": 410.64, "r": 587.28, "b": 397.2 }, "text": "Flexible Spending Account (FSA)", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 9 }, { "id": "p6.11", "order": 14, "type": "text", "bbox": { "l": 406.56, "t": 394.08, "r": 753.36, "b": 359.76 }, "text": "The amount you can contribute to a Healthcare Flexible Spending Account will increase to $3,200 per year. The carryover maximum will increase to $640 per year from 2025 to 2026.", "reading_order": 10 }, { "id": "p6.12", "order": 15, "type": "figure", "bbox": { "l": 34.32, "t": 335.04, "r": 755.76, "b": 34.8 }, "text": "", "attrs": { "block_label": "image" }, "reading_order": 11 }, { "id": "p6.13", "order": 16, "type": "footer", "bbox": { "l": 34.8, "t": 30, "r": 42.48, "b": 20.64 }, "text": "6", "attrs": { "block_label": "number" }, "reading_order": 12 } ] }, { "document_id": 13522, "page": 7, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 37, "counts_by_type": { "footer": 1, "heading": 4, "text": 32 }, "build_ms": 4, "items": [ { "id": "p7.1", "order": 1, "type": "heading", "bbox": { "l": 34.8, "t": 576, "r": 213.36, "b": 555.12 }, "text": "Health Insurance", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p7.2", "order": 2, "type": "text", "bbox": { "l": 33.36, "t": 537.36, "r": 366, "b": 447.12 }, "text": "The Kentucky Employees' Health Plan (KEHP) offers four health insurance plan options. The new plan option for 2025 is the LivingWell HDHP, which is a high-deductible health plan. Review the details below to see which plan option is best for you and your family. There are more plan specifics in this guide and in the Medical Benefit Booklet for each plan.", "reading_order": 1 }, { "id": "p7.3", "order": 3, "type": "heading", "bbox": { "l": 34.32, "t": 433.44, "r": 126.96, "b": 420.96 }, "text": "LivingWell CDHP", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 2 }, { "id": "p7.4", "order": 4, "type": "text", "bbox": { "l": 33.12, "t": 419.28, "r": 370.32, "b": 395.04 }, "text": "Do you want to pay lower premiums and receive money in an HRA to help reduce your deductible? The LivingWell CDHP may be the plan for you.", "reading_order": 3 }, { "id": "p7.5", "order": 5, "type": "text", "bbox": { "l": 42.24, "t": 391.68, "r": 246, "b": 379.68 }, "text": "It's the best value of the plans offered by KEHP.", "reading_order": 4 }, { "id": "p7.6", "order": 6, "type": "text", "bbox": { "l": 42.48, "t": 375.36, "r": 366.96, "b": 363.36 }, "text": "It is recommended for those who have a little or a lot of healthcare expenses.", "reading_order": 5 }, { "id": "p7.7", "order": 7, "type": "text", "bbox": { "l": 42.96, "t": 358.56, "r": 360.72, "b": 334.08 }, "text": "All covered services, except for certain items like preventive care and a few specific prescriptions, are subject to the deductible.", "reading_order": 6 }, { "id": "p7.8", "order": 8, "type": "text", "bbox": { "l": 43.2, "t": 329.76, "r": 370.56, "b": 305.04 }, "text": "Once you meet the deductible, the plan will pay 80% of covered expenses and you will pay a 20% co-insurance.", "reading_order": 7 }, { "id": "p7.9", "order": 9, "type": "text", "bbox": { "l": 42.96, "t": 300.96, "r": 359.76, "b": 276 }, "text": "Both your medical and pharmacy expenses apply to the deductible and the maximum out-of-pocket.", "reading_order": 8 }, { "id": "p7.10", "order": 10, "type": "text", "bbox": { "l": 42, "t": 271.68, "r": 375.6, "b": 246.96 }, "text": "Once your maximum out-of-pocket is met, your covered medical and pharmacy claims will be paid at 100%.", "reading_order": 9 }, { "id": "p7.11", "order": 11, "type": "text", "bbox": { "l": 34.32, "t": 240.24, "r": 359.76, "b": 227.76 }, "text": "You will receive HRA funds through a HealthEquity debit VISA Healthcare Card.", "reading_order": 10 }, { "id": "p7.12", "order": 12, "type": "text", "bbox": { "l": 42.48, "t": 224.16, "r": 366, "b": 199.44 }, "text": "The card is pre-funded with $500 if you have single coverage, or $1,000 if you have couple, parent-plus, or family coverage levels.", "reading_order": 11 }, { "id": "p7.13", "order": 13, "type": "text", "bbox": { "l": 42.96, "t": 195.36, "r": 351.36, "b": 170.88 }, "text": "Use the HRA funds to help pay for your co-insurance, which reduces your deductible.", "reading_order": 12 }, { "id": "p7.14", "order": 14, "type": "text", "bbox": { "l": 42.48, "t": 166.56, "r": 367.68, "b": 129.12 }, "text": "Use this card at your doctor's office, hospital, or pharmacy. Simply swipe the card to help pay for your eligible expenses, which will be deducted from your card balance.", "reading_order": 13 }, { "id": "p7.15", "order": 15, "type": "text", "bbox": { "l": 42.96, "t": 124.8, "r": 374.88, "b": 100.32 }, "text": "You can also use this card to pay for eligible vision and dental expenses. These expenses do not reduce your deductible.", "reading_order": 14 }, { "id": "p7.16", "order": 16, "type": "text", "bbox": { "l": 42.48, "t": 96.48, "r": 377.04, "b": 83.28 }, "text": "• Your HRA funds may roll over to a subsequent year, up to a maximum of $7,500.", "reading_order": 15 }, { "id": "p7.17", "order": 17, "type": "heading", "bbox": { "l": 407.52, "t": 536.88, "r": 491.76, "b": 524.16 }, "text": "LivingWell PPO", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 16 }, { "id": "p7.18", "order": 18, "type": "text", "bbox": { "l": 406.8, "t": 522.96, "r": 728.64, "b": 497.76 }, "text": "Are you willing to pay more in premiums to limit your out-of-pocket costs to a co-payment for certain services? The LivingWell PPO may be the plan for you.", "reading_order": 17 }, { "id": "p7.19", "order": 19, "type": "text", "bbox": { "l": 415.92, "t": 495.12, "r": 745.44, "b": 469.92 }, "text": "- Co-pays apply to doctor's office visits, allergy serum, allergy shots, urgent care centers, and non-specialty prescriptions.", "reading_order": 18 }, { "id": "p7.20", "order": 20, "type": "text", "bbox": { "l": 416.16, "t": 466.32, "r": 738.72, "b": 441.36 }, "text": "An emergency room co-pay, plus your deductible and then co-insurance, will apply when you use an emergency room.", "reading_order": 19 }, { "id": "p7.21", "order": 21, "type": "text", "bbox": { "l": 416.16, "t": 437.28, "r": 614.4, "b": 424.8 }, "text": "Your co-pays will not apply to your deductible.", "reading_order": 20 }, { "id": "p7.22", "order": 22, "type": "text", "bbox": { "l": 415.92, "t": 420.24, "r": 753.36, "b": 396 }, "text": "Your co-pays will apply to your maximum out-of-pocket. Once your out-of-pocket is met, no other co-pays apply.", "reading_order": 21 }, { "id": "p7.23", "order": 23, "type": "text", "bbox": { "l": 415.92, "t": 391.68, "r": 714.48, "b": 379.2 }, "text": "Most expenses are subject to the deductible and then covered at 75%.", "reading_order": 22 }, { "id": "p7.24", "order": 24, "type": "text", "bbox": { "l": 416.16, "t": 374.88, "r": 752.16, "b": 337.2 }, "text": "This plan has two maximum out-of-pocket amounts — one for medical expenses and the other for prescription expenses. They accumulate separately, which means you may pay more out of your pocket depending on your expenses.", "reading_order": 23 }, { "id": "p7.25", "order": 25, "type": "heading", "bbox": { "l": 407.52, "t": 328.08, "r": 532.08, "b": 315.36 }, "text": "LivingWell Basic CDHP", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 24 }, { "id": "p7.26", "order": 26, "type": "text", "bbox": { "l": 407.28, "t": 314.16, "r": 755.04, "b": 289.44 }, "text": "How about more basic health insurance coverage and lower premiums, and an HRA to help reduce your deductible? LivingWell Basic CDHP is just that.", "reading_order": 25 }, { "id": "p7.27", "order": 27, "type": "text", "bbox": { "l": 415.68, "t": 286.32, "r": 604.56, "b": 274.08 }, "text": "This is basic coverage for a lower premium.", "reading_order": 26 }, { "id": "p7.28", "order": 28, "type": "text", "bbox": { "l": 415.68, "t": 270, "r": 708.48, "b": 257.76 }, "text": "You will pay 30% for covered services after you meet your deductible.", "reading_order": 27 }, { "id": "p7.29", "order": 29, "type": "text", "bbox": { "l": 415.44, "t": 252.96, "r": 755.52, "b": 240.72 }, "text": "Both your medical and pharmacy expenses apply to the maximum out-of-pocket.", "reading_order": 28 }, { "id": "p7.30", "order": 30, "type": "text", "bbox": { "l": 415.92, "t": 236.64, "r": 750.24, "b": 212.16 }, "text": "Once your maximum out-of-pocket is met, your covered medical and pharmacy claims will be paid at 100%.", "reading_order": 29 }, { "id": "p7.31", "order": 31, "type": "text", "bbox": { "l": 407.28, "t": 205.2, "r": 732.72, "b": 192.72 }, "text": "You will receive HRA funds through a HealthEquity debit VISA Healthcare Card.", "reading_order": 30 }, { "id": "p7.32", "order": 32, "type": "text", "bbox": { "l": 416.16, "t": 189.6, "r": 753.12, "b": 164.4 }, "text": "The card is pre-funded with $250 if you have single coverage, or $500 if you have couple, parent-plus, or family coverage levels.", "reading_order": 31 }, { "id": "p7.33", "order": 33, "type": "text", "bbox": { "l": 415.92, "t": 160.56, "r": 745.68, "b": 148.08 }, "text": "Use the HRA to help pay for your co-insurance, which reduces your deductible.", "reading_order": 32 }, { "id": "p7.34", "order": 34, "type": "text", "bbox": { "l": 415.44, "t": 143.76, "r": 742.32, "b": 107.04 }, "text": "Use this card at your doctor's office, hospital, or pharmacy. Simply swipe the card to help pay for your eligible expenses, which will be deducted from your card balance.", "reading_order": 33 }, { "id": "p7.35", "order": 35, "type": "text", "bbox": { "l": 415.92, "t": 102.72, "r": 748.08, "b": 77.52 }, "text": "You can also use this card to pay for eligible vision and dental expenses. These expenses do not reduce your deductible.", "reading_order": 34 }, { "id": "p7.36", "order": 36, "type": "text", "bbox": { "l": 415.44, "t": 73.68, "r": 750.48, "b": 60.72 }, "text": "• Your HRA funds may roll over to a subsequent year, up to a maximum of $7,500.", "reading_order": 35 }, { "id": "p7.37", "order": 37, "type": "footer", "bbox": { "l": 750, "t": 30.24, "r": 756.96, "b": 21.36 }, "text": "7", "attrs": { "block_label": "number" }, "reading_order": 36 } ] }, { "document_id": 13522, "page": 8, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 23, "counts_by_type": { "figure": 1, "footer": 1, "heading": 3, "list": 1, "list_item": 9, "text": 8 }, "build_ms": 2, "items": [ { "id": "p8.1", "order": 1, "type": "heading", "bbox": { "l": 35.04, "t": 576.24, "r": 213.12, "b": 555.12 }, "text": "Health Insurance", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p8.2", "order": 2, "type": "heading", "bbox": { "l": 34.56, "t": 536.88, "r": 177.84, "b": 523.44 }, "text": "New Plan Option for 2025", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 1 }, { "id": "p8.3", "order": 3, "type": "heading", "bbox": { "l": 34.32, "t": 517.68, "r": 289.44, "b": 504.48 }, "text": "LivingWell High Deductible Health Plan (HDHP)", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 2 }, { "id": "p8.4", "order": 4, "type": "text", "bbox": { "l": 33.84, "t": 503.52, "r": 365.28, "b": 479.04 }, "text": "Do you want to pay lower premiums in exchange for higher out-of-pocket costs? The LivingWell HDHP may be the plan for you.", "reading_order": 3 }, { "id": "p8.5", "order": 5, "type": "list", "bbox": { "l": 42.24, "t": 475.44, "r": 375.84, "b": 206.88 }, "text": "", "attrs": { "item_count": 9 }, "children": [ { "id": "p8.5.1", "order": 6, "type": "list_item", "bbox": { "l": 42.72, "t": 475.44, "r": 362.16, "b": 451.44 }, "text": "This is a catastrophic-type of health plan, with higher deductibles and lower premiums.", "reading_order": 0 }, { "id": "p8.5.2", "order": 7, "type": "list_item", "bbox": { "l": 43.2, "t": 446.4, "r": 349.92, "b": 422.4 }, "text": "It is recommended for those who expect to have lower overall healthcare expenses and only need preventive care.", "reading_order": 1 }, { "id": "p8.5.3", "order": 8, "type": "list_item", "bbox": { "l": 43.44, "t": 417.84, "r": 369.12, "b": 393.6 }, "text": "If you have a Health Savings Account (HSA), you can use it with this plan. HSAs are not available through KEHP.", "marker": "•", "reading_order": 2 }, { "id": "p8.5.4", "order": 9, "type": "list_item", "bbox": { "l": 43.2, "t": 388.56, "r": 249.6, "b": 377.04 }, "text": "You don't have to have an HSA to elect this plan.", "reading_order": 3 }, { "id": "p8.5.5", "order": 10, "type": "list_item", "bbox": { "l": 43.2, "t": 371.76, "r": 340.08, "b": 348 }, "text": "All covered services, except for qualified preventive care are subject to the deductible.", "marker": "-", "reading_order": 4 }, { "id": "p8.5.6", "order": 11, "type": "list_item", "bbox": { "l": 42.48, "t": 343.2, "r": 375.84, "b": 293.76 }, "text": "Unlike other KEHP plan offerings, the HDHP does not have separate single and family deductibles accumulating simultaneously; only one deductible will apply (\"single\" if single-only coverage or the higher \"family\" deductible if any other option is elected).", "marker": "-", "reading_order": 5 }, { "id": "p8.5.7", "order": 12, "type": "list_item", "bbox": { "l": 43.2, "t": 289.2, "r": 371.04, "b": 264.24 }, "text": "Once you meet the deductible, the plan will pay 70% of covered expenses and you will pay a 30% co-insurance.", "reading_order": 6 }, { "id": "p8.5.8", "order": 13, "type": "list_item", "bbox": { "l": 43.44, "t": 260.16, "r": 359.52, "b": 235.68 }, "text": "Both your medical and pharmacy expenses apply to the deductible and the maximum out-of-pocket.", "reading_order": 7 }, { "id": "p8.5.9", "order": 14, "type": "list_item", "bbox": { "l": 42.24, "t": 231.12, "r": 374.88, "b": 206.88 }, "text": "Once your maximum out-of-pocket is met, your covered medical and pharmacy claims will be paid at 100%.", "reading_order": 8 } ], "reading_order": 4 }, { "id": "p8.6", "order": 15, "type": "text", "bbox": { "l": 34.08, "t": 199.2, "r": 367.44, "b": 174.48 }, "text": "Many complementary benefits offered under the other three health plan options are not covered under the HDHP, including:", "reading_order": 5 }, { "id": "p8.7", "order": 16, "type": "text", "bbox": { "l": 43.2, "t": 170.88, "r": 115.2, "b": 159.84 }, "text": "• Carrum Health", "reading_order": 6 }, { "id": "p8.8", "order": 17, "type": "text", "bbox": { "l": 42.96, "t": 154.8, "r": 108.72, "b": 143.28 }, "text": "Hinge Health", "reading_order": 7 }, { "id": "p8.9", "order": 18, "type": "text", "bbox": { "l": 42.96, "t": 138, "r": 154.8, "b": 126.48 }, "text": "LivingWell Health Clinics", "reading_order": 8 }, { "id": "p8.10", "order": 19, "type": "text", "bbox": { "l": 42.96, "t": 121.44, "r": 127.2, "b": 110.16 }, "text": "LiveHealth Online", "reading_order": 9 }, { "id": "p8.11", "order": 20, "type": "text", "bbox": { "l": 42.96, "t": 105.12, "r": 121.44, "b": 93.6 }, "text": "UK Acupuncture", "reading_order": 10 }, { "id": "p8.12", "order": 21, "type": "text", "bbox": { "l": 34.08, "t": 85.68, "r": 378, "b": 60.96 }, "text": "However, some of the above services may be available to you once your deductible for the plan year is met.", "reading_order": 11 }, { "id": "p8.13", "order": 22, "type": "figure", "bbox": { "l": 416.88, "t": 608.88, "r": 756.48, "b": 69.36 }, "text": "", "attrs": { "block_label": "image" }, "reading_order": 12 }, { "id": "p8.14", "order": 23, "type": "footer", "bbox": { "l": 34.8, "t": 29.28, "r": 42.24, "b": 20.88 }, "text": "8", "attrs": { "block_label": "number" }, "reading_order": 13 } ] }, { "document_id": 13522, "page": 9, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 140, "counts_by_type": { "footer": 1, "heading": 1, "table": 1, "table_cell": 137 }, "build_ms": 30, "items": [ { "id": "p9.1", "order": 1, "type": "heading", "bbox": { "l": 35.28, "t": 577.92, "r": 173.76, "b": 554.64 }, "text": "Benefits Grid", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p9.2", "order": 2, "type": "table", "bbox": { "l": 35.04, "t": 548.64, "r": 758.4, "b": 72.16489999999999 }, "text": "", "attrs": { "block_label": "table", "n_rows": 18, "n_cols": 9, "integrity": { "cells_checked": 137, "cells_flagged": 0 } }, "children": [ { "id": "p9.2.1", "order": 3, "type": "table_cell", "bbox": { "l": 67.4269, "t": 537.5482, "r": 128.6335, "b": 520.6502 }, "text": "Plan Options", "attrs": { "row": 0, "col": 0, "rowspan": 2, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "reading_order": 0 }, { "id": "p9.2.2", "order": 4, "type": "table_cell", "bbox": { "l": 210.0056, "t": 543.6205, "r": 265.3546, "b": 531.5505 }, "text": "LivingWell CDHP", "attrs": { "row": 0, "col": 1, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "reading_order": 1 }, { "id": "p9.2.3", "order": 5, "type": "table_cell", "bbox": { "l": 363.5557, "t": 543.6205, "r": 414.2047, "b": 531.5505 }, "text": "LivingWell PPO", "attrs": { "row": 0, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "reading_order": 2 }, { "id": "p9.2.4", "order": 6, "type": "table_cell", "bbox": { "l": 494.3409, "t": 543.6205, "r": 570.6989, "b": 531.5505 }, "text": "LivingWell Basic CDHP", "attrs": { "row": 0, "col": 3, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "reading_order": 3 }, { "id": "p9.2.5", "order": 7, "type": "table_cell", "bbox": { "l": 652.2431, "t": 543.6205, "r": 706.4331, "b": 531.5505 }, "text": "LivingWell HDHP", "attrs": { "row": 0, "col": 4, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "reading_order": 4 }, { "id": "p9.2.6", "order": 8, "type": "table_cell", "bbox": { "l": 41.22, "t": 523.3132, "r": 214.2227, "b": 497.2059 }, "text": "In-Network\nLifetime Maximum", "attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 5 }, { "id": "p9.2.7", "order": 9, "type": "table_cell", "bbox": { "l": 251.0788, "t": 523.3132, "r": 468.6091, "b": 498.26189999999997 }, "text": "Out-of-Network\nUnlimited", "attrs": { "row": 1, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 6 }, { "id": "p9.2.8", "order": 10, "type": "table_cell", "bbox": { "l": 333.2588, "t": 523.3132, "r": 368.3039, "b": 512.4502 }, "text": "In-Network", "attrs": { "row": 1, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 7 }, { "id": "p9.2.9", "order": 11, "type": "table_cell", "bbox": { "l": 398.6801, "t": 523.3132, "r": 447.6023, "b": 512.4502 }, "text": "Out-of-Network", "attrs": { "row": 1, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 8 }, { "id": "p9.2.10", "order": 12, "type": "table_cell", "bbox": { "l": 480.3976, "t": 523.3132, "r": 515.4427, "b": 512.4502 }, "text": "In-Network", "attrs": { "row": 1, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 9 }, { "id": "p9.2.11", "order": 13, "type": "table_cell", "bbox": { "l": 544.7388, "t": 523.3132, "r": 593.661, "b": 512.4502 }, "text": "Out-of-Network", "attrs": { "row": 1, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 10 }, { "id": "p9.2.12", "order": 14, "type": "table_cell", "bbox": { "l": 624.0464, "t": 523.3132, "r": 659.0915, "b": 512.4502 }, "text": "In-Network", "attrs": { "row": 1, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 11 }, { "id": "p9.2.13", "order": 15, "type": "table_cell", "bbox": { "l": 692.6451, "t": 523.3132, "r": 741.5673, "b": 512.4502 }, "text": "Out-of-Network", "attrs": { "row": 1, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 12 }, { "id": "p9.2.14", "order": 16, "type": "table_cell", "bbox": { "l": 41.22, "t": 494.0689, "r": 53.721, "b": 483.20590000000004 }, "text": "HRA", "attrs": { "row": 2, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 13 }, { "id": "p9.2.15", "order": 17, "type": "table_cell", "bbox": { "l": 202.885, "t": 492.9979, "r": 272.4754, "b": 484.26189999999997 }, "text": "Single 500; Family 1,000", "attrs": { "row": 2, "col": 1, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 14 }, { "id": "p9.2.16", "order": 18, "type": "table_cell", "bbox": { "l": 379.7682, "t": 492.9979, "r": 397.9922, "b": 484.26189999999997 }, "text": "No HRA", "attrs": { "row": 2, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 15 }, { "id": "p9.2.17", "order": 19, "type": "table_cell", "bbox": { "l": 500.1609, "t": 492.9979, "r": 564.8793, "b": 484.26189999999997 }, "text": "Single 250; Family 500", "attrs": { "row": 2, "col": 3, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 16 }, { "id": "p9.2.18", "order": 20, "type": "table_cell", "bbox": { "l": 620.9031, "t": 492.9979, "r": 737.7719, "b": 484.26189999999997 }, "text": "No HRA. Can use a non-KEHP HSA with this plan.", "attrs": { "row": 2, "col": 4, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 17 }, { "id": "p9.2.19", "order": 21, "type": "table_cell", "bbox": { "l": 41.22, "t": 476.04769999999996, "r": 97.7922, "b": 465.1847 }, "text": "Annual Deductible", "attrs": { "row": 3, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 18 }, { "id": "p9.2.20", "order": 22, "type": "table_cell", "bbox": { "l": 178.6606, "t": 479.7579, "r": 214.7398, "b": 461.4595 }, "text": "Single 1,500\\nFamily 2,750", "attrs": { "row": 3, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 19 }, { "id": "p9.2.21", "order": 23, "type": "table_cell", "bbox": { "l": 257.5006, "t": 479.7579, "r": 293.5798, "b": 461.4595 }, "text": "Single 2,750\\nFamily 5,250", "attrs": { "row": 3, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 20 }, { "id": "p9.2.22", "order": 24, "type": "table_cell", "bbox": { "l": 332.7419, "t": 479.7579, "r": 368.8211, "b": 461.4595 }, "text": "Single 1,000\\nFamily 1,750", "attrs": { "row": 3, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 21 }, { "id": "p9.2.23", "order": 25, "type": "table_cell", "bbox": { "l": 405.1019, "t": 479.7579, "r": 441.1811, "b": 461.4595 }, "text": "Single 1,750\\nFamily 3,250", "attrs": { "row": 3, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 22 }, { "id": "p9.2.24", "order": 26, "type": "table_cell", "bbox": { "l": 479.8806, "t": 479.7579, "r": 515.9598, "b": 461.4595 }, "text": "Single 2,000\\nFamily 3,750", "attrs": { "row": 3, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 23 }, { "id": "p9.2.25", "order": 27, "type": "table_cell", "bbox": { "l": 551.1606, "t": 479.7579, "r": 587.2398, "b": 461.4595 }, "text": "Single 3,250\\nFamily 6,250", "attrs": { "row": 3, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 24 }, { "id": "p9.2.26", "order": 28, "type": "table_cell", "bbox": { "l": 622.1254, "t": 479.7579, "r": 661.0126, "b": 461.4595 }, "text": "Single 2,000 ^{{*}}\\nFamily 4,000 ^{{*}}", "attrs": { "row": 3, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 25 }, { "id": "p9.2.27", "order": 29, "type": "table_cell", "bbox": { "l": 699.0668, "t": 479.7579, "r": 735.146, "b": 461.4595 }, "text": "Single 4,000\\nFamily 8,000", "attrs": { "row": 3, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 26 }, { "id": "p9.2.28", "order": 30, "type": "table_cell", "bbox": { "l": 41.22, "t": 451.00530000000003, "r": 94.6611, "b": 432.1423 }, "text": "Annual Maximum Out-of-Pocket", "attrs": { "row": 4, "col": 0, "rowspan": 2, "colspan": 1, "bbox_refit": true }, "reading_order": 27 }, { "id": "p9.2.29", "order": 31, "type": "table_cell", "bbox": { "l": 196.7533, "t": 456.95550000000003, "r": 278.6069, "b": 448.21950000000004 }, "text": "Applies to Medical and Pharmacy", "attrs": { "row": 4, "col": 1, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 28 }, { "id": "p9.2.30", "order": 32, "type": "table_cell", "bbox": { "l": 366.1647, "t": 456.95550000000003, "r": 411.5959, "b": 448.21950000000004 }, "text": "Applies to Medical", "attrs": { "row": 4, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 29 }, { "id": "p9.2.31", "order": 33, "type": "table_cell", "bbox": { "l": 491.5933, "t": 456.95550000000003, "r": 573.4469, "b": 448.21950000000004 }, "text": "Applies to Medical and Pharmacy", "attrs": { "row": 4, "col": 3, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 30 }, { "id": "p9.2.32", "order": 34, "type": "table_cell", "bbox": { "l": 638.4108, "t": 456.95550000000003, "r": 720.2644, "b": 448.21950000000004 }, "text": "Applies to Medical and Pharmacy", "attrs": { "row": 4, "col": 4, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 31 }, { "id": "p9.2.33", "order": 35, "type": "table_cell", "bbox": { "l": 178.6606, "t": 443.7155, "r": 580.0741, "b": 410.7033 }, "text": "Single 3,000\\nFamily 5,750\nDeductibles and Maximum Out-of-Pocket for In-Network and Out-of-Network providers accumulate separately and do not cross-apply", "attrs": { "row": 5, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 32 }, { "id": "p9.2.34", "order": 36, "type": "table_cell", "bbox": { "l": 255.7726, "t": 443.7155, "r": 295.3078, "b": 425.4171 }, "text": "Single 5,750\\nFamily 11,250", "attrs": { "row": 5, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 33 }, { "id": "p9.2.35", "order": 37, "type": "table_cell", "bbox": { "l": 332.7419, "t": 443.7155, "r": 368.8211, "b": 425.4171 }, "text": "Single 3,000\\nFamily 5,750", "attrs": { "row": 5, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 34 }, { "id": "p9.2.36", "order": 38, "type": "table_cell", "bbox": { "l": 403.3739, "t": 443.7155, "r": 442.9091, "b": 425.4171 }, "text": "Single 5,750\\nFamily 11,250", "attrs": { "row": 5, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 35 }, { "id": "p9.2.37", "order": 39, "type": "table_cell", "bbox": { "l": 479.8806, "t": 443.7155, "r": 515.9598, "b": 425.4171 }, "text": "Single 4,000\\nFamily 7,750", "attrs": { "row": 5, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 36 }, { "id": "p9.2.38", "order": 40, "type": "table_cell", "bbox": { "l": 549.4326, "t": 443.7155, "r": 588.9678, "b": 425.4171 }, "text": "Single 7,750\\nFamily 11,250", "attrs": { "row": 5, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 37 }, { "id": "p9.2.39", "order": 41, "type": "table_cell", "bbox": { "l": 621.8014, "t": 443.7155, "r": 661.3366, "b": 425.4171 }, "text": "Single 8,050\\nFamily 16,100", "attrs": { "row": 5, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 38 }, { "id": "p9.2.40", "order": 42, "type": "table_cell", "bbox": { "l": 697.3389, "t": 443.7155, "r": 736.8741, "b": 425.4171 }, "text": "Single 16,100\\nFamily 32,200", "attrs": { "row": 5, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 39 }, { "id": "p9.2.41", "order": 43, "type": "table_cell", "bbox": { "l": 41.22, "t": 402.2453, "r": 81.8901, "b": 391.3823 }, "text": "Co-Insurance", "attrs": { "row": 6, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 40 }, { "id": "p9.2.42", "order": 44, "type": "table_cell", "bbox": { "l": 179.0323, "t": 405.95550000000003, "r": 214.3683, "b": 387.6571 }, "text": "Plan: 80%\\nMember: 20%", "attrs": { "row": 6, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 41 }, { "id": "p9.2.43", "order": 45, "type": "table_cell", "bbox": { "l": 257.8723, "t": 405.95550000000003, "r": 293.2083, "b": 387.6571 }, "text": "Plan: 50%\\nMember: 50%", "attrs": { "row": 6, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 42 }, { "id": "p9.2.44", "order": 46, "type": "table_cell", "bbox": { "l": 333.1136, "t": 405.95550000000003, "r": 368.4496, "b": 387.6571 }, "text": "Plan: 75%\\nMember: 25%", "attrs": { "row": 6, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 43 }, { "id": "p9.2.45", "order": 47, "type": "table_cell", "bbox": { "l": 405.4736, "t": 405.95550000000003, "r": 440.8096, "b": 387.6571 }, "text": "Plan: 50%\\nMember: 50%", "attrs": { "row": 6, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 44 }, { "id": "p9.2.46", "order": 48, "type": "table_cell", "bbox": { "l": 480.2523, "t": 405.95550000000003, "r": 515.5883, "b": 387.6571 }, "text": "Plan: 70%\\nMember: 30%", "attrs": { "row": 6, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 45 }, { "id": "p9.2.47", "order": 49, "type": "table_cell", "bbox": { "l": 551.5323, "t": 405.95550000000003, "r": 586.8683, "b": 387.6571 }, "text": "Plan: 50%\\nMember: 50%", "attrs": { "row": 6, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 46 }, { "id": "p9.2.48", "order": 50, "type": "table_cell", "bbox": { "l": 623.9011, "t": 405.95550000000003, "r": 659.2371, "b": 387.6571 }, "text": "Plan: 70%\\nMember: 30%", "attrs": { "row": 6, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 47 }, { "id": "p9.2.49", "order": 51, "type": "table_cell", "bbox": { "l": 699.4385, "t": 405.95550000000003, "r": 734.7745, "b": 387.6571 }, "text": "Plan: 50%\\nMember: 50%", "attrs": { "row": 6, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 48 }, { "id": "p9.2.50", "order": 52, "type": "table_cell", "bbox": { "l": 41.22, "t": 376.8241, "r": 103.8582, "b": 365.9611 }, "text": "Doctor's Office Visit", "attrs": { "row": 7, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 49 }, { "id": "p9.2.51", "order": 53, "type": "table_cell", "bbox": { "l": 169.5208, "t": 375.7531, "r": 223.8792, "b": 367.0171 }, "text": "Deductible, then 20%", "attrs": { "row": 7, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 50 }, { "id": "p9.2.52", "order": 54, "type": "table_cell", "bbox": { "l": 248.3608, "t": 375.7531, "r": 302.7192, "b": 367.0171 }, "text": "Deductible, then 50%", "attrs": { "row": 7, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 51 }, { "id": "p9.2.53", "order": 55, "type": "table_cell", "bbox": { "l": 332.7098, "t": 383.7531, "r": 368.853, "b": 359.0171 }, "text": "Co-pay:\\n25 PCP\\n50 Specialist", "attrs": { "row": 7, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 52 }, { "id": "p9.2.54", "order": 56, "type": "table_cell", "bbox": { "l": 395.9621, "t": 375.7531, "r": 450.3205, "b": 367.0171 }, "text": "Deductible, then 50%", "attrs": { "row": 7, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 53 }, { "id": "p9.2.55", "order": 57, "type": "table_cell", "bbox": { "l": 470.7408, "t": 375.7531, "r": 525.0992, "b": 367.0171 }, "text": "Deductible, then 30%", "attrs": { "row": 7, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 54 }, { "id": "p9.2.56", "order": 58, "type": "table_cell", "bbox": { "l": 542.0208, "t": 375.7531, "r": 596.3792, "b": 367.0171 }, "text": "Deductible, then 50%", "attrs": { "row": 7, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 55 }, { "id": "p9.2.57", "order": 59, "type": "table_cell", "bbox": { "l": 614.3896, "t": 375.7531, "r": 668.748, "b": 367.0171 }, "text": "Deductible, then 30%", "attrs": { "row": 7, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 56 }, { "id": "p9.2.58", "order": 60, "type": "table_cell", "bbox": { "l": 689.9271, "t": 375.7531, "r": 744.2855, "b": 367.0171 }, "text": "Deductible, then 50%", "attrs": { "row": 7, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 57 }, { "id": "p9.2.59", "order": 61, "type": "table_cell", "bbox": { "l": 41.22, "t": 355.4029, "r": 119.4723, "b": 336.5399 }, "text": "Annual Prescription Drug Maximum Out-of-Pocket", "attrs": { "row": 8, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 58 }, { "id": "p9.2.60", "order": 62, "type": "table_cell", "bbox": { "l": 209.1447, "t": 350.3319, "r": 266.2151, "b": 341.5959 }, "text": "Combined with Medical", "attrs": { "row": 8, "col": 1, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 59 }, { "id": "p9.2.61", "order": 63, "type": "table_cell", "bbox": { "l": 332.7419, "t": 355.1131, "r": 368.8211, "b": 336.8147 }, "text": "Single 2,500\\nFamily 5,000", "attrs": { "row": 8, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 60 }, { "id": "p9.2.62", "order": 64, "type": "table_cell", "bbox": { "l": 403.3739, "t": 355.1131, "r": 442.9091, "b": 336.8147 }, "text": "Single 5,000\\nFamily 10,000", "attrs": { "row": 8, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 61 }, { "id": "p9.2.63", "order": 65, "type": "table_cell", "bbox": { "l": 503.9847, "t": 350.3319, "r": 561.0551, "b": 341.5959 }, "text": "Combined with Medical", "attrs": { "row": 8, "col": 4, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 62 }, { "id": "p9.2.64", "order": 66, "type": "table_cell", "bbox": { "l": 650.8022, "t": 350.3319, "r": 707.8726, "b": 341.5959 }, "text": "Combined with Medical", "attrs": { "row": 8, "col": 5, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 63 }, { "id": "p9.2.65", "order": 67, "type": "table_cell", "bbox": { "l": 41.22, "t": 333.7667, "r": 96.9192, "b": 303.9013 }, "text": "30-Day Supply\\nTier 1 - Generic\\nTier 2 - Formulary", "attrs": { "row": 9, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 64 }, { "id": "p9.2.66", "order": 68, "type": "table_cell", "bbox": { "l": 169.5208, "t": 319.1945, "r": 223.8792, "b": 310.4585 }, "text": "Deductible, then 20%", "attrs": { "row": 9, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 65 }, { "id": "p9.2.67", "order": 69, "type": "table_cell", "bbox": { "l": 248.3608, "t": 319.1945, "r": 302.7192, "b": 310.4585 }, "text": "Deductible, then 50%", "attrs": { "row": 9, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 66 }, { "id": "p9.2.68", "order": 70, "type": "table_cell", "bbox": { "l": 345.5974, "t": 323.1945, "r": 355.9654, "b": 306.4585 }, "text": "20\\n40", "attrs": { "row": 9, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 67 }, { "id": "p9.2.69", "order": 71, "type": "table_cell", "bbox": { "l": 417.9574, "t": 323.1945, "r": 428.3254, "b": 306.4585 }, "text": "40\\n80", "attrs": { "row": 9, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 68 }, { "id": "p9.2.70", "order": 72, "type": "table_cell", "bbox": { "l": 470.7408, "t": 319.1945, "r": 525.0992, "b": 310.4585 }, "text": "Deductible, then 30%", "attrs": { "row": 9, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 69 }, { "id": "p9.2.71", "order": 73, "type": "table_cell", "bbox": { "l": 542.0208, "t": 319.1945, "r": 596.3792, "b": 310.4585 }, "text": "Deductible, then 50%", "attrs": { "row": 9, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 70 }, { "id": "p9.2.72", "order": 74, "type": "table_cell", "bbox": { "l": 614.3896, "t": 319.1945, "r": 668.748, "b": 310.4585 }, "text": "Deductible, then 30%", "attrs": { "row": 9, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 71 }, { "id": "p9.2.73", "order": 75, "type": "table_cell", "bbox": { "l": 689.9271, "t": 319.1945, "r": 744.2855, "b": 310.4585 }, "text": "Deductible, then 50%", "attrs": { "row": 9, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 72 }, { "id": "p9.2.74", "order": 76, "type": "table_cell", "bbox": { "l": 41.22, "t": 301.5343, "r": 106.2342, "b": 282.6713 }, "text": "90-Day Supply\\n(Retail or Mail Order)", "attrs": { "row": 10, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 73 }, { "id": "p9.2.75", "order": 77, "type": "table_cell", "bbox": { "l": 169.5208, "t": 296.4633, "r": 223.8792, "b": 287.7273 }, "text": "Deductible, then 20%", "attrs": { "row": 10, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 74 }, { "id": "p9.2.76", "order": 78, "type": "table_cell", "bbox": { "l": 260.2923, "t": 296.4633, "r": 290.7883, "b": 287.7273 }, "text": "Not Covered", "attrs": { "row": 10, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 75 }, { "id": "p9.2.77", "order": 79, "type": "table_cell", "bbox": { "l": 345.5974, "t": 300.4633, "r": 355.9654, "b": 283.7273 }, "text": "40\\n80", "attrs": { "row": 10, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 76 }, { "id": "p9.2.78", "order": 80, "type": "table_cell", "bbox": { "l": 407.8936, "t": 296.4633, "r": 438.3896, "b": 287.7273 }, "text": "Not Covered", "attrs": { "row": 10, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 77 }, { "id": "p9.2.79", "order": 81, "type": "table_cell", "bbox": { "l": 470.7408, "t": 296.4633, "r": 525.0992, "b": 287.7273 }, "text": "Deductible, then 30%", "attrs": { "row": 10, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 78 }, { "id": "p9.2.80", "order": 82, "type": "table_cell", "bbox": { "l": 553.9523, "t": 296.4633, "r": 584.4483, "b": 287.7273 }, "text": "Not Covered", "attrs": { "row": 10, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 79 }, { "id": "p9.2.81", "order": 83, "type": "table_cell", "bbox": { "l": 614.3896, "t": 296.4633, "r": 668.748, "b": 287.7273 }, "text": "Deductible, then 30%", "attrs": { "row": 10, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 80 }, { "id": "p9.2.82", "order": 84, "type": "table_cell", "bbox": { "l": 701.8585, "t": 296.4633, "r": 732.3545, "b": 287.7273 }, "text": "Not Covered", "attrs": { "row": 10, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 81 }, { "id": "p9.2.83", "order": 85, "type": "table_cell", "bbox": { "l": 41.22, "t": 265.965, "r": 120.4896, "b": 236.69600000000003 }, "text": "Covered Services\nPreventive Care Office Visits", "attrs": { "row": 11, "col": 0, "rowspan": 1, "colspan": 9, "bbox_refit": true, "merged_continuation": true }, "reading_order": 82 }, { "id": "p9.2.84", "order": 86, "type": "table_cell", "bbox": { "l": 41.22, "t": 232.00650000000002, "r": 112.4656, "b": 214.7985 }, "text": "Well-baby, well-child visits, as recommended", "attrs": { "row": 12, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 83 }, { "id": "p9.2.85", "order": 87, "type": "table_cell", "bbox": { "l": 188.7522, "t": 227.7745, "r": 204.6482, "b": 219.0385 }, "text": "100%", "attrs": { "row": 12, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 84 }, { "id": "p9.2.86", "order": 88, "type": "table_cell", "bbox": { "l": 248.3608, "t": 227.7745, "r": 302.7192, "b": 219.0385 }, "text": "Deductible, then 50%", "attrs": { "row": 12, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 85 }, { "id": "p9.2.87", "order": 89, "type": "table_cell", "bbox": { "l": 342.8334, "t": 227.7745, "r": 358.7294, "b": 219.0385 }, "text": "100%", "attrs": { "row": 12, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 86 }, { "id": "p9.2.88", "order": 90, "type": "table_cell", "bbox": { "l": 395.9621, "t": 227.7745, "r": 450.3205, "b": 219.0385 }, "text": "Deductible, then 50%", "attrs": { "row": 12, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 87 }, { "id": "p9.2.89", "order": 91, "type": "table_cell", "bbox": { "l": 489.9721, "t": 227.7745, "r": 505.8681, "b": 219.0385 }, "text": "100%", "attrs": { "row": 12, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 88 }, { "id": "p9.2.90", "order": 92, "type": "table_cell", "bbox": { "l": 542.0208, "t": 227.7745, "r": 596.3792, "b": 219.0385 }, "text": "Deductible, then 50%", "attrs": { "row": 12, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 89 }, { "id": "p9.2.91", "order": 93, "type": "table_cell", "bbox": { "l": 633.6209, "t": 227.7745, "r": 649.5169, "b": 219.0385 }, "text": "100%", "attrs": { "row": 12, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 90 }, { "id": "p9.2.92", "order": 94, "type": "table_cell", "bbox": { "l": 689.9271, "t": 227.7745, "r": 744.2855, "b": 219.0385 }, "text": "Deductible, then 50%", "attrs": { "row": 12, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 91 }, { "id": "p9.2.93", "order": 95, "type": "table_cell", "bbox": { "l": 41.22, "t": 210.2081, "r": 128.4896, "b": 187.00330000000002 }, "text": "Adult annual physical exam\nImmunizations, as recommended", "attrs": { "row": 13, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 92 }, { "id": "p9.2.94", "order": 96, "type": "table_cell", "bbox": { "l": 188.7522, "t": 209.97609999999997, "r": 204.6482, "b": 187.24329999999998 }, "text": "100%\n100%", "attrs": { "row": 13, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 93 }, { "id": "p9.2.95", "order": 97, "type": "table_cell", "bbox": { "l": 248.3608, "t": 209.97609999999997, "r": 302.7192, "b": 187.24329999999998 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 13, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 94 }, { "id": "p9.2.96", "order": 98, "type": "table_cell", "bbox": { "l": 342.8334, "t": 209.97609999999997, "r": 358.7294, "b": 187.24329999999998 }, "text": "100%\n100%", "attrs": { "row": 13, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 95 }, { "id": "p9.2.97", "order": 99, "type": "table_cell", "bbox": { "l": 395.9621, "t": 209.97609999999997, "r": 450.3205, "b": 187.24329999999998 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 13, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 96 }, { "id": "p9.2.98", "order": 100, "type": "table_cell", "bbox": { "l": 489.9721, "t": 209.97609999999997, "r": 505.8681, "b": 187.24329999999998 }, "text": "100%\n100%", "attrs": { "row": 13, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 97 }, { "id": "p9.2.99", "order": 101, "type": "table_cell", "bbox": { "l": 542.0208, "t": 209.97609999999997, "r": 596.3792, "b": 187.24329999999998 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 13, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 98 }, { "id": "p9.2.100", "order": 102, "type": "table_cell", "bbox": { "l": 633.6209, "t": 209.97609999999997, "r": 649.5169, "b": 187.24329999999998 }, "text": "100%\n100%", "attrs": { "row": 13, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 99 }, { "id": "p9.2.101", "order": 103, "type": "table_cell", "bbox": { "l": 689.9271, "t": 209.97609999999997, "r": 744.2855, "b": 187.24329999999998 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 13, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 100 }, { "id": "p9.2.102", "order": 104, "type": "table_cell", "bbox": { "l": 41.22, "t": 182.41289999999998, "r": 151.7368, "b": 151.2529 }, "text": "Screenings including Pap smears, and labs, as part of the preventive office visit\nOutpatient Services", "attrs": { "row": 14, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 101 }, { "id": "p9.2.103", "order": 105, "type": "table_cell", "bbox": { "l": 188.7522, "t": 178.1809, "r": 204.6482, "b": 169.44490000000002 }, "text": "100%", "attrs": { "row": 14, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 102 }, { "id": "p9.2.104", "order": 106, "type": "table_cell", "bbox": { "l": 248.3608, "t": 178.1809, "r": 302.7192, "b": 169.44490000000002 }, "text": "Deductible, then 50%", "attrs": { "row": 14, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 103 }, { "id": "p9.2.105", "order": 107, "type": "table_cell", "bbox": { "l": 342.8334, "t": 178.1809, "r": 358.7294, "b": 169.44490000000002 }, "text": "100%", "attrs": { "row": 14, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 104 }, { "id": "p9.2.106", "order": 108, "type": "table_cell", "bbox": { "l": 395.9621, "t": 178.1809, "r": 450.3205, "b": 169.44490000000002 }, "text": "Deductible, then 50%", "attrs": { "row": 14, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 105 }, { "id": "p9.2.107", "order": 109, "type": "table_cell", "bbox": { "l": 489.9721, "t": 178.1809, "r": 505.8681, "b": 169.44490000000002 }, "text": "100%", "attrs": { "row": 14, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 106 }, { "id": "p9.2.108", "order": 110, "type": "table_cell", "bbox": { "l": 542.0208, "t": 178.1809, "r": 596.3792, "b": 169.44490000000002 }, "text": "Deductible, then 50%", "attrs": { "row": 14, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 107 }, { "id": "p9.2.109", "order": 111, "type": "table_cell", "bbox": { "l": 633.6209, "t": 178.1809, "r": 649.5169, "b": 169.44490000000002 }, "text": "100%", "attrs": { "row": 14, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 108 }, { "id": "p9.2.110", "order": 112, "type": "table_cell", "bbox": { "l": 689.9271, "t": 178.1809, "r": 744.2855, "b": 169.44490000000002 }, "text": "Deductible, then 50%", "attrs": { "row": 14, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 109 }, { "id": "p9.2.111", "order": 113, "type": "table_cell", "bbox": { "l": 41.22, "t": 139.37290000000002, "r": 148.4168, "b": 130.1649 }, "text": "Primary Care and Specialist Office Visits", "attrs": { "row": 15, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 110 }, { "id": "p9.2.112", "order": 114, "type": "table_cell", "bbox": { "l": 169.5208, "t": 139.1409, "r": 223.8792, "b": 130.4049 }, "text": "Deductible, then 20%", "attrs": { "row": 15, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 111 }, { "id": "p9.2.113", "order": 115, "type": "table_cell", "bbox": { "l": 248.3608, "t": 139.1409, "r": 302.7192, "b": 130.4049 }, "text": "Deductible, then 50%", "attrs": { "row": 15, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 112 }, { "id": "p9.2.114", "order": 116, "type": "table_cell", "bbox": { "l": 332.7098, "t": 147.1409, "r": 368.853, "b": 122.4049 }, "text": "Co-pay\\n25 PCP\\n50 Specialist", "attrs": { "row": 15, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 113 }, { "id": "p9.2.115", "order": 117, "type": "table_cell", "bbox": { "l": 395.9621, "t": 139.1409, "r": 450.3205, "b": 130.4049 }, "text": "Deductible, then 50%", "attrs": { "row": 15, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 114 }, { "id": "p9.2.116", "order": 118, "type": "table_cell", "bbox": { "l": 470.7408, "t": 139.1409, "r": 525.0992, "b": 130.4049 }, "text": "Deductible, then 30%", "attrs": { "row": 15, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 115 }, { "id": "p9.2.117", "order": 119, "type": "table_cell", "bbox": { "l": 542.0208, "t": 139.1409, "r": 596.3792, "b": 130.4049 }, "text": "Deductible, then 50%", "attrs": { "row": 15, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 116 }, { "id": "p9.2.118", "order": 120, "type": "table_cell", "bbox": { "l": 614.3896, "t": 139.1409, "r": 668.748, "b": 130.4049 }, "text": "Deductible, then 30%", "attrs": { "row": 15, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 117 }, { "id": "p9.2.119", "order": 121, "type": "table_cell", "bbox": { "l": 689.9271, "t": 139.1409, "r": 744.2855, "b": 130.4049 }, "text": "Deductible, then 50%", "attrs": { "row": 15, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 118 }, { "id": "p9.2.120", "order": 122, "type": "table_cell", "bbox": { "l": 41.22, "t": 118.3329, "r": 147.8096, "b": 101.12490000000003 }, "text": "LiveHealth Online telehealth for Medical and Behavioral Health", "attrs": { "row": 16, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 119 }, { "id": "p9.2.121", "order": 123, "type": "table_cell", "bbox": { "l": 188.7522, "t": 114.10090000000002, "r": 204.6482, "b": 105.36489999999998 }, "text": "100%", "attrs": { "row": 16, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 120 }, { "id": "p9.2.122", "order": 124, "type": "table_cell", "bbox": { "l": 271.0081, "t": 114.10090000000002, "r": 280.0721, "b": 105.36489999999998 }, "text": "N/A", "attrs": { "row": 16, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 121 }, { "id": "p9.2.123", "order": 125, "type": "table_cell", "bbox": { "l": 342.8334, "t": 114.10090000000002, "r": 358.7294, "b": 105.36489999999998 }, "text": "100%", "attrs": { "row": 16, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 122 }, { "id": "p9.2.124", "order": 126, "type": "table_cell", "bbox": { "l": 418.6094, "t": 114.10090000000002, "r": 427.6734, "b": 105.36489999999998 }, "text": "N/A", "attrs": { "row": 16, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 123 }, { "id": "p9.2.125", "order": 127, "type": "table_cell", "bbox": { "l": 489.9721, "t": 114.10090000000002, "r": 505.8681, "b": 105.36489999999998 }, "text": "100%", "attrs": { "row": 16, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 124 }, { "id": "p9.2.126", "order": 128, "type": "table_cell", "bbox": { "l": 564.6681, "t": 114.10090000000002, "r": 573.7321, "b": 105.36489999999998 }, "text": "N/A", "attrs": { "row": 16, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 125 }, { "id": "p9.2.127", "order": 129, "type": "table_cell", "bbox": { "l": 637.0369, "t": 114.10090000000002, "r": 646.1009, "b": 105.36489999999998 }, "text": "N/A", "attrs": { "row": 16, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 126 }, { "id": "p9.2.128", "order": 130, "type": "table_cell", "bbox": { "l": 712.5743, "t": 114.10090000000002, "r": 721.6383, "b": 105.36489999999998 }, "text": "N/A", "attrs": { "row": 16, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 127 }, { "id": "p9.2.129", "order": 131, "type": "table_cell", "bbox": { "l": 41.22, "t": 93.13289999999995, "r": 134.5608, "b": 75.92489999999998 }, "text": "Telehealth with provider other than LiveHealth Online", "attrs": { "row": 17, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 128 }, { "id": "p9.2.130", "order": 132, "type": "table_cell", "bbox": { "l": 169.5208, "t": 88.90089999999998, "r": 223.8792, "b": 80.16489999999999 }, "text": "Deductible, then 20%", "attrs": { "row": 17, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 129 }, { "id": "p9.2.131", "order": 133, "type": "table_cell", "bbox": { "l": 248.3608, "t": 88.90089999999998, "r": 302.7192, "b": 80.16489999999999 }, "text": "Deductible, then 50%", "attrs": { "row": 17, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 130 }, { "id": "p9.2.132", "order": 134, "type": "table_cell", "bbox": { "l": 332.7098, "t": 96.90089999999998, "r": 368.853, "b": 72.16489999999999 }, "text": "Co-pay\\n25 PCP\\n50 Specialist", "attrs": { "row": 17, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 131 }, { "id": "p9.2.133", "order": 135, "type": "table_cell", "bbox": { "l": 395.9621, "t": 88.90089999999998, "r": 450.3205, "b": 80.16489999999999 }, "text": "Deductible, then 50%", "attrs": { "row": 17, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 132 }, { "id": "p9.2.134", "order": 136, "type": "table_cell", "bbox": { "l": 470.7408, "t": 88.90089999999998, "r": 525.0992, "b": 80.16489999999999 }, "text": "Deductible, then 30%", "attrs": { "row": 17, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 133 }, { "id": "p9.2.135", "order": 137, "type": "table_cell", "bbox": { "l": 542.0208, "t": 88.90089999999998, "r": 596.3792, "b": 80.16489999999999 }, "text": "Deductible, then 50%", "attrs": { "row": 17, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 134 }, { "id": "p9.2.136", "order": 138, "type": "table_cell", "bbox": { "l": 614.3896, "t": 88.90089999999998, "r": 668.748, "b": 80.16489999999999 }, "text": "Deductible, then 30%", "attrs": { "row": 17, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 135 }, { "id": "p9.2.137", "order": 139, "type": "table_cell", "bbox": { "l": 689.9271, "t": 88.90089999999998, "r": 744.2855, "b": 80.16489999999999 }, "text": "Deductible, then 50%", "attrs": { "row": 17, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 136 } ], "reading_order": 1 }, { "id": "p9.3", "order": 140, "type": "footer", "bbox": { "l": 749.04, "t": 30.48, "r": 757.68, "b": 21.36 }, "text": "9", "attrs": { "block_label": "number" }, "reading_order": 2 } ] }, { "document_id": 13522, "page": 10, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 140, "counts_by_type": { "footer": 1, "footnote": 4, "heading": 1, "table": 1, "table_cell": 133 }, "build_ms": 63, "items": [ { "id": "p10.1", "order": 1, "type": "heading", "bbox": { "l": 34.8, "t": 577.68, "r": 173.04, "b": 554.64 }, "text": "Benefits Grid", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p10.2", "order": 2, "type": "table", "bbox": { "l": 35.28, "t": 559.2, "r": 757.92, "b": 85.92 }, "text": "", "attrs": { "block_label": "table", "n_rows": 18, "n_cols": 9, "integrity": { "cells_checked": 133, "cells_flagged": 1, "flags": [ { "row": 6, "col": 0, "coverage": 0.53, "text": "Therapy Services (per visit: physical, occupational, speech…" } ] } }, "children": [ { "id": "p10.2.1", "order": 3, "type": "table_cell", "bbox": { "l": 68.0194, "t": 537.8417, "r": 129.226, "b": 520.9437 }, "text": "Plan Options", "attrs": { "row": 0, "col": 0, "rowspan": 2, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "reading_order": 0 }, { "id": "p10.2.2", "order": 4, "type": "table_cell", "bbox": { "l": 210.5981, "t": 543.914, "r": 265.9471, "b": 531.844 }, "text": "LivingWell CDHP", "attrs": { "row": 0, "col": 1, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "reading_order": 1 }, { "id": "p10.2.3", "order": 5, "type": "table_cell", "bbox": { "l": 364.1482, "t": 543.914, "r": 414.7972, "b": 531.844 }, "text": "LivingWell PPO", "attrs": { "row": 0, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "reading_order": 2 }, { "id": "p10.2.4", "order": 6, "type": "table_cell", "bbox": { "l": 494.9334, "t": 543.914, "r": 571.2914, "b": 531.844 }, "text": "LivingWell Basic CDHP", "attrs": { "row": 0, "col": 3, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "reading_order": 3 }, { "id": "p10.2.5", "order": 7, "type": "table_cell", "bbox": { "l": 652.1356, "t": 543.914, "r": 707.7246, "b": 531.844 }, "text": "LivingWell HDHP", "attrs": { "row": 0, "col": 4, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "reading_order": 4 }, { "id": "p10.2.6", "order": 8, "type": "table_cell", "bbox": { "l": 179.7701, "t": 523.6067, "r": 214.8152, "b": 512.7437 }, "text": "In-Network", "attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 5 }, { "id": "p10.2.7", "order": 9, "type": "table_cell", "bbox": { "l": 251.6713, "t": 523.6067, "r": 300.5935, "b": 512.7437 }, "text": "Out-of-Network", "attrs": { "row": 1, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 6 }, { "id": "p10.2.8", "order": 10, "type": "table_cell", "bbox": { "l": 333.8513, "t": 523.6067, "r": 368.8964, "b": 512.7437 }, "text": "In-Network", "attrs": { "row": 1, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 7 }, { "id": "p10.2.9", "order": 11, "type": "table_cell", "bbox": { "l": 399.2726, "t": 523.6067, "r": 448.1948, "b": 512.7437 }, "text": "Out-of-Network", "attrs": { "row": 1, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 8 }, { "id": "p10.2.10", "order": 12, "type": "table_cell", "bbox": { "l": 480.9901, "t": 523.6067, "r": 516.0352, "b": 512.7437 }, "text": "In-Network", "attrs": { "row": 1, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 9 }, { "id": "p10.2.11", "order": 13, "type": "table_cell", "bbox": { "l": 545.3313, "t": 523.6067, "r": 594.2535, "b": 512.7437 }, "text": "Out-of-Network", "attrs": { "row": 1, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 10 }, { "id": "p10.2.12", "order": 14, "type": "table_cell", "bbox": { "l": 624.6389, "t": 523.6067, "r": 659.684, "b": 512.7437 }, "text": "In-Network", "attrs": { "row": 1, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 11 }, { "id": "p10.2.13", "order": 15, "type": "table_cell", "bbox": { "l": 693.2375, "t": 523.6067, "r": 742.1597, "b": 512.7437 }, "text": "Out-of-Network", "attrs": { "row": 1, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 12 }, { "id": "p10.2.14", "order": 16, "type": "table_cell", "bbox": { "l": 41.8125, "t": 506.22839999999997, "r": 132.5613, "b": 481.18039999999996 }, "text": "Diagnostic tests in doctor's office\nSurgery in Office Setting", "attrs": { "row": 2, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 13 }, { "id": "p10.2.15", "order": 17, "type": "table_cell", "bbox": { "l": 170.1133, "t": 505.9964, "r": 224.4717, "b": 481.4204 }, "text": "Deductible, then 20%\nDeductible, then 20%", "attrs": { "row": 2, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 14 }, { "id": "p10.2.16", "order": 18, "type": "table_cell", "bbox": { "l": 248.9533, "t": 505.9964, "r": 303.3117, "b": 481.4204 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 2, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 15 }, { "id": "p10.2.17", "order": 19, "type": "table_cell", "bbox": { "l": 324.1945, "t": 505.9964, "r": 378.5529, "b": 481.4204 }, "text": "Office Visit Co-pay\nDeductible, then 25%", "attrs": { "row": 2, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 16 }, { "id": "p10.2.18", "order": 20, "type": "table_cell", "bbox": { "l": 396.5546, "t": 505.9964, "r": 450.913, "b": 481.4204 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 2, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 17 }, { "id": "p10.2.19", "order": 21, "type": "table_cell", "bbox": { "l": 471.3333, "t": 505.9964, "r": 525.6917, "b": 481.4204 }, "text": "Deductible, then 30%\nDeductible, then 30%", "attrs": { "row": 2, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 18 }, { "id": "p10.2.20", "order": 22, "type": "table_cell", "bbox": { "l": 542.6133, "t": 505.9964, "r": 596.9717, "b": 481.4204 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 2, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 19 }, { "id": "p10.2.21", "order": 23, "type": "table_cell", "bbox": { "l": 614.9821, "t": 505.9964, "r": 669.3405, "b": 481.4204 }, "text": "Deductible, then 30%\nDeductible, then 30%", "attrs": { "row": 2, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 20 }, { "id": "p10.2.22", "order": 24, "type": "table_cell", "bbox": { "l": 690.5195, "t": 505.9964, "r": 744.8779, "b": 481.4204 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 2, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 21 }, { "id": "p10.2.23", "order": 25, "type": "table_cell", "bbox": { "l": 41.8125, "t": 475.6684, "r": 129.6021, "b": 458.4604 }, "text": "Behavioral Health and Substance Abuse Use", "attrs": { "row": 3, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 22 }, { "id": "p10.2.24", "order": 26, "type": "table_cell", "bbox": { "l": 170.1133, "t": 471.4364, "r": 224.4717, "b": 462.7004 }, "text": "Deductible, then 20%", "attrs": { "row": 3, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 23 }, { "id": "p10.2.25", "order": 27, "type": "table_cell", "bbox": { "l": 248.9533, "t": 471.4364, "r": 303.3117, "b": 462.7004 }, "text": "Deductible, then 50%", "attrs": { "row": 3, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 24 }, { "id": "p10.2.26", "order": 28, "type": "table_cell", "bbox": { "l": 324.1945, "t": 471.4364, "r": 378.5529, "b": 462.7004 }, "text": "Deductible, then 25%", "attrs": { "row": 3, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 25 }, { "id": "p10.2.27", "order": 29, "type": "table_cell", "bbox": { "l": 396.5546, "t": 471.4364, "r": 450.913, "b": 462.7004 }, "text": "Deductible, then 50%", "attrs": { "row": 3, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 26 }, { "id": "p10.2.28", "order": 30, "type": "table_cell", "bbox": { "l": 471.3333, "t": 471.4364, "r": 525.6917, "b": 462.7004 }, "text": "Deductible, then 30%", "attrs": { "row": 3, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 27 }, { "id": "p10.2.29", "order": 31, "type": "table_cell", "bbox": { "l": 542.6133, "t": 471.4364, "r": 596.9717, "b": 462.7004 }, "text": "Deductible, then 50%", "attrs": { "row": 3, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 28 }, { "id": "p10.2.30", "order": 32, "type": "table_cell", "bbox": { "l": 614.9821, "t": 471.4364, "r": 669.3405, "b": 462.7004 }, "text": "Deductible, then 30%", "attrs": { "row": 3, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 29 }, { "id": "p10.2.31", "order": 33, "type": "table_cell", "bbox": { "l": 690.5195, "t": 471.4364, "r": 744.8779, "b": 462.7004 }, "text": "Deductible, then 50%", "attrs": { "row": 3, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 30 }, { "id": "p10.2.32", "order": 34, "type": "table_cell", "bbox": { "l": 41.8125, "t": 452.9484, "r": 137.7941, "b": 412.06039999999996 }, "text": "Autism Services\nAllergy Injection without Office Visit\nAllergy Serum", "attrs": { "row": 4, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 31 }, { "id": "p10.2.33", "order": 35, "type": "table_cell", "bbox": { "l": 170.1133, "t": 452.7164, "r": 224.4717, "b": 412.30039999999997 }, "text": "Deductible, then 20%\nDeductible, then 20%\nDeductible, then 20%", "attrs": { "row": 4, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 32 }, { "id": "p10.2.34", "order": 36, "type": "table_cell", "bbox": { "l": 248.9533, "t": 452.7164, "r": 303.3117, "b": 412.30039999999997 }, "text": "Deductible, then 50%\nDeductible, then 50%\nDeductible, then 50%", "attrs": { "row": 4, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 33 }, { "id": "p10.2.35", "order": 37, "type": "table_cell", "bbox": { "l": 324.1945, "t": 452.7164, "r": 378.5529, "b": 412.30039999999997 }, "text": "Deductible, then 25%\n$15 Co-pay\n$15 Co-pay", "attrs": { "row": 4, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 34 }, { "id": "p10.2.36", "order": 38, "type": "table_cell", "bbox": { "l": 396.5546, "t": 452.7164, "r": 450.913, "b": 412.30039999999997 }, "text": "Deductible, then 50%\nDeductible, then 50%\nDeductible, then 50%", "attrs": { "row": 4, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 35 }, { "id": "p10.2.37", "order": 39, "type": "table_cell", "bbox": { "l": 471.3333, "t": 452.7164, "r": 525.6917, "b": 412.30039999999997 }, "text": "Deductible, then 30%\nDeductible, then 30%\nDeductible, then 30%", "attrs": { "row": 4, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 36 }, { "id": "p10.2.38", "order": 40, "type": "table_cell", "bbox": { "l": 542.6133, "t": 452.7164, "r": 596.9717, "b": 412.30039999999997 }, "text": "Deductible, then 50%\nDeductible, then 50%\nDeductible, then 50%", "attrs": { "row": 4, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 37 }, { "id": "p10.2.39", "order": 41, "type": "table_cell", "bbox": { "l": 614.9821, "t": 452.7164, "r": 669.3405, "b": 412.30039999999997 }, "text": "Deductible, then 30%\nDeductible, then 30%\nDeductible, then 30%", "attrs": { "row": 4, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 38 }, { "id": "p10.2.40", "order": 42, "type": "table_cell", "bbox": { "l": 690.5195, "t": 452.7164, "r": 744.8779, "b": 412.30039999999997 }, "text": "Deductible, then 50%\nDeductible, then 50%\nDeductible, then 50%", "attrs": { "row": 4, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 39 }, { "id": "p10.2.41", "order": 43, "type": "table_cell", "bbox": { "l": 41.8125, "t": 405.14840000000004, "r": 150.5773, "b": 379.9404 }, "text": "Chiropractic Care (manipulation therapy) (maximum of 26 visits per year, no more than one visit a day)", "attrs": { "row": 5, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 40 }, { "id": "p10.2.42", "order": 44, "type": "table_cell", "bbox": { "l": 170.1133, "t": 396.9164, "r": 224.4717, "b": 388.18039999999996 }, "text": "Deductible, then 20%", "attrs": { "row": 5, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 41 }, { "id": "p10.2.43", "order": 45, "type": "table_cell", "bbox": { "l": 248.9533, "t": 396.9164, "r": 303.3117, "b": 388.18039999999996 }, "text": "Deductible, then 50%", "attrs": { "row": 5, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 42 }, { "id": "p10.2.44", "order": 46, "type": "table_cell", "bbox": { "l": 337.1101, "t": 396.9164, "r": 365.6373, "b": 388.18039999999996 }, "text": "$25 Co-pay", "attrs": { "row": 5, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 43 }, { "id": "p10.2.45", "order": 47, "type": "table_cell", "bbox": { "l": 396.5546, "t": 396.9164, "r": 450.913, "b": 388.18039999999996 }, "text": "Deductible, then 50%", "attrs": { "row": 5, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 44 }, { "id": "p10.2.46", "order": 48, "type": "table_cell", "bbox": { "l": 471.3333, "t": 396.9164, "r": 525.6917, "b": 388.18039999999996 }, "text": "Deductible, then 30%", "attrs": { "row": 5, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 45 }, { "id": "p10.2.47", "order": 49, "type": "table_cell", "bbox": { "l": 542.6133, "t": 396.9164, "r": 596.9717, "b": 388.18039999999996 }, "text": "Deductible, then 50%", "attrs": { "row": 5, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 46 }, { "id": "p10.2.48", "order": 50, "type": "table_cell", "bbox": { "l": 614.9821, "t": 396.9164, "r": 669.3405, "b": 388.18039999999996 }, "text": "Deductible, then 30%", "attrs": { "row": 5, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 47 }, { "id": "p10.2.49", "order": 51, "type": "table_cell", "bbox": { "l": 690.5195, "t": 396.9164, "r": 744.8779, "b": 388.18039999999996 }, "text": "Deductible, then 50%", "attrs": { "row": 5, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 48 }, { "id": "p10.2.50", "order": 52, "type": "table_cell", "bbox": { "l": 41.8125, "t": 372.7484, "r": 139.0253, "b": 355.5404 }, "text": "Therapy Services (per visit: physical, occupational, speech - maximum combined limit of 90 visits per year)", "attrs": { "row": 6, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 49 }, { "id": "p10.2.51", "order": 53, "type": "table_cell", "bbox": { "l": 170.1133, "t": 364.5164, "r": 224.4717, "b": 355.7804 }, "text": "Deductible, then 20%", "attrs": { "row": 6, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 50 }, { "id": "p10.2.52", "order": 54, "type": "table_cell", "bbox": { "l": 248.9533, "t": 364.5164, "r": 303.3117, "b": 355.7804 }, "text": "Deductible, then 50%", "attrs": { "row": 6, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 51 }, { "id": "p10.2.53", "order": 55, "type": "table_cell", "bbox": { "l": 324.1945, "t": 364.5164, "r": 378.5529, "b": 355.7804 }, "text": "Deductible, then 25%", "attrs": { "row": 6, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 52 }, { "id": "p10.2.54", "order": 56, "type": "table_cell", "bbox": { "l": 396.5546, "t": 364.5164, "r": 450.913, "b": 355.7804 }, "text": "Deductible, then 50%", "attrs": { "row": 6, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 53 }, { "id": "p10.2.55", "order": 57, "type": "table_cell", "bbox": { "l": 471.3333, "t": 364.5164, "r": 525.6917, "b": 355.7804 }, "text": "Deductible, then 30%", "attrs": { "row": 6, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 54 }, { "id": "p10.2.56", "order": 58, "type": "table_cell", "bbox": { "l": 542.6133, "t": 364.5164, "r": 596.9717, "b": 355.7804 }, "text": "Deductible, then 50%", "attrs": { "row": 6, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 55 }, { "id": "p10.2.57", "order": 59, "type": "table_cell", "bbox": { "l": 614.9821, "t": 364.5164, "r": 669.3405, "b": 355.7804 }, "text": "Deductible, then 30%", "attrs": { "row": 6, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 56 }, { "id": "p10.2.58", "order": 60, "type": "table_cell", "bbox": { "l": 690.5195, "t": 364.5164, "r": 744.8779, "b": 355.7804 }, "text": "Deductible, then 50%", "attrs": { "row": 6, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 57 }, { "id": "p10.2.59", "order": 61, "type": "table_cell", "bbox": { "l": 41.8125, "t": 340.9847, "r": 98.2189, "b": 331.3287 }, "text": "Emergency Services", "attrs": { "row": 7, "col": 0, "rowspan": 1, "colspan": 9, "bbox_refit": true }, "reading_order": 58 }, { "id": "p10.2.60", "order": 62, "type": "table_cell", "bbox": { "l": 41.8125, "t": 324.909, "r": 93.4277, "b": 315.701 }, "text": "Urgent Care Center", "attrs": { "row": 8, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 59 }, { "id": "p10.2.61", "order": 63, "type": "table_cell", "bbox": { "l": 211.0933, "t": 324.677, "r": 265.4517, "b": 315.941 }, "text": "Deductible, then 20%", "attrs": { "row": 8, "col": 1, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 60 }, { "id": "p10.2.62", "order": 64, "type": "table_cell", "bbox": { "l": 375.2088, "t": 324.677, "r": 403.736, "b": 315.941 }, "text": "$50 Co-pay", "attrs": { "row": 8, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 61 }, { "id": "p10.2.63", "order": 65, "type": "table_cell", "bbox": { "l": 505.9333, "t": 324.677, "r": 560.2917, "b": 315.941 }, "text": "Deductible, then 30%", "attrs": { "row": 8, "col": 3, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 62 }, { "id": "p10.2.64", "order": 66, "type": "table_cell", "bbox": { "l": 652.7508, "t": 324.677, "r": 707.1092, "b": 315.941 }, "text": "Deductible, then 30%", "attrs": { "row": 8, "col": 4, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 63 }, { "id": "p10.2.65", "order": 67, "type": "table_cell", "bbox": { "l": 41.8125, "t": 310.189, "r": 142.9389, "b": 292.981 }, "text": "Emergency Room (emergency medical treatment only)", "attrs": { "row": 9, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 64 }, { "id": "p10.2.66", "order": 68, "type": "table_cell", "bbox": { "l": 211.0933, "t": 305.957, "r": 265.4517, "b": 297.221 }, "text": "Deductible, then 20%", "attrs": { "row": 9, "col": 1, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 65 }, { "id": "p10.2.67", "order": 69, "type": "table_cell", "bbox": { "l": 337.89, "t": 309.957, "r": 441.0556, "b": 293.221 }, "text": "$150 Co-pay, then Deductible, then 25%. Co-pay waived if admitted.", "attrs": { "row": 9, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 66 }, { "id": "p10.2.68", "order": 70, "type": "table_cell", "bbox": { "l": 505.9333, "t": 305.957, "r": 560.2917, "b": 297.221 }, "text": "Deductible, then 30%", "attrs": { "row": 9, "col": 3, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 67 }, { "id": "p10.2.69", "order": 71, "type": "table_cell", "bbox": { "l": 652.7508, "t": 305.957, "r": 707.1092, "b": 297.221 }, "text": "Deductible, then 30%", "attrs": { "row": 9, "col": 4, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 68 }, { "id": "p10.2.70", "order": 72, "type": "table_cell", "bbox": { "l": 41.8125, "t": 287.469, "r": 114.2909, "b": 278.261 }, "text": "Emergency Room Physician", "attrs": { "row": 10, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 69 }, { "id": "p10.2.71", "order": 73, "type": "table_cell", "bbox": { "l": 211.0933, "t": 287.237, "r": 265.4517, "b": 278.501 }, "text": "Deductible, then 20%", "attrs": { "row": 10, "col": 1, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 70 }, { "id": "p10.2.72", "order": 74, "type": "table_cell", "bbox": { "l": 362.2933, "t": 287.237, "r": 416.6517, "b": 278.501 }, "text": "Deductible, then 25%", "attrs": { "row": 10, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 71 }, { "id": "p10.2.73", "order": 75, "type": "table_cell", "bbox": { "l": 505.9333, "t": 287.237, "r": 560.2917, "b": 278.501 }, "text": "Deductible, then 30%", "attrs": { "row": 10, "col": 3, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 72 }, { "id": "p10.2.74", "order": 76, "type": "table_cell", "bbox": { "l": 652.7508, "t": 287.237, "r": 707.1092, "b": 278.501 }, "text": "Deductible, then 30%", "attrs": { "row": 10, "col": 4, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 73 }, { "id": "p10.2.75", "order": 77, "type": "table_cell", "bbox": { "l": 41.8125, "t": 271.629, "r": 82.9709, "b": 246.42899999999997 }, "text": "Ambulance\nOther Services", "attrs": { "row": 11, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 74 }, { "id": "p10.2.76", "order": 78, "type": "table_cell", "bbox": { "l": 170.1133, "t": 239.71699999999998, "r": 224.4717, "b": 230.981 }, "text": "Deductible, then 20%", "attrs": { "row": 11, "col": 1, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 75 }, { "id": "p10.2.77", "order": 79, "type": "table_cell", "bbox": { "l": 362.2933, "t": 271.397, "r": 416.6517, "b": 262.661 }, "text": "Deductible, then 25%", "attrs": { "row": 11, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 76 }, { "id": "p10.2.78", "order": 80, "type": "table_cell", "bbox": { "l": 505.9333, "t": 271.397, "r": 560.2917, "b": 262.661 }, "text": "Deductible, then 30%", "attrs": { "row": 11, "col": 3, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 77 }, { "id": "p10.2.79", "order": 81, "type": "table_cell", "bbox": { "l": 652.7508, "t": 271.397, "r": 707.1092, "b": 262.661 }, "text": "Deductible, then 30%", "attrs": { "row": 11, "col": 4, "rowspan": 1, "colspan": 2, "bbox_refit": true }, "reading_order": 78 }, { "id": "p10.2.80", "order": 82, "type": "table_cell", "bbox": { "l": 41.8125, "t": 239.949, "r": 144.1133, "b": 214.901 }, "text": "Inpatient Hospital (Semi-private room)\nOutpatient Hospital/Surgery", "attrs": { "row": 12, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 79 }, { "id": "p10.2.81", "order": 83, "type": "table_cell", "bbox": { "l": 170.1133, "t": 223.877, "r": 224.4717, "b": 199.301 }, "text": "Deductible, then 20%\nDeductible, then 20%", "attrs": { "row": 12, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 80 }, { "id": "p10.2.82", "order": 84, "type": "table_cell", "bbox": { "l": 248.9533, "t": 223.877, "r": 303.3117, "b": 199.301 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 12, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 81 }, { "id": "p10.2.83", "order": 85, "type": "table_cell", "bbox": { "l": 324.1945, "t": 223.877, "r": 378.5529, "b": 199.301 }, "text": "Deductible, then 25%\nDeductible, then 25%", "attrs": { "row": 12, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 82 }, { "id": "p10.2.84", "order": 86, "type": "table_cell", "bbox": { "l": 396.5546, "t": 223.877, "r": 450.913, "b": 199.301 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 12, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 83 }, { "id": "p10.2.85", "order": 87, "type": "table_cell", "bbox": { "l": 471.3333, "t": 223.877, "r": 525.6917, "b": 199.301 }, "text": "Deductible, then 30%\nDeductible, then 30%", "attrs": { "row": 12, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 84 }, { "id": "p10.2.86", "order": 88, "type": "table_cell", "bbox": { "l": 542.6133, "t": 223.877, "r": 596.9717, "b": 199.301 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 12, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 85 }, { "id": "p10.2.87", "order": 89, "type": "table_cell", "bbox": { "l": 614.9821, "t": 223.877, "r": 669.3405, "b": 199.301 }, "text": "Deductible, then 30%\nDeductible, then 30%", "attrs": { "row": 12, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 86 }, { "id": "p10.2.88", "order": 90, "type": "table_cell", "bbox": { "l": 690.5195, "t": 223.877, "r": 744.8779, "b": 199.301 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 12, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 87 }, { "id": "p10.2.89", "order": 91, "type": "table_cell", "bbox": { "l": 41.8125, "t": 208.269, "r": 145.4093, "b": 199.06099999999998 }, "text": "Outpatient/Ambulatory Surgery Center", "attrs": { "row": 13, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 88 }, { "id": "p10.2.90", "order": 92, "type": "table_cell", "bbox": { "l": 170.1133, "t": 181.11700000000002, "r": 224.4717, "b": 172.38099999999997 }, "text": "Deductible, then 20%", "attrs": { "row": 13, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 89 }, { "id": "p10.2.91", "order": 93, "type": "table_cell", "bbox": { "l": 248.9533, "t": 181.11700000000002, "r": 303.3117, "b": 172.38099999999997 }, "text": "Deductible, then 50%", "attrs": { "row": 13, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 90 }, { "id": "p10.2.92", "order": 94, "type": "table_cell", "bbox": { "l": 324.1945, "t": 169.11700000000002, "r": 378.5529, "b": 160.38099999999997 }, "text": "Deductible, then 25%", "attrs": { "row": 13, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 91 }, { "id": "p10.2.93", "order": 95, "type": "table_cell", "bbox": { "l": 396.5546, "t": 181.11700000000002, "r": 450.913, "b": 172.38099999999997 }, "text": "Deductible, then 50%", "attrs": { "row": 13, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 92 }, { "id": "p10.2.94", "order": 96, "type": "table_cell", "bbox": { "l": 471.3333, "t": 181.11700000000002, "r": 525.6917, "b": 172.38099999999997 }, "text": "Deductible, then 30%", "attrs": { "row": 13, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 93 }, { "id": "p10.2.95", "order": 97, "type": "table_cell", "bbox": { "l": 542.6133, "t": 181.11700000000002, "r": 596.9717, "b": 172.38099999999997 }, "text": "Deductible, then 50%", "attrs": { "row": 13, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 94 }, { "id": "p10.2.96", "order": 98, "type": "table_cell", "bbox": { "l": 614.9821, "t": 181.11700000000002, "r": 669.3405, "b": 172.38099999999997 }, "text": "Deductible, then 30%", "attrs": { "row": 13, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 95 }, { "id": "p10.2.97", "order": 99, "type": "table_cell", "bbox": { "l": 690.5195, "t": 181.11700000000002, "r": 744.8779, "b": 172.38099999999997 }, "text": "Deductible, then 50%", "attrs": { "row": 13, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 96 }, { "id": "p10.2.98", "order": 100, "type": "table_cell", "bbox": { "l": 41.8125, "t": 181.349, "r": 82.4189, "b": 172.14100000000002 }, "text": "Maternity Care", "attrs": { "row": 14, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 97 }, { "id": "p10.2.99", "order": 101, "type": "table_cell", "bbox": { "l": 170.1133, "t": 154.197, "r": 224.4717, "b": 145.461 }, "text": "Deductible, then 20%", "attrs": { "row": 14, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 98 }, { "id": "p10.2.100", "order": 102, "type": "table_cell", "bbox": { "l": 248.9533, "t": 138.35700000000003, "r": 303.3117, "b": 129.62099999999998 }, "text": "Deductible, then 50%", "attrs": { "row": 14, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 99 }, { "id": "p10.2.101", "order": 103, "type": "table_cell", "bbox": { "l": 322.2664, "t": 193.11700000000002, "r": 380.4816, "b": 145.461 }, "text": "$25 Co-pay (office visit pregnancy diagnosed) Delivery Charge: Deductible, then 25%", "attrs": { "row": 14, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 100 }, { "id": "p10.2.102", "order": 104, "type": "table_cell", "bbox": { "l": 396.5546, "t": 138.35700000000003, "r": 450.913, "b": 129.62099999999998 }, "text": "Deductible, then 50%", "attrs": { "row": 14, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 101 }, { "id": "p10.2.103", "order": 105, "type": "table_cell", "bbox": { "l": 471.3333, "t": 154.197, "r": 525.6917, "b": 145.461 }, "text": "Deductible, then 30%", "attrs": { "row": 14, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 102 }, { "id": "p10.2.104", "order": 106, "type": "table_cell", "bbox": { "l": 542.6133, "t": 138.35700000000003, "r": 596.9717, "b": 129.62099999999998 }, "text": "Deductible, then 50%", "attrs": { "row": 14, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 103 }, { "id": "p10.2.105", "order": 107, "type": "table_cell", "bbox": { "l": 614.9821, "t": 154.197, "r": 669.3405, "b": 145.461 }, "text": "Deductible, then 30%", "attrs": { "row": 14, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 104 }, { "id": "p10.2.106", "order": 108, "type": "table_cell", "bbox": { "l": 690.5195, "t": 138.35700000000003, "r": 744.8779, "b": 129.62099999999998 }, "text": "Deductible, then 50%", "attrs": { "row": 14, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 105 }, { "id": "p10.2.107", "order": 109, "type": "table_cell", "bbox": { "l": 41.8125, "t": 154.42899999999997, "r": 149.7693, "b": 145.221 }, "text": "Durable Medical Equipment and Supplies", "attrs": { "row": 15, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 106 }, { "id": "p10.2.108", "order": 110, "type": "table_cell", "bbox": { "l": 170.1133, "t": 138.35700000000003, "r": 224.4717, "b": 129.62099999999998 }, "text": "Deductible, then 20%", "attrs": { "row": 15, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 107 }, { "id": "p10.2.109", "order": 111, "type": "table_cell", "bbox": { "l": 248.9533, "t": 154.197, "r": 303.3117, "b": 145.461 }, "text": "Deductible, then 20%", "attrs": { "row": 15, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 108 }, { "id": "p10.2.110", "order": 112, "type": "table_cell", "bbox": { "l": 324.1945, "t": 138.35700000000003, "r": 378.5529, "b": 129.62099999999998 }, "text": "Deductible, then 25%", "attrs": { "row": 15, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 109 }, { "id": "p10.2.111", "order": 113, "type": "table_cell", "bbox": { "l": 396.5546, "t": 154.197, "r": 450.913, "b": 145.461 }, "text": "Deductible, then 25%", "attrs": { "row": 15, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 110 }, { "id": "p10.2.112", "order": 114, "type": "table_cell", "bbox": { "l": 471.3333, "t": 138.35700000000003, "r": 525.6917, "b": 129.62099999999998 }, "text": "Deductible, then 30%", "attrs": { "row": 15, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 111 }, { "id": "p10.2.113", "order": 115, "type": "table_cell", "bbox": { "l": 542.6133, "t": 154.197, "r": 596.9717, "b": 145.461 }, "text": "Deductible, then 30%", "attrs": { "row": 15, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 112 }, { "id": "p10.2.114", "order": 116, "type": "table_cell", "bbox": { "l": 614.9821, "t": 138.35700000000003, "r": 669.3405, "b": 129.62099999999998 }, "text": "Deductible, then 30%", "attrs": { "row": 15, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 113 }, { "id": "p10.2.115", "order": 117, "type": "table_cell", "bbox": { "l": 690.5195, "t": 154.197, "r": 744.8779, "b": 145.461 }, "text": "Deductible, then 30%", "attrs": { "row": 15, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 114 }, { "id": "p10.2.116", "order": 118, "type": "table_cell", "bbox": { "l": 41.8125, "t": 138.589, "r": 89.8189, "b": 129.38099999999997 }, "text": "Home Health Care", "attrs": { "row": 16, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 115 }, { "id": "p10.2.117", "order": 119, "type": "table_cell", "bbox": { "l": 170.1133, "t": 119.43689999999998, "r": 224.4717, "b": 110.70089999999999 }, "text": "Deductible, then 20%", "attrs": { "row": 16, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 116 }, { "id": "p10.2.118", "order": 120, "type": "table_cell", "bbox": { "l": 248.9533, "t": 119.43689999999998, "r": 303.3117, "b": 110.70089999999999 }, "text": "Deductible, then 50%", "attrs": { "row": 16, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 117 }, { "id": "p10.2.119", "order": 121, "type": "table_cell", "bbox": { "l": 324.1945, "t": 119.43689999999998, "r": 378.5529, "b": 110.70089999999999 }, "text": "Deductible, then 25%", "attrs": { "row": 16, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 118 }, { "id": "p10.2.120", "order": 122, "type": "table_cell", "bbox": { "l": 396.5546, "t": 119.43689999999998, "r": 450.913, "b": 110.70089999999999 }, "text": "Deductible, then 50%", "attrs": { "row": 16, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 119 }, { "id": "p10.2.121", "order": 123, "type": "table_cell", "bbox": { "l": 471.3333, "t": 119.43689999999998, "r": 525.6917, "b": 110.70089999999999 }, "text": "Deductible, then 30%", "attrs": { "row": 16, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 120 }, { "id": "p10.2.122", "order": 124, "type": "table_cell", "bbox": { "l": 542.6133, "t": 119.43689999999998, "r": 596.9717, "b": 110.70089999999999 }, "text": "Deductible, then 50%", "attrs": { "row": 16, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 121 }, { "id": "p10.2.123", "order": 125, "type": "table_cell", "bbox": { "l": 614.9821, "t": 119.43689999999998, "r": 669.3405, "b": 110.70089999999999 }, "text": "Deductible, then 30%", "attrs": { "row": 16, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 122 }, { "id": "p10.2.124", "order": 126, "type": "table_cell", "bbox": { "l": 690.5195, "t": 119.43689999999998, "r": 744.8779, "b": 110.70089999999999 }, "text": "Deductible, then 50%", "attrs": { "row": 16, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 123 }, { "id": "p10.2.125", "order": 127, "type": "table_cell", "bbox": { "l": 41.8125, "t": 123.66890000000001, "r": 152.3693, "b": 106.46089999999998 }, "text": "X-ray, Lab, and Diagnostics including MRI, CT, and PET scans", "attrs": { "row": 17, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 124 }, { "id": "p10.2.126", "order": 128, "type": "table_cell", "bbox": { "l": 211.0933, "t": 271.397, "r": 265.4517, "b": 262.661 }, "text": "Deductible, then 20%", "attrs": { "row": 17, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 125 }, { "id": "p10.2.127", "order": 129, "type": "table_cell", "bbox": { "l": 248.9533, "t": 239.71699999999998, "r": 303.3117, "b": 230.981 }, "text": "Deductible, then 50%", "attrs": { "row": 17, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 126 }, { "id": "p10.2.128", "order": 130, "type": "table_cell", "bbox": { "l": 324.1945, "t": 239.71699999999998, "r": 378.5529, "b": 230.981 }, "text": "Deductible, then 25%", "attrs": { "row": 17, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 127 }, { "id": "p10.2.129", "order": 131, "type": "table_cell", "bbox": { "l": 396.5546, "t": 239.71699999999998, "r": 450.913, "b": 230.981 }, "text": "Deductible, then 50%", "attrs": { "row": 17, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 128 }, { "id": "p10.2.130", "order": 132, "type": "table_cell", "bbox": { "l": 471.3333, "t": 239.71699999999998, "r": 525.6917, "b": 230.981 }, "text": "Deductible, then 30%", "attrs": { "row": 17, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 129 }, { "id": "p10.2.131", "order": 133, "type": "table_cell", "bbox": { "l": 542.6133, "t": 239.71699999999998, "r": 596.9717, "b": 230.981 }, "text": "Deductible, then 50%", "attrs": { "row": 17, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 130 }, { "id": "p10.2.132", "order": 134, "type": "table_cell", "bbox": { "l": 614.9821, "t": 239.71699999999998, "r": 669.3405, "b": 230.981 }, "text": "Deductible, then 30%", "attrs": { "row": 17, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 131 }, { "id": "p10.2.133", "order": 135, "type": "table_cell", "bbox": { "l": 690.5195, "t": 239.71699999999998, "r": 744.8779, "b": 230.981 }, "text": "Deductible, then 50%", "attrs": { "row": 17, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 132 } ], "reading_order": 1 }, { "id": "p10.3", "order": 136, "type": "footnote", "bbox": { "l": 32.16, "t": 100.56, "r": 756.48, "b": 82.32 }, "text": "Notes: The boxed areas of the grid are components of each plan most often used by members when choosing a plan option, but are not all inclusive. You can refer to the Summary of Benefits and Coverage (SBC) for more information. KEHP has made every attempt to ensure the accuracy of the benefits outlined in this Benefits Grid. If an error has occurred, the benefits outlined in the 2025 Summary Plan Descriptions (SPDs) and Medical Benefit Booklets will determine how benefits are paid. Benefits are subject to the terms, conditions, limitations, and exclusions set forth in the SPDs.", "attrs": { "block_label": "vision_footnote" }, "reading_order": 2 }, { "id": "p10.4", "order": 137, "type": "footnote", "bbox": { "l": 30.48, "t": 82.56, "r": 525.6, "b": 72.72 }, "text": "• Co-pays do not accumulate toward the deductible, but they do accumulate toward the applicable maximum out-of-pocket. Once your maximum out-of-pocket is met, you do not have to pay any more co-pays.", "attrs": { "block_label": "vision_footnote" }, "reading_order": 3 }, { "id": "p10.5", "order": 138, "type": "footnote", "bbox": { "l": 32.88, "t": 72.72, "r": 738.48, "b": 54.24 }, "text": "- Certain drugs to treat diabetes, COPD, asthma, and hypertension are subject to reduced co-pays and co-insurance with no Deductibles. A 90-day supply of maintenance drugs may be subject to lower co-pays and co-insurance. Select preventive/maintenance drugs bypass the deductible on the CDHPs. Claims are processed based on provider billing type, which may include separate charges from a lab performing services outside of the doctor's office visit.", "attrs": { "block_label": "vision_footnote" }, "reading_order": 4 }, { "id": "p10.6", "order": 139, "type": "footnote", "bbox": { "l": 31.92, "t": 52.32, "r": 752.16, "b": 35.04 }, "text": "*The HDHP has a non-embedded deductible which means all family members share a deductible and out-of-pocket (OOP) maximum, regardless of the number of family members. The entire deductible must be met before any one family member receives benefits. The entire OOP must be met before the family has satisfied the OOP maximum.", "attrs": { "block_label": "vision_footnote" }, "reading_order": 5 }, { "id": "p10.7", "order": 140, "type": "footer", "bbox": { "l": 34.8, "t": 29.76, "r": 47.28, "b": 20.64 }, "text": "10", "attrs": { "block_label": "number" }, "reading_order": 6 } ] }, { "document_id": 13522, "page": 11, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 17, "counts_by_type": { "caption": 2, "footer": 1, "footnote": 2, "heading": 1, "table": 2, "table_cell": 8, "text": 1 }, "build_ms": 12, "items": [ { "id": "p11.1", "order": 1, "type": "heading", "bbox": { "l": 35.04, "t": 577.44, "r": 669.6, "b": 552.72 }, "text": "2025 Monthly Premium Contributions for Non-Tobacco Users", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p11.2", "order": 2, "type": "caption", "bbox": { "l": 37.68, "t": 532.32, "r": 238.08, "b": 519.12 }, "text": "Who completed the LivingWell Promise in 2024 for 2025", "attrs": { "block_label": "figure_title" }, "reading_order": 1 }, { "id": "p11.3", "order": 3, "type": "table", "bbox": { "l": 36, "t": 517.44, "r": 391.2, "b": 151.68 }, "text": "", "attrs": { "block_label": "table", "n_rows": 1, "n_cols": 4, "integrity": { "cells_checked": 4, "cells_flagged": 0 } }, "children": [ { "id": "p11.3.1", "order": 4, "type": "table_cell", "bbox": { "l": 40.5, "t": 513.0035, "r": 114.3252, "b": 152.8014 }, "text": "LivingWell CDHP\nSingle\nParent-Plus\nCouple\nFamily\nFamily Cross-Reference ^{{*}}\nLivingWell PPO\nSingle\nParent-Plus\nCouple\nFamily\nFamily Cross-Reference ^{{*}}\nLivingWell Basic CDHP\nSingle\nParent-Plus\nCouple\nFamily\nFamily Cross-Reference ^{{*}}\nLivingWell HDHP\nSingle\nParent-Plus\nCouple\nFamily\nFamily Cross-Reference ^{{*}}", "attrs": { "row": 0, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 0 }, { "id": "p11.3.2", "order": 5, "type": "table_cell", "bbox": { "l": 145.62, "t": 513.0035, "r": 190.0881, "b": 153.07139999999998 }, "text": "Total Premium\n930.76\n1,269.28\n1,866.24\n2,078.08\n1,068.66\nTotal Premium\n949.04\n1,320.40\n1,981.62\n2,185.78\n1,126.28\nTotal Premium\n901.04\n1,234.80\n1,863.04\n2,069.88\n1,057.40\nTotal Premium\n835.42\n1,144.86\n1,727.36\n1,919.14\n980.38", "attrs": { "row": 0, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 1 }, { "id": "p11.3.3", "order": 6, "type": "table_cell", "bbox": { "l": 220.5, "t": 513.0035, "r": 290.5992, "b": 153.07139999999998 }, "text": "Employer Contribution\n877.30\n1,132.22\n1,526.90\n1,679.16\n981.76\nEmployer Contribution\n859.90\n1,066.30\n1,409.86\n1,469.14\n955.80\nEmployer Contribution\n872.70\n1,167.28\n1,581.62\n1,732.20\n1,025.90\nEmployer Contribution\n814.54\n1,088.76\n1,476.90\n1,617.84\n951.18", "attrs": { "row": 0, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 2 }, { "id": "p11.3.4", "order": 7, "type": "table_cell", "bbox": { "l": 305.46, "t": 513.0035, "r": 376.7112, "b": 153.07139999999998 }, "text": "Employee Contribution\n53.46\n137.06\n339.34\n398.92\n86.90\nEmployee Contribution\n89.14\n254.10\n571.76\n716.64\n170.48\nEmployee Contribution\n28.34\n67.52\n281.42\n337.68\n31.50\nEmployee Contribution\n20.88\n56.10\n250.46\n301.30\n29.20", "attrs": { "row": 0, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 3 } ], "reading_order": 2 }, { "id": "p11.4", "order": 8, "type": "caption", "bbox": { "l": 403.92, "t": 532.8, "r": 627.84, "b": 519.36 }, "text": "Who did NOT complete the LivingWell Promise in 2024 for 2025", "attrs": { "block_label": "figure_title" }, "reading_order": 3 }, { "id": "p11.5", "order": 9, "type": "table", "bbox": { "l": 402.72, "t": 522, "r": 757.68, "b": 150 }, "text": "", "attrs": { "block_label": "table", "n_rows": 1, "n_cols": 4, "integrity": { "cells_checked": 4, "cells_flagged": 0 } }, "children": [ { "id": "p11.5.1", "order": 10, "type": "table_cell", "bbox": { "l": 406.5, "t": 513.6513, "r": 480.3252, "b": 153.53379999999999 }, "text": "LivingWell CDHP\nSingle\nParent-Plus\nCouple\nFamily\nFamily Cross-Reference ^{{*}}\nLivingWell PPO\nSingle\nParent-Plus\nCouple\nFamily\nFamily Cross-Reference ^{{*}}\nLivingWell Basic CDHP\nSingle\nParent-Plus\nCouple\nFamily\nFamily Cross-Reference ^{{*}}\nLivingWell HDHP\nSingle\nParent-Plus\nCouple\nFamily\nFamily Cross-Reference ^{{*}}", "attrs": { "row": 0, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 0 }, { "id": "p11.5.2", "order": 11, "type": "table_cell", "bbox": { "l": 513.04, "t": 513.6513, "r": 557.5081, "b": 153.80380000000002 }, "text": "Total Premium\n930.76\n1,269.28\n1,866.24\n2,078.08\n1,068.66\nTotal Premium\n949.04\n1,320.40\n1,981.62\n2,185.78\n1,126.28\nTotal Premium\n901.04\n1,234.80\n1,863.04\n2,069.88\n1,057.40\nTotal Premium\n835.42\n1,144.86\n1,727.36\n1,919.14\n980.38", "attrs": { "row": 0, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 1 }, { "id": "p11.5.3", "order": 12, "type": "table_cell", "bbox": { "l": 587.92, "t": 513.6513, "r": 658.0192, "b": 153.80380000000002 }, "text": "Employer Contribution\n837.30\n1,092.22\n1,486.90\n1,639.16\n941.76\nEmployer Contribution\n819.90\n1,026.30\n1,369.86\n1,429.14\n915.80\nEmployer Contribution\n832.70\n1,127.28\n1,541.62\n1,692.20\n985.90\nEmployer Contribution\n774.54\n1,048.76\n1,436.90\n1,577.84\n911.18", "attrs": { "row": 0, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 2 }, { "id": "p11.5.4", "order": 13, "type": "table_cell", "bbox": { "l": 673.6, "t": 513.6513, "r": 744.8512, "b": 153.80380000000002 }, "text": "Employee Contribution\n93.46\n177.06\n379.34\n438.92\n126.90\nEmployee Contribution\n129.14\n294.10\n611.76\n756.64\n210.48\nEmployee Contribution\n68.34\n107.52\n321.42\n377.68\n71.50\nEmployee Contribution\n60.88\n96.10\n290.46\n341.30\n69.20", "attrs": { "row": 0, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 3 } ], "reading_order": 4 }, { "id": "p11.6", "order": 14, "type": "footnote", "bbox": { "l": 33.6, "t": 133.68, "r": 247.92, "b": 121.2 }, "text": "All employee premium contributions are per employee, per month.", "attrs": { "block_label": "vision_footnote" }, "reading_order": 5 }, { "id": "p11.7", "order": 15, "type": "footnote", "bbox": { "l": 33.36, "t": 113.04, "r": 363.84, "b": 101.52 }, "text": "[p11.7.1] Family Cross-Reference is not an available payment option if you are hired on January 1, 2025 or after.", "attrs": { "block_label": "vision_footnote" }, "children": [ { "id": "p11.7.1", "order": 16, "type": "text", "bbox": { "l": 33.36, "t": 113.04, "r": 363.84, "b": 101.52 }, "text": "^{*}", "attrs": { "inline": true, "text_offset": 0, "text_span": 9, "bbox_estimated": true }, "reading_order": 0 } ], "reading_order": 6 }, { "id": "p11.8", "order": 17, "type": "footer", "bbox": { "l": 745.2, "t": 30.72, "r": 757.44, "b": 21.12 }, "text": "11", "attrs": { "block_label": "number" }, "reading_order": 7 } ] }, { "document_id": 13522, "page": 12, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 17, "counts_by_type": { "caption": 2, "footer": 1, "footnote": 2, "heading": 1, "table": 2, "table_cell": 8, "text": 1 }, "build_ms": 11, "items": [ { "id": "p12.1", "order": 1, "type": "heading", "bbox": { "l": 32.64, "t": 577.68, "r": 621.12, "b": 552.96 }, "text": "2025 Monthly Premium Contributions for Tobacco Users", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p12.2", "order": 2, "type": "caption", "bbox": { "l": 37.68, "t": 532.32, "r": 236.88, "b": 519.36 }, "text": "Who completed the LivingWell Promise in 2024 for 2025", "attrs": { "block_label": "figure_title" }, "reading_order": 1 }, { "id": "p12.3", "order": 3, "type": "table", "bbox": { "l": 36, "t": 519.6, "r": 390, "b": 151.92 }, "text": "", "attrs": { "block_label": "table", "n_rows": 1, "n_cols": 4, "integrity": { "cells_checked": 4, "cells_flagged": 0 } }, "children": [ { "id": "p12.3.1", "order": 4, "type": "table_cell", "bbox": { "l": 40.02, "t": 513.7234, "r": 113.8452, "b": 153.2815 }, "text": "LivingWell CDHP\nSingle\nParent-Plus\nCouple\nFamily\nFamily Cross-Reference ^{{*}}\nLivingWell PPO\nSingle\nParent-Plus\nCouple\nFamily\nFamily Cross-Reference ^{{*}}\nLivingWell Basic CDHP\nSingle\nParent-Plus\nCouple\nFamily\nFamily Cross-Reference ^{{*}}\nLivingWell HDHP\nSingle\nParent-Plus\nCouple\nFamily\nFamily Cross-Reference ^{{*}}", "attrs": { "row": 0, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 0 }, { "id": "p12.3.2", "order": 5, "type": "table_cell", "bbox": { "l": 146.56, "t": 513.7234, "r": 191.0281, "b": 153.55149999999998 }, "text": "Total Premium\n930.76\n1,269.28\n1,866.24\n2,078.08\n1,068.66\nTotal Premium\n949.04\n1,320.40\n1,981.62\n2,185.78\n1,126.28\nTotal Premium\n901.04\n1,234.80\n1,863.04\n2,069.88\n1,057.40\nTotal Premium\n835.42\n1,144.86\n1,727.36\n1,919.14\n980.38", "attrs": { "row": 0, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 1 }, { "id": "p12.3.3", "order": 6, "type": "table_cell", "bbox": { "l": 220.48, "t": 513.7234, "r": 290.5783, "b": 153.55149999999998 }, "text": "Employer Contribution\n837.30\n1,052.22\n1,446.90\n1,599.16\n941.76\nEmployer Contribution\n819.90\n986.30\n1,329.86\n1,389.14\n915.80\nEmployer Contribution\n832.70\n1,087.28\n1,501.62\n1,652.20\n985.90\nEmployer Contribution\n774.54\n1,008.76\n1,396.90\n1,537.84\n911.18", "attrs": { "row": 0, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 2 }, { "id": "p12.3.4", "order": 7, "type": "table_cell", "bbox": { "l": 305.68, "t": 513.7234, "r": 376.9312, "b": 153.55149999999998 }, "text": "Employee Contribution\n93.46\n217.06\n419.34\n478.92\n126.90\nEmployee Contribution\n129.14\n334.10\n651.76\n796.64\n210.48\nEmployee Contribution\n68.34\n147.52\n361.42\n417.68\n71.50\nEmployee Contribution\n60.88\n136.10\n330.46\n381.30\n69.20", "attrs": { "row": 0, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 3 } ], "reading_order": 2 }, { "id": "p12.4", "order": 8, "type": "caption", "bbox": { "l": 403.92, "t": 532.8, "r": 628.08, "b": 519.36 }, "text": "Who did NOT complete the LivingWell Promise in 2024 for 2025", "attrs": { "block_label": "figure_title" }, "reading_order": 3 }, { "id": "p12.5", "order": 9, "type": "table", "bbox": { "l": 402.24, "t": 517.68, "r": 756, "b": 152.16 }, "text": "", "attrs": { "block_label": "table", "n_rows": 1, "n_cols": 4, "integrity": { "cells_checked": 4, "cells_flagged": 0 } }, "children": [ { "id": "p12.5.1", "order": 10, "type": "table_cell", "bbox": { "l": 406.5, "t": 513.8985, "r": 480.3252, "b": 153.3155 }, "text": "LivingWell CDHP\nSingle\nParent-Plus\nCouple\nFamily\nFamily Cross-Reference ^{{*}}\nLivingWell PPO\nSingle\nParent-Plus\nCouple\nFamily\nFamily Cross-Reference ^{{*}}\nLivingWell Basic CDHP\nSingle\nParent-Plus\nCouple\nFamily\nFamily Cross-Reference ^{{*}}\nLivingWell HDHP\nSingle\nParent-Plus\nCouple\nFamily\nFamily Cross-Reference ^{{*}}", "attrs": { "row": 0, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 0 }, { "id": "p12.5.2", "order": 11, "type": "table_cell", "bbox": { "l": 512.32, "t": 513.8985, "r": 556.7881, "b": 153.58550000000002 }, "text": "Total Premium\n930.76\n1,269.28\n1,866.24\n2,078.08\n1,068.66\nTotal Premium\n949.04\n1,320.40\n1,981.62\n2,185.78\n1,126.28\nTotal Premium\n901.04\n1,234.80\n1,863.04\n2,069.88\n1,057.40\nTotal Premium\n835.42\n1,144.86\n1,727.36\n1,919.14\n980.38", "attrs": { "row": 0, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 1 }, { "id": "p12.5.3", "order": 12, "type": "table_cell", "bbox": { "l": 585.76, "t": 513.8985, "r": 655.8592, "b": 153.58550000000002 }, "text": "Employer Contribution\n797.30\n1,012.22\n1,406.90\n1,559.16\n901.76\nEmployer Contribution\n779.90\n946.30\n1,289.86\n1,349.14\n875.80\nEmployer Contribution\n792.70\n1,047.28\n1,461.62\n1,612.20\n945.90\nEmployer Contribution\n734.54\n968.76\n1,356.90\n1,497.84\n871.18", "attrs": { "row": 0, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 2 }, { "id": "p12.5.4", "order": 13, "type": "table_cell", "bbox": { "l": 672.16, "t": 513.8985, "r": 743.4112, "b": 153.58550000000002 }, "text": "Employee Contribution\n133.46\n257.06\n459.34\n518.92\n166.90\nEmployee Contribution\n169.14\n374.10\n691.76\n836.64\n250.48\nEmployee Contribution\n108.34\n187.52\n401.42\n457.68\n111.50\nEmployee Contribution\n100.88\n176.10\n370.46\n421.30\n109.20", "attrs": { "row": 0, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 3 } ], "reading_order": 4 }, { "id": "p12.6", "order": 14, "type": "footnote", "bbox": { "l": 33.6, "t": 133.68, "r": 247.68, "b": 121.44 }, "text": "All employee premium contributions are per employee, per month.", "attrs": { "block_label": "vision_footnote" }, "reading_order": 5 }, { "id": "p12.7", "order": 15, "type": "footnote", "bbox": { "l": 33.36, "t": 113.04, "r": 363.84, "b": 101.52 }, "text": "[p12.7.1] Family Cross-Reference is not an available payment option if you are hired on January 1, 2025 or after.", "attrs": { "block_label": "vision_footnote" }, "children": [ { "id": "p12.7.1", "order": 16, "type": "text", "bbox": { "l": 33.36, "t": 113.04, "r": 363.84, "b": 101.52 }, "text": "^{*}", "attrs": { "inline": true, "text_offset": 0, "text_span": 9, "bbox_estimated": true }, "reading_order": 0 } ], "reading_order": 6 }, { "id": "p12.8", "order": 17, "type": "footer", "bbox": { "l": 34.8, "t": 30, "r": 46.8, "b": 20.4 }, "text": "12", "attrs": { "block_label": "number" }, "reading_order": 7 } ] }, { "document_id": 13522, "page": 13, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 24, "counts_by_type": { "footer": 1, "heading": 5, "link": 5, "text": 13 }, "build_ms": 2, "items": [ { "id": "p13.1", "order": 1, "type": "heading", "bbox": { "l": 34.8, "t": 576.96, "r": 321.6, "b": 551.76 }, "text": "Prescription Drug Coverage", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p13.2", "order": 2, "type": "text", "bbox": { "l": 32.64, "t": 537.12, "r": 353.28, "b": 447.12 }, "text": "All health plan options have prescription drug coverage.\nCVS/Caremark manages the prescription benefits for KEHP, but you do not have to use a CVS pharmacy. Go to any in-network pharmacy that you choose and get a 30-day or 90-day supply of drugs! If you prefer to have your prescriptions delivered to your door, use the CVS/Caremark retail mail-order program.", "reading_order": 1 }, { "id": "p13.3", "order": 3, "type": "heading", "bbox": { "l": 33.6, "t": 433.2, "r": 174.96, "b": 420 }, "text": "Sign up at caremark.com", "attrs": { "block_label": "paragraph_title" }, "children": [ { "id": "p13.3.1", "order": 4, "type": "link", "bbox": { "l": 93.8558, "t": 434.023, "r": 173.026, "b": 419.779 }, "text": "caremark.com", "attrs": { "uri": "http://caremark.com", "action_type": "/URI" }, "reading_order": 0 } ], "level": 3, "reading_order": 2 }, { "id": "p13.4", "order": 5, "type": "text", "bbox": { "l": 32.64, "t": 416.64, "r": 383.04, "b": 341.04 }, "text": "Your drug coverage is limited to drugs on the Value Formulary. You can view both the condensed and detailed versions of the Value Formulary at kehp.ky.gov or caremark.com. Some drugs are subject to prior authorization. An appeals process is available for drugs not covered under the Value Formulary or for drugs prescribed by a physician where usage or dosage is contrary to FDA approval. For specific questions about your prescriptions, contact CVS/Caremark at 866-601-6934.", "children": [ { "id": "p13.4.1", "order": 6, "type": "link", "bbox": { "l": 295.906, "t": 404.227, "r": 346.615, "b": 392.357 }, "text": "kehp.ky.gov", "attrs": { "uri": "http://kehp.ky.gov", "action_type": "/URI" }, "reading_order": 0 }, { "id": "p13.4.2", "order": 7, "type": "link", "bbox": { "l": 36, "t": 391.727, "r": 98.2089, "b": 379.857 }, "text": "caremark.com.", "attrs": { "uri": "http://www.caremark.com", "action_type": "/URI" }, "reading_order": 1 } ], "reading_order": 3 }, { "id": "p13.5", "order": 8, "type": "text", "bbox": { "l": 33.12, "t": 335.76, "r": 364.56, "b": 311.52 }, "text": "You may want to share the formulary listing with your primary care physician or other providers.", "reading_order": 4 }, { "id": "p13.6", "order": 9, "type": "heading", "bbox": { "l": 33.36, "t": 302.64, "r": 359.04, "b": 265.68 }, "text": "Preventive Therapy Drug Benefit — Bypass Your Deductible (LivingWell CDHP, LivingWell Basic CDHP and the LivingWell HDHP only)", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 5 }, { "id": "p13.7", "order": 10, "type": "text", "bbox": { "l": 32.88, "t": 262.32, "r": 378, "b": 185.52 }, "text": "If you have the LivingWell CDHP, LivingWell Basic CDHP, or the LivingWell HDHP you only have to pay for the co-insurance amount for medications on the Preventive Therapy Drug Benefit list without having to first meet your deductible. This list includes medications you need on a regular basis to prevent conditions, such as high blood pressure or high cholesterol. You can see the Preventive Therapy Drug Benefit list at kehp.ky.gov.", "children": [ { "id": "p13.7.1", "order": 11, "type": "link", "bbox": { "l": 92.6388, "t": 198.973, "r": 143.348, "b": 187.103 }, "text": "kehp.ky.gov.", "attrs": { "uri": "http://kehp.ky.gov", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 6 }, { "id": "p13.8", "order": 12, "type": "heading", "bbox": { "l": 407.04, "t": 536.88, "r": 597.6, "b": 523.2 }, "text": "CVS Weight Management Program", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 7 }, { "id": "p13.9", "order": 13, "type": "text", "bbox": { "l": 407.04, "t": 519.6, "r": 735.84, "b": 480.96 }, "text": "You may benefit from the CVS Weight Management program. This program provides the customized nutrition planning and coaching support you need for lasting results.", "reading_order": 8 }, { "id": "p13.10", "order": 14, "type": "text", "bbox": { "l": 407.04, "t": 474.96, "r": 675.12, "b": 461.76 }, "text": "The program will help you reach your weight loss goals through:", "reading_order": 9 }, { "id": "p13.11", "order": 15, "type": "text", "bbox": { "l": 416.4, "t": 459.12, "r": 713.52, "b": 434.4 }, "text": "One-on-one support from a team of clinicians, including providers and registered dietitians.", "reading_order": 10 }, { "id": "p13.12", "order": 16, "type": "text", "bbox": { "l": 415.92, "t": 430.08, "r": 595.2, "b": 417.84 }, "text": "• A nutrition plan personalized just for you.", "reading_order": 11 }, { "id": "p13.13", "order": 17, "type": "text", "bbox": { "l": 415.92, "t": 413.76, "r": 704.88, "b": 389.28 }, "text": "The Weight Coach app with helpful guides, recipes, goal setting, and much more.", "reading_order": 12 }, { "id": "p13.14", "order": 18, "type": "text", "bbox": { "l": 415.2, "t": 384.72, "r": 732.24, "b": 359.04 }, "text": "• A connected bodyweight scale and other devices, as applicable, to support and track your progress.", "reading_order": 13 }, { "id": "p13.15", "order": 19, "type": "text", "bbox": { "l": 405.84, "t": 352.08, "r": 756.24, "b": 312.24 }, "text": "There is no cost to you to participate in this program, but you will be responsible for your deductible, co-insurance, or co-pay for any drugs and supplies. Participation in the program may be required to have certain weight loss drugs covered.", "reading_order": 14 }, { "id": "p13.16", "order": 20, "type": "text", "bbox": { "l": 406.8, "t": 307.2, "r": 685.44, "b": 294 }, "text": "You can call 800-706-9317 to speak with a clinician to learn more.", "reading_order": 15 }, { "id": "p13.17", "order": 21, "type": "heading", "bbox": { "l": 450.48, "t": 233.52, "r": 569.04, "b": 213.12 }, "text": "HEALTH ACTION", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 16 }, { "id": "p13.18", "order": 22, "type": "text", "bbox": { "l": 429.12, "t": 176.64, "r": 733.92, "b": 95.76 }, "text": "CVS/Caremark has a Check Drug and Cost Coverage tool that is helpful in comparing the cost of drugs at nearby pharmacies. The lower the cost of the drug, the less you will pay in co-insurance (except for the LivingWell PPO plan, which offers a fixed co-pay for prescription drugs). Sign in at caremark.com, select Plan & Benefits, and choose Check Drug and Cost Coverage.", "children": [ { "id": "p13.18.1", "order": 23, "type": "link", "bbox": { "l": 562.43, "t": 123.424, "r": 628.22, "b": 110.367 }, "text": "caremark.com,", "attrs": { "uri": "http://www.caremark.com", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 17 }, { "id": "p13.19", "order": 24, "type": "footer", "bbox": { "l": 745.68, "t": 30.48, "r": 757.2, "b": 21.12 }, "text": "13", "attrs": { "block_label": "number" }, "reading_order": 18 } ] }, { "document_id": 13522, "page": 14, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 42, "counts_by_type": { "figure": 1, "footer": 1, "heading": 1, "list": 1, "list_item": 6, "table": 1, "table_cell": 25, "text": 5, "title": 1 }, "build_ms": 5, "items": [ { "id": "p14.1", "order": 1, "type": "title", "bbox": { "l": 33.84, "t": 576.96, "r": 320.64, "b": 552 }, "text": "Prescription Drug Coverage", "attrs": { "block_label": "doc_title" }, "level": 2, "reading_order": 0 }, { "id": "p14.2", "order": 2, "type": "heading", "bbox": { "l": 33.36, "t": 536.4, "r": 372.96, "b": 523.44 }, "text": "Value Benefits for Diabetes, COPD, Asthma, and Hypertension", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 1 }, { "id": "p14.3", "order": 3, "type": "text", "bbox": { "l": 33.12, "t": 519.12, "r": 428.16, "b": 467.28 }, "text": "As costs of prescription drugs continue to rise, KEHP wants to help you by reducing what you have to pay! For several years, KEHP has offered Value Benefits, and we now know that you are being more compliant in taking your medications – because they cost you less! This is effective in improving your health, saving you money, and reducing plan costs. It's a win-win for all!", "reading_order": 2 }, { "id": "p14.4", "order": 4, "type": "text", "bbox": { "l": 33.36, "t": 461.52, "r": 426.96, "b": 436.56 }, "text": "The Value Benefit for diabetes, COPD, asthma, and hypertension means your costs are reduced if you receive maintenance prescriptions or supplies. Some examples include:", "reading_order": 3 }, { "id": "p14.5", "order": 5, "type": "list", "bbox": { "l": 42.48, "t": 432, "r": 223.92, "b": 335.28 }, "text": "", "attrs": { "item_count": 6 }, "children": [ { "id": "p14.5.1", "order": 6, "type": "list_item", "bbox": { "l": 42.96, "t": 432, "r": 89.28, "b": 421.44 }, "text": "Inhalers", "marker": "•", "reading_order": 0 }, { "id": "p14.5.2", "order": 7, "type": "list_item", "bbox": { "l": 42.96, "t": 414.96, "r": 133.68, "b": 403.92 }, "text": "Pressure machines", "reading_order": 1 }, { "id": "p14.5.3", "order": 8, "type": "list_item", "bbox": { "l": 43.2, "t": 398.16, "r": 119.04, "b": 386.64 }, "text": "Infusion pumps", "reading_order": 2 }, { "id": "p14.5.4", "order": 9, "type": "list_item", "bbox": { "l": 42.72, "t": 381.36, "r": 197.52, "b": 370.08 }, "text": "Blood pressure monitoring devices", "reading_order": 3 }, { "id": "p14.5.5", "order": 10, "type": "list_item", "bbox": { "l": 42.72, "t": 364.32, "r": 126.48, "b": 353.28 }, "text": "Cardiac monitors", "marker": "•", "reading_order": 4 }, { "id": "p14.5.6", "order": 11, "type": "list_item", "bbox": { "l": 42.48, "t": 347.52, "r": 223.92, "b": 335.28 }, "text": "Supplies and durable medical equipment", "marker": "•", "reading_order": 5 } ], "reading_order": 4 }, { "id": "p14.6", "order": 12, "type": "text", "bbox": { "l": 33.36, "t": 327.84, "r": 386.16, "b": 315.12 }, "text": "You will pay a reduced co-pay and/or co-insurance, and you won't have a deductible.", "reading_order": 5 }, { "id": "p14.7", "order": 13, "type": "text", "bbox": { "l": 33.84, "t": 308.4, "r": 403.44, "b": 282.96 }, "text": "See the chart below for the cost that you will pay. The maximum you will pay for a 30-day supply of insulin is $30.", "reading_order": 6 }, { "id": "p14.8", "order": 14, "type": "text", "bbox": { "l": 33.84, "t": 276.48, "r": 393.12, "b": 251.04 }, "text": "Most supplies and durable medical equipment related to diabetes, COPD, asthma, and hypertension are covered in full with NO DEDUCTIBLE.", "reading_order": 7 }, { "id": "p14.9", "order": 15, "type": "figure", "bbox": { "l": 452.16, "t": 576.96, "r": 755.28, "b": 255.36 }, "text": "", "attrs": { "block_label": "image" }, "reading_order": 8 }, { "id": "p14.10", "order": 16, "type": "table", "bbox": { "l": 37.44, "t": 226.8, "r": 624.72, "b": 68.4 }, "text": "", "attrs": { "block_label": "table", "n_rows": 5, "n_cols": 5, "integrity": { "cells_checked": 23, "cells_flagged": 0 } }, "children": [ { "id": "p14.10.1", "order": 17, "type": "table_cell", "bbox": { "l": 40.5, "t": 218.0552, "r": 119.2358, "b": 204.77820000000003 }, "text": "Value Benefit Design", "attrs": { "row": 0, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "reading_order": 0 }, { "id": "p14.10.2", "order": 18, "type": "table_cell", "bbox": { "l": 156.752, "t": 218.0552, "r": 217.6359, "b": 204.77820000000003 }, "text": "LivingWell CDHP", "attrs": { "row": 0, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "reading_order": 1 }, { "id": "p14.10.3", "order": 19, "type": "table_cell", "bbox": { "l": 273.004, "t": 218.0552, "r": 328.7179, "b": 204.77820000000003 }, "text": "LivingWell PPO", "attrs": { "row": 0, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "reading_order": 2 }, { "id": "p14.10.4", "order": 20, "type": "table_cell", "bbox": { "l": 379.84, "t": 218.0552, "r": 463.8338, "b": 204.77820000000003 }, "text": "LivingWell Basic CDHP", "attrs": { "row": 0, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "reading_order": 3 }, { "id": "p14.10.5", "order": 21, "type": "table_cell", "bbox": { "l": 512.32, "t": 218.0552, "r": 573.4679, "b": 204.77820000000003 }, "text": "LivingWell HDHP", "attrs": { "row": 0, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "reading_order": 4 }, { "id": "p14.10.6", "order": 22, "type": "table_cell", "bbox": { "l": 45.5, "t": 190.5824, "r": 115.648, "b": 167.5124 }, "text": "1 to 30 - Day Supply\\n(Retail)", "attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 5 }, { "id": "p14.10.7", "order": 23, "type": "table_cell", "bbox": { "l": 161.752, "t": 189.92239999999998, "r": 210.011, "b": 179.00240000000002 }, "text": "(No Deductible)", "attrs": { "row": 1, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 6 }, { "id": "p14.10.8", "order": 24, "type": "table_cell", "bbox": { "l": 272.352, "t": 204.1714, "r": 389.808, "b": 181.5429 }, "text": "", "attrs": { "row": 1, "col": 2, "rowspan": 1, "colspan": 1 }, "reading_order": 7 }, { "id": "p14.10.9", "order": 25, "type": "table_cell", "bbox": { "l": 384.84, "t": 189.92239999999998, "r": 433.099, "b": 179.00240000000002 }, "text": "(No Deductible)", "attrs": { "row": 1, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 8 }, { "id": "p14.10.10", "order": 26, "type": "table_cell", "bbox": { "l": 517.32, "t": 189.92239999999998, "r": 565.579, "b": 179.00240000000002 }, "text": "(No Deductible)", "attrs": { "row": 1, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 9 }, { "id": "p14.10.11", "order": 27, "type": "table_cell", "bbox": { "l": 45.5, "t": 165.57999999999998, "r": 107.2086, "b": 139.50760000000002 }, "text": "Tier 1 – Generic\nTier 2 – Formulary", "attrs": { "row": 2, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 10 }, { "id": "p14.10.12", "order": 28, "type": "table_cell", "bbox": { "l": 161.752, "t": 164.92000000000002, "r": 177.302, "b": 139.99759999999998 }, "text": "0%\n10%", "attrs": { "row": 2, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 11 }, { "id": "p14.10.13", "order": 29, "type": "table_cell", "bbox": { "l": 278.004, "t": 164.92000000000002, "r": 290.964, "b": 139.99759999999998 }, "text": "$0\n$25", "attrs": { "row": 2, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 12 }, { "id": "p14.10.14", "order": 30, "type": "table_cell", "bbox": { "l": 384.84, "t": 164.92000000000002, "r": 400.39, "b": 139.99759999999998 }, "text": "0%\n25%", "attrs": { "row": 2, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 13 }, { "id": "p14.10.15", "order": 31, "type": "table_cell", "bbox": { "l": 517.32, "t": 164.92000000000002, "r": 532.87, "b": 139.99759999999998 }, "text": "0%\n25%", "attrs": { "row": 2, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 14 }, { "id": "p14.10.16", "order": 32, "type": "table_cell", "bbox": { "l": 45.5, "t": 126.07760000000002, "r": 120.148, "b": 103.00760000000002 }, "text": "31 to 90 - Day Supply\\n(Retail or Mail Order)", "attrs": { "row": 3, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 15 }, { "id": "p14.10.17", "order": 33, "type": "table_cell", "bbox": { "l": 161.752, "t": 125.4176, "r": 210.011, "b": 114.49759999999998 }, "text": "(No Deductible)", "attrs": { "row": 3, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 16 }, { "id": "p14.10.18", "order": 34, "type": "table_cell", "bbox": { "l": 272.352, "t": 136.2857, "r": 389.808, "b": 113.6571 }, "text": "", "attrs": { "row": 3, "col": 2, "rowspan": 1, "colspan": 1 }, "reading_order": 17 }, { "id": "p14.10.19", "order": 35, "type": "table_cell", "bbox": { "l": 384.84, "t": 125.4176, "r": 433.099, "b": 114.49759999999998 }, "text": "(No Deductible)", "attrs": { "row": 3, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 18 }, { "id": "p14.10.20", "order": 36, "type": "table_cell", "bbox": { "l": 517.32, "t": 125.4176, "r": 565.579, "b": 114.49759999999998 }, "text": "(No Deductible)", "attrs": { "row": 3, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 19 }, { "id": "p14.10.21", "order": 37, "type": "table_cell", "bbox": { "l": 45.5, "t": 101.0752, "r": 107.2785, "b": 75.00279999999998 }, "text": "Tier 1 – Generic\nTier 2 – Formulary", "attrs": { "row": 4, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 20 }, { "id": "p14.10.22", "order": 38, "type": "table_cell", "bbox": { "l": 161.752, "t": 100.41520000000003, "r": 177.302, "b": 75.49279999999999 }, "text": "0%\n10%", "attrs": { "row": 4, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 21 }, { "id": "p14.10.23", "order": 39, "type": "table_cell", "bbox": { "l": 278.004, "t": 100.41520000000003, "r": 290.964, "b": 75.49279999999999 }, "text": "$0\n$50", "attrs": { "row": 4, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 22 }, { "id": "p14.10.24", "order": 40, "type": "table_cell", "bbox": { "l": 384.84, "t": 100.41520000000003, "r": 400.39, "b": 75.49279999999999 }, "text": "0%\n25%", "attrs": { "row": 4, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 23 }, { "id": "p14.10.25", "order": 41, "type": "table_cell", "bbox": { "l": 517.32, "t": 100.41520000000003, "r": 532.87, "b": 75.49279999999999 }, "text": "0%\n25%", "attrs": { "row": 4, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 24 } ], "reading_order": 9 }, { "id": "p14.11", "order": 42, "type": "footer", "bbox": { "l": 34.8, "t": 29.52, "r": 47.04, "b": 20.64 }, "text": "14", "attrs": { "block_label": "number" }, "reading_order": 10 } ] }, { "document_id": 13522, "page": 15, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 30, "counts_by_type": { "figure": 1, "footer": 1, "heading": 5, "list": 2, "list_item": 8, "text": 13 }, "build_ms": 3, "items": [ { "id": "p15.1", "order": 1, "type": "heading", "bbox": { "l": 33.6, "t": 577.2, "r": 335.28, "b": 553.92 }, "text": "Waiver General Purpose HRA", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p15.2", "order": 2, "type": "text", "bbox": { "l": 33.12, "t": 537.6, "r": 350.64, "b": 477.36 }, "text": "NOTE: You MUST log in to KHRIS during open enrollment and re-enroll in the Waiver General Purpose Health Reimbursement Arrangement (HRA) to continue to receive the employer contribution of $2,100 and receive any carryover funds.", "reading_order": 1 }, { "id": "p15.3", "order": 3, "type": "heading", "bbox": { "l": 34.08, "t": 468.48, "r": 350.88, "b": 418.8 }, "text": "The balance remaining in your Waiver General Purpose HRA (up to $2,100) at the end of 2025 will carry over to 2026 as long as you continue to waive your health insurance coverage and elect the Waiver General Purpose HRA.", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 2 }, { "id": "p15.4", "order": 4, "type": "text", "bbox": { "l": 33.36, "t": 405.84, "r": 379.68, "b": 369.6 }, "text": "If you don't need health insurance, you may be eligible for the Waiver General Purpose HRA. The HRA covers medical, dental, and vision services that your health insurance plan doesn't cover, such as the deductible and other out-of-pocket costs.", "reading_order": 3 }, { "id": "p15.5", "order": 5, "type": "text", "bbox": { "l": 34.32, "t": 366.48, "r": 357.36, "b": 306.72 }, "text": "You will be eligible for a Waiver General Purpose HRA only if you have other employer-sponsored health insurance. You can use this HRA for you and your dependents as long as you can attest that all persons covered under the Waiver General Purpose HRA have other employer-sponsored group health insurance coverage.", "reading_order": 4 }, { "id": "p15.6", "order": 6, "type": "text", "bbox": { "l": 33.6, "t": 304.08, "r": 355.2, "b": 267.6 }, "text": "Your employer will contribute $175 per month, up to $2,100 per year, to your HealthEquity debit VISA Healthcare Card. It will be funded in two equal installments: $1,050 on January 1 and $1,050 on July 1.", "reading_order": 5 }, { "id": "p15.7", "order": 7, "type": "text", "bbox": { "l": 33.6, "t": 264.96, "r": 374.64, "b": 227.76 }, "text": "You have a 90-day run-out period until March 31, 2026, to request reimbursement for eligible expenses that occurred between January 1, 2025, and December 31, 2025.", "reading_order": 6 }, { "id": "p15.8", "order": 8, "type": "text", "bbox": { "l": 33.6, "t": 213.6, "r": 346.8, "b": 188.4 }, "text": "Expenses that may be reimbursed under your Waiver General Purpose HRA include:", "reading_order": 7 }, { "id": "p15.9", "order": 9, "type": "list", "bbox": { "l": 42, "t": 182.88, "r": 366.24, "b": 44.16 }, "text": "", "attrs": { "item_count": 6 }, "children": [ { "id": "p15.9.1", "order": 10, "type": "list_item", "bbox": { "l": 42.24, "t": 182.88, "r": 366.24, "b": 144.72 }, "text": "Medical and prescription expenses, including over-the-counter (OTC) medications, feminine products, and certain protective equipment, such as face masks and hand sanitizer.", "marker": "•", "reading_order": 0 }, { "id": "p15.9.2", "order": 11, "type": "list_item", "bbox": { "l": 42.72, "t": 138.96, "r": 186, "b": 126.96 }, "text": "Co-payments and co-insurance.", "marker": "•", "reading_order": 1 }, { "id": "p15.9.3", "order": 12, "type": "list_item", "bbox": { "l": 42, "t": 121.92, "r": 362.64, "b": 109.2 }, "text": "Certain dental fees, such as fees for exams, cleanings, fillings, and crowns.", "marker": "•", "reading_order": 2 }, { "id": "p15.9.4", "order": 13, "type": "list_item", "bbox": { "l": 42.72, "t": 103.92, "r": 150.72, "b": 92.4 }, "text": "Orthodontic treatment.", "marker": "•", "reading_order": 3 }, { "id": "p15.9.5", "order": 14, "type": "list_item", "bbox": { "l": 42.96, "t": 86.88, "r": 338.88, "b": 61.92 }, "text": "Vision fees, including fees for exams, contacts, eyeglasses, and laser vision correction.", "marker": "-", "reading_order": 4 }, { "id": "p15.9.6", "order": 15, "type": "list_item", "bbox": { "l": 42.48, "t": 56.4, "r": 309.6, "b": 44.16 }, "text": "Medical supplies, such as wheelchairs, crutches, and walkers.", "marker": "•", "reading_order": 5 } ], "reading_order": 8 }, { "id": "p15.10", "order": 16, "type": "heading", "bbox": { "l": 432.96, "t": 539.28, "r": 552, "b": 519.36 }, "text": "HEALTH ACTION", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 9 }, { "id": "p15.11", "order": 17, "type": "heading", "bbox": { "l": 418.08, "t": 487.68, "r": 655.68, "b": 461.52 }, "text": "Who Is Eligible to Waive Coverage and Receive the Waiver General Purpose HRA", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 10 }, { "id": "p15.12", "order": 18, "type": "list", "bbox": { "l": 426.96, "t": 455.76, "r": 742.08, "b": 376.56 }, "text": "", "attrs": { "item_count": 2 }, "children": [ { "id": "p15.12.1", "order": 19, "type": "list_item", "bbox": { "l": 427.68, "t": 455.76, "r": 718.08, "b": 405.6 }, "text": "Any active employee of a state agency, school board, or certain quasi-governmental agencies, who is eligible for state-sponsored health insurance coverage, and who has other employer-sponsored health insurance.", "marker": "•", "reading_order": 0 }, { "id": "p15.12.2", "order": 20, "type": "list_item", "bbox": { "l": 426.96, "t": 400.56, "r": 742.08, "b": 376.56 }, "text": "A retiree who has returned to work who has other group health insurance (not with KPPA or TRS).", "marker": "•", "reading_order": 1 } ], "reading_order": 11 }, { "id": "p15.13", "order": 21, "type": "heading", "bbox": { "l": 418.32, "t": 366.48, "r": 509.28, "b": 353.28 }, "text": "Who Is Not Eligible", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 12 }, { "id": "p15.14", "order": 22, "type": "text", "bbox": { "l": 427.2, "t": 348, "r": 733.92, "b": 322.32 }, "text": "An employee of an agency that does not participate in KEHP's FSA/HRA program with HealthEquity.", "reading_order": 13 }, { "id": "p15.15", "order": 23, "type": "text", "bbox": { "l": 426.96, "t": 317.28, "r": 738, "b": 292.56 }, "text": "- A retiree under age 65 who has gone back to work and elected coverage under the retirement system.", "reading_order": 14 }, { "id": "p15.16", "order": 24, "type": "text", "bbox": { "l": 427.44, "t": 287.04, "r": 715.92, "b": 261.84 }, "text": "An employee who does not have employer-sponsored group health insurance coverage.", "reading_order": 15 }, { "id": "p15.17", "order": 25, "type": "text", "bbox": { "l": 427.2, "t": 256.56, "r": 735.36, "b": 231.84 }, "text": "An employee who has individual health insurance coverage through the Marketplace.", "reading_order": 16 }, { "id": "p15.18", "order": 26, "type": "text", "bbox": { "l": 427.44, "t": 226.32, "r": 742.56, "b": 200.64 }, "text": "An employee whose only other insurance is Medicare, TRICARE, Medicaid, Veterans' Benefits, or other government-sponsored health insurance.", "reading_order": 17 }, { "id": "p15.19", "order": 27, "type": "text", "bbox": { "l": 426.96, "t": 195.6, "r": 733.2, "b": 170.64 }, "text": "An employee who is contributing, or whose spouse is contributing, to a Health Savings Account (HSA).", "reading_order": 18 }, { "id": "p15.20", "order": 28, "type": "text", "bbox": { "l": 420.48, "t": 150.24, "r": 609.12, "b": 84.96 }, "text": "The HealthEquity debit VISA Healthcare Card can only be used for services rendered in 2025. You must file a Pay-Me-Back or Pay-My-Provider claim with HealthEquity for any services rendered in 2024.", "reading_order": 19 }, { "id": "p15.21", "order": 29, "type": "figure", "bbox": { "l": 625.2, "t": 149.76, "r": 735.12, "b": 85.44 }, "text": "", "attrs": { "block_label": "image" }, "reading_order": 20 }, { "id": "p15.22", "order": 30, "type": "footer", "bbox": { "l": 745.44, "t": 30.24, "r": 757.44, "b": 21.36 }, "text": "15", "attrs": { "block_label": "number" }, "reading_order": 21 } ] }, { "document_id": 13522, "page": 16, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 21, "counts_by_type": { "figure": 1, "footer": 1, "heading": 4, "list": 1, "list_item": 3, "text": 11 }, "build_ms": 2, "items": [ { "id": "p16.1", "order": 1, "type": "heading", "bbox": { "l": 32.4, "t": 577.68, "r": 332.88, "b": 553.92 }, "text": "Waiver Limited Purpose HRA", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p16.2", "order": 2, "type": "text", "bbox": { "l": 33.6, "t": 537.36, "r": 371.52, "b": 479.76 }, "text": "The balance remaining in your Waiver Limited Purpose HRA (up to $2,100) at the end of 2025 will carry over to 2026, as long as you continue to waive your health insurance coverage and elect the Waiver Limited Purpose HRA.", "reading_order": 1 }, { "id": "p16.3", "order": 3, "type": "text", "bbox": { "l": 33.36, "t": 470.16, "r": 380.16, "b": 379.44 }, "text": "If you have a Waiver Limited Purpose HRA in 2024 and wish to keep it, you do not have to make an election during open enrollment. If you do not wish to keep the Waiver Limited Purpose HRA in 2025, you must make a different election during open enrollment. The Waiver Limited Purpose HRA is available to those who have individual or government-sponsored health insurance, such as Medicare, Medicaid, or TRICARE, and don't need a health plan. This HRA only covers dental and vision expenses incurred by you and your dependents.", "reading_order": 2 }, { "id": "p16.4", "order": 4, "type": "text", "bbox": { "l": 33.6, "t": 372.96, "r": 383.52, "b": 334.32 }, "text": "Your employer will contribute $175 per month, up to $2,100 per year, to your HealthEquity debit VISA Healthcare Card. It will be funded in two equal installments: $1,050 on January 1 and $1,050 on July 1.", "reading_order": 3 }, { "id": "p16.5", "order": 5, "type": "text", "bbox": { "l": 34.08, "t": 328.56, "r": 375.12, "b": 290.4 }, "text": "You have a 90-day run-out period until March 31, 2026, to request reimbursement for eligible HRA expenses that occurred between January 1, 2025, and December 31, 2025.", "reading_order": 4 }, { "id": "p16.6", "order": 6, "type": "text", "bbox": { "l": 33.84, "t": 276, "r": 377.28, "b": 237.36 }, "text": "Note: The Waiver Limited Purpose HRA is not dental or vision insurance, but it may be used to pay for or reimburse you for dental and vision expenses. Examples of expenses that may be reimbursed from your Waiver Limited Purpose HRA include:", "reading_order": 5 }, { "id": "p16.7", "order": 7, "type": "text", "bbox": { "l": 42.48, "t": 233.76, "r": 358.32, "b": 221.28 }, "text": "• Certain dental fees, such as fees for exams, cleanings, fillings, and crowns.", "reading_order": 6 }, { "id": "p16.8", "order": 8, "type": "text", "bbox": { "l": 43.2, "t": 216.48, "r": 150.24, "b": 205.2 }, "text": "Orthodontic treatment.", "reading_order": 7 }, { "id": "p16.9", "order": 9, "type": "text", "bbox": { "l": 43.44, "t": 199.68, "r": 333.6, "b": 175.2 }, "text": "- Vision fees, including fees for exams, contacts, eyeglasses, and laser vision correction.", "reading_order": 8 }, { "id": "p16.10", "order": 10, "type": "heading", "bbox": { "l": 431.76, "t": 528.48, "r": 550.8, "b": 508.32 }, "text": "HEALTH ACTION", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 9 }, { "id": "p16.11", "order": 11, "type": "heading", "bbox": { "l": 419.76, "t": 464.4, "r": 661.2, "b": 451.2 }, "text": "Who Is Eligible for the Waiver Limited Purpose HRA", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 10 }, { "id": "p16.12", "order": 12, "type": "list", "bbox": { "l": 429.12, "t": 445.44, "r": 716.88, "b": 333.6 }, "text": "", "attrs": { "item_count": 3 }, "children": [ { "id": "p16.12.1", "order": 13, "type": "list_item", "bbox": { "l": 429.12, "t": 445.44, "r": 711.36, "b": 407.52 }, "text": "Any active employee of a state agency, school board, or certain quasi-governmental agencies, who is eligible for state-sponsored health insurance coverage.", "marker": "•", "reading_order": 0 }, { "id": "p16.12.2", "order": 14, "type": "list_item", "bbox": { "l": 429.36, "t": 402.24, "r": 716.88, "b": 377.28 }, "text": "A retiree who has returned to work who has other health insurance (not with KPPA or TRS).", "marker": "•", "reading_order": 1 }, { "id": "p16.12.3", "order": 15, "type": "list_item", "bbox": { "l": 429.12, "t": 372, "r": 714.48, "b": 333.6 }, "text": "Members who are not eligible for the Waiver General Purpose HRA because they have an individual or government-sponsored health insurance plan.", "marker": "•", "reading_order": 2 } ], "reading_order": 11 }, { "id": "p16.13", "order": 16, "type": "heading", "bbox": { "l": 420.48, "t": 324.72, "r": 511.44, "b": 311.76 }, "text": "Who Is Not Eligible", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 12 }, { "id": "p16.14", "order": 17, "type": "text", "bbox": { "l": 429.12, "t": 306.48, "r": 696.72, "b": 280.8 }, "text": "An employee of an agency that does not participate in KEHP's FSA/HRA program with HealthEquity.", "reading_order": 13 }, { "id": "p16.15", "order": 18, "type": "text", "bbox": { "l": 429.12, "t": 276, "r": 700.08, "b": 250.08 }, "text": "• A retiree under age 65 who has gone back to work and elected coverage under the retirement system.", "reading_order": 14 }, { "id": "p16.16", "order": 19, "type": "text", "bbox": { "l": 419.04, "t": 229.68, "r": 729.84, "b": 190.32 }, "text": "The HealthEquity debit VISA Healthcare Card can only be used for services rendered in 2025. You must file a Pay-Me-Back or Pay-My-Provider claim with HealthEquity for any services rendered in 2024.", "reading_order": 15 }, { "id": "p16.17", "order": 20, "type": "figure", "bbox": { "l": 404.16, "t": 170.88, "r": 748.56, "b": 61.92 }, "text": "", "attrs": { "block_label": "image" }, "reading_order": 16 }, { "id": "p16.18", "order": 21, "type": "footer", "bbox": { "l": 34.56, "t": 30, "r": 47.04, "b": 20.4 }, "text": "16", "attrs": { "block_label": "number" }, "reading_order": 17 } ] }, { "document_id": 13522, "page": 17, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 38, "counts_by_type": { "footer": 1, "heading": 7, "link": 1, "list": 5, "list_item": 18, "text": 6 }, "build_ms": 4, "items": [ { "id": "p17.1", "order": 1, "type": "heading", "bbox": { "l": 33.36, "t": 577.92, "r": 495.6, "b": 552.96 }, "text": "Healthcare Flexible Spending Account (FSA)", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p17.2", "order": 2, "type": "text", "bbox": { "l": 32.88, "t": 537.6, "r": 360.48, "b": 477.84 }, "text": "Consider enrolling in an FSA for 2025 and save on a variety of expenses by paying for them on a pre-tax basis. If you're not currently enrolled, you are paying more in taxes for out-of-pocket healthcare expenses.", "reading_order": 1 }, { "id": "p17.3", "order": 3, "type": "heading", "bbox": { "l": 33.6, "t": 468.48, "r": 366.48, "b": 443.04 }, "text": "You must re-enroll in the Healthcare FSA if you want to elect new contributions into this account for 2025.", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 2 }, { "id": "p17.4", "order": 4, "type": "text", "bbox": { "l": 33.36, "t": 430.8, "r": 369.6, "b": 378.48 }, "text": "A Healthcare FSA lets you put pre-tax money into an account to use for out-of-pocket expenses, such as deductibles, co-payments, and co-insurance for medical claims, as well as prescriptions and some over-the-counter medications and supplies. You can also use a Healthcare FSA to cover dental and vision costs.", "reading_order": 3 }, { "id": "p17.5", "order": 5, "type": "text", "bbox": { "l": 32.88, "t": 372.24, "r": 370.32, "b": 347.28 }, "text": "The money you elect to contribute for the entire year is available to you on a pre-funded Healthcare VISA card on January 1.", "reading_order": 4 }, { "id": "p17.6", "order": 6, "type": "heading", "bbox": { "l": 33.6, "t": 337.92, "r": 232.32, "b": 326.16 }, "text": "Reasons to Select a Healthcare FSA", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 5 }, { "id": "p17.7", "order": 7, "type": "list", "bbox": { "l": 41.76, "t": 324.48, "r": 382.8, "b": 179.28 }, "text": "", "attrs": { "item_count": 4 }, "children": [ { "id": "p17.7.1", "order": 8, "type": "list_item", "bbox": { "l": 42.48, "t": 324.48, "r": 371.52, "b": 300.48 }, "text": "Contribute up to a maximum of $3,200 per year before taxes. The minimum you can contribute is $120 per year.", "marker": "•", "reading_order": 0 }, { "id": "p17.7.2", "order": 9, "type": "list_item", "bbox": { "l": 42.24, "t": 296.88, "r": 382.32, "b": 261.12 }, "text": "Carry over a minimum of $50 and a maximum of $640 from one calendar year to the next. Carryover funds do not count toward the annual contribution maximum of $3,200.", "reading_order": 1 }, { "id": "p17.7.3", "order": 10, "type": "list_item", "bbox": { "l": 41.76, "t": 257.04, "r": 382.8, "b": 208.8 }, "text": "You have a 90-day run-out period until March 31, 2026, to request reimbursement for eligible FSA expenses that occurred between January 1, 2025 and December 31, 2025. Any of your funds that are in excess of $640 that are not used before the run-out period will be forfeited.", "marker": "•", "reading_order": 2 }, { "id": "p17.7.4", "order": 11, "type": "list_item", "bbox": { "l": 42, "t": 204.96, "r": 372.96, "b": 179.28 }, "text": "Use your FSA to pay for eligible medical expenses for family members who are considered a tax dependent, even if they are not enrolled in your health plan.", "marker": "-", "reading_order": 3 } ], "reading_order": 6 }, { "id": "p17.8", "order": 12, "type": "heading", "bbox": { "l": 34.32, "t": 169.68, "r": 138.48, "b": 157.44 }, "text": "Covered Expenses", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 7 }, { "id": "p17.9", "order": 13, "type": "list", "bbox": { "l": 41.76, "t": 155.52, "r": 379.92, "b": 84.24 }, "text": "", "attrs": { "item_count": 3 }, "children": [ { "id": "p17.9.1", "order": 14, "type": "list_item", "bbox": { "l": 41.76, "t": 155.52, "r": 212.88, "b": 143.52 }, "text": "Medical and prescription co-payments.", "marker": "•", "reading_order": 0 }, { "id": "p17.9.2", "order": 15, "type": "list_item", "bbox": { "l": 42.48, "t": 138.96, "r": 379.92, "b": 101.04 }, "text": "Medical and prescription expenses, including over-the-counter (OTC) medications, feminine products, and certain protective equipment, such as face masks and hand sanitizer.", "marker": "•", "reading_order": 1 }, { "id": "p17.9.3", "order": 16, "type": "list_item", "bbox": { "l": 42.48, "t": 95.76, "r": 133.92, "b": 84.24 }, "text": "Certain dental fees.", "reading_order": 2 } ], "reading_order": 8 }, { "id": "p17.10", "order": 17, "type": "list", "bbox": { "l": 415.44, "t": 536.88, "r": 573.6, "b": 474 }, "text": "", "attrs": { "item_count": 4 }, "children": [ { "id": "p17.10.1", "order": 18, "type": "list_item", "bbox": { "l": 415.92, "t": 536.88, "r": 523.68, "b": 524.88 }, "text": "Orthodontic treatment.", "reading_order": 0 }, { "id": "p17.10.2", "order": 19, "type": "list_item", "bbox": { "l": 415.68, "t": 520.08, "r": 563.76, "b": 507.84 }, "text": "Vision fees, including eyeglasses.", "marker": "•", "reading_order": 1 }, { "id": "p17.10.3", "order": 20, "type": "list_item", "bbox": { "l": 415.92, "t": 503.04, "r": 486, "b": 491.28 }, "text": "Co-insurance.", "marker": "•", "reading_order": 2 }, { "id": "p17.10.4", "order": 21, "type": "list_item", "bbox": { "l": 415.44, "t": 486.24, "r": 573.6, "b": 474 }, "text": "Wheelchairs, crutches, and walkers.", "reading_order": 3 } ], "reading_order": 9 }, { "id": "p17.11", "order": 22, "type": "text", "bbox": { "l": 406.8, "t": 466.8, "r": 653.04, "b": 453.36 }, "text": "For a full list of covered expenses, go to healthequity.com.", "children": [ { "id": "p17.11.1", "order": 23, "type": "link", "bbox": { "l": 575.197, "t": 465.98, "r": 650.116, "b": 454.11 }, "text": "healthequity.com.", "attrs": { "uri": "http://www.healthequity.com", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 10 }, { "id": "p17.12", "order": 24, "type": "heading", "bbox": { "l": 407.52, "t": 445.2, "r": 489.84, "b": 432.24 }, "text": "Who Is Eligible", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 11 }, { "id": "p17.13", "order": 25, "type": "list", "bbox": { "l": 407.28, "t": 430.56, "r": 638.64, "b": 381.36 }, "text": "", "attrs": { "item_count": 3 }, "children": [ { "id": "p17.13.1", "order": 26, "type": "list_item", "bbox": { "l": 415.68, "t": 430.56, "r": 616.32, "b": 418.32 }, "text": "Employees of state agencies or school boards.", "marker": "•", "reading_order": 0 }, { "id": "p17.13.2", "order": 27, "type": "list_item", "bbox": { "l": 415.2, "t": 414, "r": 638.64, "b": 401.04 }, "text": "Employees of certain quasi-governmental agencies.", "marker": "•", "reading_order": 1 }, { "id": "p17.13.3", "order": 28, "type": "list_item", "bbox": { "l": 407.28, "t": 394.08, "r": 605.76, "b": 381.36 }, "text": "Contact your Insurance Coordinator for details.", "reading_order": 2 } ], "reading_order": 12 }, { "id": "p17.14", "order": 29, "type": "heading", "bbox": { "l": 407.52, "t": 372.96, "r": 512.4, "b": 360 }, "text": "Who Is Not Eligible", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 13 }, { "id": "p17.15", "order": 30, "type": "text", "bbox": { "l": 416.16, "t": 358.08, "r": 464.88, "b": 347.04 }, "text": "Retirees.", "reading_order": 14 }, { "id": "p17.16", "order": 31, "type": "text", "bbox": { "l": 416.16, "t": 342, "r": 746.88, "b": 316.32 }, "text": "• Employees of an agency that does not participate in KEHP's FSA/HRA program with HealthEquity.", "reading_order": 15 }, { "id": "p17.17", "order": 32, "type": "heading", "bbox": { "l": 432.48, "t": 229.2, "r": 551.52, "b": 209.04 }, "text": "HEALTH ACTION", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 16 }, { "id": "p17.18", "order": 33, "type": "list", "bbox": { "l": 427.68, "t": 177.84, "r": 740.64, "b": 60.24 }, "text": "", "attrs": { "item_count": 4 }, "children": [ { "id": "p17.18.1", "order": 34, "type": "list_item", "bbox": { "l": 428.16, "t": 177.84, "r": 716.64, "b": 139.2 }, "text": "If you have not actively elected a Healthcare FSA contribution for two years, your Healthcare FSA will terminate and you will lose any carryover balance.", "marker": "•", "reading_order": 0 }, { "id": "p17.18.2", "order": 35, "type": "list_item", "bbox": { "l": 428.16, "t": 134.64, "r": 723.12, "b": 109.2 }, "text": "Funds from a HealthEquity Healthcare FSA will be used before funds from an HRA.", "marker": "•", "reading_order": 1 }, { "id": "p17.18.3", "order": 36, "type": "list_item", "bbox": { "l": 427.68, "t": 104.16, "r": 713.76, "b": 91.2 }, "text": "Do not use your VISA debit card in 2025 to pay for 2024 expenses.", "reading_order": 2 }, { "id": "p17.18.4", "order": 37, "type": "list_item", "bbox": { "l": 427.92, "t": 86.4, "r": 740.64, "b": 60.24 }, "text": "You can use the EZ Receipts app to submit reimbursement or to have HealthEquity pay your provider directly using the Pay-My-Provider option.", "reading_order": 3 } ], "reading_order": 17 }, { "id": "p17.19", "order": 38, "type": "footer", "bbox": { "l": 745.44, "t": 30.48, "r": 756.72, "b": 21.12 }, "text": "17", "attrs": { "block_label": "number" }, "reading_order": 18 } ] }, { "document_id": 13522, "page": 18, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 24, "counts_by_type": { "figure": 1, "footer": 1, "heading": 3, "list": 1, "list_item": 3, "text": 14, "title": 1 }, "build_ms": 2, "items": [ { "id": "p18.1", "order": 1, "type": "title", "bbox": { "l": 34.32, "t": 577.2, "r": 333.36, "b": 553.92 }, "text": "Child and Adult Daycare FSA", "attrs": { "block_label": "doc_title" }, "level": 2, "reading_order": 0 }, { "id": "p18.2", "order": 2, "type": "heading", "bbox": { "l": 35.04, "t": 536.64, "r": 252.24, "b": 523.68 }, "text": "Cut Your Child and Adult Daycare Costs", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 1 }, { "id": "p18.3", "order": 3, "type": "text", "bbox": { "l": 33.84, "t": 519.36, "r": 388.32, "b": 467.76 }, "text": "If you need a child or adult daycare to care for your loved ones while you work, then a Child and Adult Daycare FSA may be right for you. You know how expensive that care can be. But, with a Child and Adult Daycare FSA, you can save money on eligible childcare and adult daycare expenses by using pre-tax dollars.", "reading_order": 2 }, { "id": "p18.4", "order": 4, "type": "text", "bbox": { "l": 33.84, "t": 461.52, "r": 390, "b": 436.32 }, "text": "With a Child and Adult Daycare FSA, you elect an amount to be deducted pre-tax from your paycheck to use to pay eligible expenses below:", "reading_order": 3 }, { "id": "p18.5", "order": 5, "type": "text", "bbox": { "l": 42.96, "t": 432.48, "r": 232.08, "b": 420.48 }, "text": "• Child or adult care (during work hours only)", "reading_order": 4 }, { "id": "p18.6", "order": 6, "type": "text", "bbox": { "l": 43.44, "t": 415.2, "r": 96.96, "b": 404.16 }, "text": "Preschool", "reading_order": 5 }, { "id": "p18.7", "order": 7, "type": "text", "bbox": { "l": 43.68, "t": 397.92, "r": 132.72, "b": 386.88 }, "text": "Summer day camp", "reading_order": 6 }, { "id": "p18.8", "order": 8, "type": "text", "bbox": { "l": 43.2, "t": 381.36, "r": 173.52, "b": 370.08 }, "text": "Before- and after-school care", "reading_order": 7 }, { "id": "p18.9", "order": 9, "type": "text", "bbox": { "l": 43.44, "t": 364.56, "r": 239.28, "b": 352.8 }, "text": "• Elder daycare expenses for dependent adults", "reading_order": 8 }, { "id": "p18.10", "order": 10, "type": "text", "bbox": { "l": 34.32, "t": 344.4, "r": 379.44, "b": 306.48 }, "text": "Just elect to enroll, then choose the amount you wish to contribute to this account. The minimum amount you can contribute is $120 per year, up to the maximum amount per year that is based on your tax-filing status:", "reading_order": 9 }, { "id": "p18.11", "order": 11, "type": "list", "bbox": { "l": 43.2, "t": 302.88, "r": 266.64, "b": 256.32 }, "text": "", "attrs": { "item_count": 3 }, "children": [ { "id": "p18.11.1", "order": 12, "type": "list_item", "bbox": { "l": 43.44, "t": 302.88, "r": 212.64, "b": 290.4 }, "text": "Married, filing a joint return — $5,000", "marker": "•", "reading_order": 0 }, { "id": "p18.11.2", "order": 13, "type": "list_item", "bbox": { "l": 43.2, "t": 285.84, "r": 177.84, "b": 274.08 }, "text": "Head-of-household — $5,000", "marker": "•", "reading_order": 1 }, { "id": "p18.11.3", "order": 14, "type": "list_item", "bbox": { "l": 43.2, "t": 268.56, "r": 266.64, "b": 256.32 }, "text": "Single or Married, filing separate returns — $2,500", "marker": "•", "reading_order": 2 } ], "reading_order": 10 }, { "id": "p18.12", "order": 15, "type": "text", "bbox": { "l": 34.08, "t": 248.4, "r": 358.8, "b": 209.76 }, "text": "You can arrange for convenient direct payments to your provider using the Pay-My-Provider option on the EZ Receipts app, or you can pay child and adult daycare expenses yourself and request reimbursement.", "reading_order": 11 }, { "id": "p18.13", "order": 16, "type": "heading", "bbox": { "l": 34.8, "t": 201.36, "r": 116.88, "b": 188.88 }, "text": "Who Is Eligible", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 12 }, { "id": "p18.14", "order": 17, "type": "text", "bbox": { "l": 43.2, "t": 186.72, "r": 244.8, "b": 175.2 }, "text": "• Employees of state agencies or school boards.", "reading_order": 13 }, { "id": "p18.15", "order": 18, "type": "text", "bbox": { "l": 43.2, "t": 170.16, "r": 265.2, "b": 157.68 }, "text": "Employees of certain quasi-governmental agencies.", "reading_order": 14 }, { "id": "p18.16", "order": 19, "type": "text", "bbox": { "l": 34.56, "t": 150.24, "r": 231.84, "b": 138.24 }, "text": "Contact your Insurance Coordinator for details.", "reading_order": 15 }, { "id": "p18.17", "order": 20, "type": "heading", "bbox": { "l": 35.04, "t": 129.12, "r": 139.2, "b": 116.4 }, "text": "Who Is Not Eligible", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 16 }, { "id": "p18.18", "order": 21, "type": "text", "bbox": { "l": 43.44, "t": 114.24, "r": 91.44, "b": 103.68 }, "text": "Retirees.", "reading_order": 17 }, { "id": "p18.19", "order": 22, "type": "text", "bbox": { "l": 43.44, "t": 97.68, "r": 373.44, "b": 72.96 }, "text": "• Employees of an agency that does not participate in KEHP's FSA/HRA program with HealthEquity.", "reading_order": 18 }, { "id": "p18.20", "order": 23, "type": "figure", "bbox": { "l": 449.28, "t": 576.72, "r": 755.52, "b": 37.92 }, "text": "", "attrs": { "block_label": "image" }, "reading_order": 19 }, { "id": "p18.21", "order": 24, "type": "footer", "bbox": { "l": 35.04, "t": 29.76, "r": 46.8, "b": 20.64 }, "text": "18", "attrs": { "block_label": "number" }, "reading_order": 20 } ] }, { "document_id": 13522, "page": 19, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 10, "counts_by_type": { "figure": 1, "footer": 1, "heading": 2, "link": 1, "text": 5 }, "build_ms": 1, "items": [ { "id": "p19.1", "order": 1, "type": "heading", "bbox": { "l": 34.8, "t": 578.16, "r": 233.04, "b": 552.96 }, "text": "LivingWell Promise", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p19.2", "order": 2, "type": "text", "bbox": { "l": 32.88, "t": 534.96, "r": 355.92, "b": 489.84 }, "text": "You are required to complete the LivingWell Promise between January 1, 2025, and July 1, 2025, if you want a health insurance premium discount in 2026.", "reading_order": 1 }, { "id": "p19.3", "order": 3, "type": "text", "bbox": { "l": 32.88, "t": 478.56, "r": 382.32, "b": 438.96 }, "text": "To complete the Promise, all you have to do is take the Castlight Health Assessment at mycastlight.com/mybenefits. The Health Assessment only takes about 10 minutes to complete and asks various health and lifestyle questions.", "children": [ { "id": "p19.3.1", "order": 4, "type": "link", "bbox": { "l": 46.2298, "t": 464.98, "r": 169.968, "b": 453.11 }, "text": "mycastlight.com/mybenefits.", "attrs": { "uri": "http://mycastlight.com/mybenefits", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 2 }, { "id": "p19.4", "order": 5, "type": "text", "bbox": { "l": 33.36, "t": 433.44, "r": 372.96, "b": 394.56 }, "text": "Note that you will not get credit for completing the Promise if you do it during Open Enrollment. The Promise must be completed between January 1, 2025, and July 1, 2025.", "reading_order": 3 }, { "id": "p19.5", "order": 6, "type": "text", "bbox": { "l": 32.88, "t": 389.04, "r": 382.08, "b": 362.16 }, "text": "By completing the Promise, you earn up to a $480 premium discount ($40 a month) for plan year 2026.", "reading_order": 4 }, { "id": "p19.6", "order": 7, "type": "heading", "bbox": { "l": 439.68, "t": 530.4, "r": 563.52, "b": 490.32 }, "text": "HEALTH ACTION", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 5 }, { "id": "p19.7", "order": 8, "type": "text", "bbox": { "l": 434.88, "t": 470.88, "r": 674.4, "b": 438 }, "text": "If you have the cross-reference payment option, both spouses must fulfill the Promise.", "reading_order": 6 }, { "id": "p19.8", "order": 9, "type": "figure", "bbox": { "l": 0, "t": 330.72, "r": 791.76, "b": 0.96 }, "text": "", "attrs": { "block_label": "image", "embedded_text": "19" }, "reading_order": 7 }, { "id": "p19.9", "order": 10, "type": "footer", "bbox": { "l": 745.44, "t": 31.2, "r": 757.68, "b": 20.88 }, "text": "19", "attrs": { "block_label": "number" }, "reading_order": 8 } ] }, { "document_id": 13522, "page": 20, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 39, "counts_by_type": { "footer": 2, "heading": 5, "link": 2, "list": 1, "list_item": 7, "text": 21, "title": 1 }, "build_ms": 3, "items": [ { "id": "p20.1", "order": 1, "type": "title", "bbox": { "l": 32.88, "t": 577.2, "r": 293.76, "b": 535.2 }, "text": "Benefit Programs\nAdditional benefits at no extra cost to you!", "attrs": { "block_label": "doc_title" }, "level": 2, "reading_order": 0 }, { "id": "p20.2", "order": 2, "type": "heading", "bbox": { "l": 33.84, "t": 517.68, "r": 182.88, "b": 489.84 }, "text": "Surgical Care and Support\nCarrum Health [p20.2.1]", "attrs": { "block_label": "paragraph_title" }, "children": [ { "id": "p20.2.1", "order": 3, "type": "text", "bbox": { "l": 33.84, "t": 517.68, "r": 182.88, "b": 489.84 }, "text": "^{*}", "attrs": { "inline": true, "text_offset": 40, "text_span": 9, "bbox_estimated": true }, "reading_order": 0 } ], "level": 3, "reading_order": 1 }, { "id": "p20.3", "order": 4, "type": "text", "bbox": { "l": 32.88, "t": 481.2, "r": 380.16, "b": 429.84 }, "text": "Better care begins here! Whether you need cancer care, knee, hip, shoulder, spine, heart, weight loss surgery and more, you can receive most if not all care at no cost to you. Carrum works with the top cancer specialists and surgeons in the country - those who have better outcomes and outstanding bedside manner.", "reading_order": 2 }, { "id": "p20.4", "order": 5, "type": "text", "bbox": { "l": 42.72, "t": 426.24, "r": 101.52, "b": 414.48 }, "text": "better care", "reading_order": 3 }, { "id": "p20.5", "order": 6, "type": "text", "bbox": { "l": 42.72, "t": 409.2, "r": 121.92, "b": 397.2 }, "text": "no surprise bills", "reading_order": 4 }, { "id": "p20.6", "order": 7, "type": "text", "bbox": { "l": 42.48, "t": 392.4, "r": 131.76, "b": 380.16 }, "text": "• dedicated support", "reading_order": 5 }, { "id": "p20.7", "order": 8, "type": "text", "bbox": { "l": 33.6, "t": 372.48, "r": 380.88, "b": 359.76 }, "text": "Planholders and their covered dependents 18 and older are eligible for this benefit.", "reading_order": 6 }, { "id": "p20.8", "order": 9, "type": "text", "bbox": { "l": 33.84, "t": 353.52, "r": 150.96, "b": 301.44 }, "text": "Ready to get started?\nVisit: carrum.me/kehp, or\nCall: 888-855-7806\nMon.-Fri. 9 a.m. to 8 p.m. ET", "children": [ { "id": "p20.8.1", "order": 10, "type": "link", "bbox": { "l": 57.8396, "t": 340.278, "r": 130.968, "b": 328.408 }, "text": "carrum.me/kehp,", "attrs": { "uri": "http://carrum.me/kehp", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 7 }, { "id": "p20.9", "order": 11, "type": "heading", "bbox": { "l": 33.6, "t": 281.76, "r": 202.32, "b": 268.32 }, "text": "Telehealth and Phone Support", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 8 }, { "id": "p20.10", "order": 12, "type": "heading", "bbox": { "l": 33.6, "t": 264.24, "r": 270.72, "b": 249.6 }, "text": "Telehealth through the LivingWell Health Clinic [p20.10.1]", "attrs": { "block_label": "paragraph_title" }, "children": [ { "id": "p20.10.1", "order": 13, "type": "text", "bbox": { "l": 33.6, "t": 264.24, "r": 270.72, "b": 249.6 }, "text": "^{*}", "attrs": { "inline": true, "text_offset": 48, "text_span": 10, "bbox_estimated": true }, "reading_order": 0 } ], "level": 3, "reading_order": 9 }, { "id": "p20.11", "order": 14, "type": "text", "bbox": { "l": 33.36, "t": 241.92, "r": 383.52, "b": 202.56 }, "text": "All full-time, active Commonwealth employees who are eligible to participate in the Kentucky Employees' Health Plan are allowed to use the LivingWell Health Clinics. Retirees, spouses, and dependents are not eligible to receive services at the clinics.", "reading_order": 10 }, { "id": "p20.12", "order": 15, "type": "text", "bbox": { "l": 33.6, "t": 197.52, "r": 381.12, "b": 172.08 }, "text": "In-person visits and telehealth are included with this benefit. Some of the available services include:", "reading_order": 11 }, { "id": "p20.13", "order": 16, "type": "list", "bbox": { "l": 42.24, "t": 168.24, "r": 753.305, "b": 54.50789999999995 }, "text": "", "attrs": { "item_count": 7 }, "children": [ { "id": "p20.13.1", "order": 17, "type": "list_item", "bbox": { "l": 42.24, "t": 168.24, "r": 123.84, "b": 155.52 }, "text": "Annual physicals", "marker": "•", "reading_order": 0 }, { "id": "p20.13.2", "order": 18, "type": "list_item", "bbox": { "l": 42.72, "t": 150.96, "r": 108.24, "b": 138.24 }, "text": "Allergy shots", "marker": "•", "reading_order": 1 }, { "id": "p20.13.3", "order": 19, "type": "list_item", "bbox": { "l": 42.48, "t": 133.92, "r": 185.28, "b": 121.2 }, "text": "Chronic condition management", "marker": "•", "reading_order": 2 }, { "id": "p20.13.4", "order": 20, "type": "list_item", "bbox": { "l": 42.48, "t": 117.12, "r": 121.2, "b": 104.88 }, "text": "Women's health", "marker": "•", "reading_order": 3 }, { "id": "p20.13.5", "order": 21, "type": "list_item", "bbox": { "l": 42.96, "t": 100.08, "r": 100.8, "b": 88.08 }, "text": "Biometrics", "marker": "•", "reading_order": 4 }, { "id": "p20.13.6", "order": 22, "type": "list_item", "bbox": { "l": 54, "t": 82.53790000000004, "r": 735.715, "b": 68.74450000000002 }, "text": "Immunizations", "marker": "•", "reading_order": 5 }, { "id": "p20.13.7", "order": 23, "type": "list_item", "bbox": { "l": 54, "t": 67.25450000000001, "r": 753.305, "b": 54.50789999999995 }, "text": "Lab services", "marker": "•", "reading_order": 6 } ], "reading_order": 12 }, { "id": "p20.14", "order": 24, "type": "text", "bbox": { "l": 406.56, "t": 517.92, "r": 731.04, "b": 492 }, "text": "Schedule a virtual visit through mypremisehealth.com or visit one of the four locations in Frankfort, and one clinic in Louisville.", "children": [ { "id": "p20.14.1", "order": 25, "type": "link", "bbox": { "l": 540.078, "t": 517.678, "r": 635.926, "b": 505.808 }, "text": "mypremisehealth.com", "attrs": { "uri": "http://mypremisehealth.com", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 13 }, { "id": "p20.15", "order": 26, "type": "heading", "bbox": { "l": 407.28, "t": 486.24, "r": 516.48, "b": 473.28 }, "text": "LivingWell Health Clinics", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 14 }, { "id": "p20.16", "order": 27, "type": "text", "bbox": { "l": 407.28, "t": 466.8, "r": 475.92, "b": 415.44 }, "text": "300 Building\n300 Sower Blvd\nFrankfort, KY\n502-564-3444", "reading_order": 15 }, { "id": "p20.17", "order": 28, "type": "text", "bbox": { "l": 407.28, "t": 408.48, "r": 491.76, "b": 357.6 }, "text": "Capitol Annex\n702 Capitol Avenue\nFrankfort, KY\n502-564-3333", "reading_order": 16 }, { "id": "p20.18", "order": 29, "type": "text", "bbox": { "l": 407.04, "t": 350.88, "r": 497.76, "b": 299.76 }, "text": "CHFS\n275 East Main Street\nFrankfort, KY\n502-564-5555", "reading_order": 17 }, { "id": "p20.19", "order": 30, "type": "text", "bbox": { "l": 407.52, "t": 293.04, "r": 520.56, "b": 241.92 }, "text": "Mayo-Underwood Building\n500 Mero Street\nFrankfort, KY\n502-564-4444", "reading_order": 18 }, { "id": "p20.20", "order": 31, "type": "text", "bbox": { "l": 406.56, "t": 235.2, "r": 721.68, "b": 170.88 }, "text": "Premise Health Wellness Center - Brownsboro. Your LivingWell Health Clinic in Louisville.\n10000 Brownsboro Road #7\nLouisville, KY 40241\n502-272-0330", "reading_order": 19 }, { "id": "p20.21", "order": 32, "type": "heading", "bbox": { "l": 407.52, "t": 162, "r": 618, "b": 148.8 }, "text": "Telehealth through LiveHealth Online [p20.21.1]", "attrs": { "block_label": "paragraph_title" }, "children": [ { "id": "p20.21.1", "order": 33, "type": "text", "bbox": { "l": 407.52, "t": 162, "r": 618, "b": 148.8 }, "text": "^{*}", "attrs": { "inline": true, "text_offset": 37, "text_span": 10, "bbox_estimated": true }, "reading_order": 0 } ], "level": 3, "reading_order": 20 }, { "id": "p20.22", "order": 34, "type": "text", "bbox": { "l": 406.56, "t": 144.48, "r": 747.12, "b": 118.32 }, "text": "Healthcare at home or on the go. Get fast, easy, virtual doctor visits whenever you need them. There is no additional cost to you through LiveHealth Online.", "reading_order": 21 }, { "id": "p20.23", "order": 35, "type": "text", "bbox": { "l": 406.32, "t": 113.04, "r": 753.84, "b": 86.16 }, "text": "LiveHealth Online lets you have a video visit with a board-certified medical doctor, psychiatrist, or therapist from your computer with a camera, tablet, or smartphone.", "reading_order": 22 }, { "id": "p20.24", "order": 36, "type": "text", "bbox": { "l": 406.56, "t": 80.64, "r": 755.76, "b": 41.76 }, "text": "Feeling under the weather? Have a health question? With LiveHealth Online, the doctor comes to you. In some cases, no appointments are needed. No traveling to a doctor's office and no sitting in the waiting room.", "reading_order": 23 }, { "id": "p20.25", "order": 37, "type": "footer", "bbox": { "l": 35.04, "t": 29.76, "r": 46.56, "b": 20.4 }, "text": "20", "attrs": { "block_label": "number" }, "reading_order": 24 }, { "id": "p20.26", "order": 38, "type": "footer", "bbox": { "l": 62.64, "t": 38.16, "r": 252.96, "b": 28.08 }, "text": "[p20.26.1] No coverage for this benefit under the LivingWell HDHP", "attrs": { "block_label": "footer" }, "children": [ { "id": "p20.26.1", "order": 39, "type": "text", "bbox": { "l": 62.64, "t": 38.16, "r": 252.96, "b": 28.08 }, "text": "^{*}", "attrs": { "inline": true, "text_offset": 0, "text_span": 10, "bbox_estimated": true }, "reading_order": 0 } ], "reading_order": 25 } ] }, { "document_id": 13522, "page": 21, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 45, "counts_by_type": { "footer": 1, "heading": 7, "link": 6, "list": 3, "list_item": 13, "text": 15 }, "build_ms": 6, "items": [ { "id": "p21.1", "order": 1, "type": "text", "bbox": { "l": 33.12, "t": 577.44, "r": 329.52, "b": 565.2 }, "text": "Some common conditions that can be treated using LiveHealth Online:", "reading_order": 0 }, { "id": "p21.2", "order": 2, "type": "list", "bbox": { "l": 41.52, "t": 561.36, "r": 169.92, "b": 464.64 }, "text": "", "attrs": { "item_count": 6 }, "children": [ { "id": "p21.2.1", "order": 3, "type": "list_item", "bbox": { "l": 41.52, "t": 561.36, "r": 150.72, "b": 549.12 }, "text": "Cold and flu symptoms", "marker": "•", "reading_order": 0 }, { "id": "p21.2.2", "order": 4, "type": "list_item", "bbox": { "l": 42.48, "t": 544.8, "r": 91.44, "b": 532.08 }, "text": "Allergies", "marker": "•", "reading_order": 1 }, { "id": "p21.2.3", "order": 5, "type": "list_item", "bbox": { "l": 42.24, "t": 528, "r": 120.96, "b": 515.76 }, "text": "Sinus infections", "marker": "•", "reading_order": 2 }, { "id": "p21.2.4", "order": 6, "type": "list_item", "bbox": { "l": 42.48, "t": 510.72, "r": 96.96, "b": 498 }, "text": "Migraines", "marker": "•", "reading_order": 3 }, { "id": "p21.2.5", "order": 7, "type": "list_item", "bbox": { "l": 42.24, "t": 493.68, "r": 169.92, "b": 480.96 }, "text": "Upper respiratory infections", "marker": "•", "reading_order": 4 }, { "id": "p21.2.6", "order": 8, "type": "list_item", "bbox": { "l": 42.48, "t": 476.64, "r": 97.68, "b": 464.64 }, "text": "Bronchitis", "marker": "•", "reading_order": 5 } ], "reading_order": 1 }, { "id": "p21.3", "order": 9, "type": "text", "bbox": { "l": 33.6, "t": 456.72, "r": 357.6, "b": 431.04 }, "text": "Go to livehealthonline.com and log in or download the app to register. Select LiveHealth Online Medical and choose the doctor you'd like to see.", "children": [ { "id": "p21.3.1", "order": 10, "type": "link", "bbox": { "l": 60.3196, "t": 456.48, "r": 149.448, "b": 444.61 }, "text": "livehealthonline.com", "attrs": { "uri": "http://livehealthonline.com", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 2 }, { "id": "p21.4", "order": 11, "type": "text", "bbox": { "l": 33.84, "t": 425.04, "r": 193.44, "b": 412.56 }, "text": "Call 888-548-3432 or 844-784-8409.", "reading_order": 3 }, { "id": "p21.5", "order": 12, "type": "heading", "bbox": { "l": 33.12, "t": 392.16, "r": 269.52, "b": 366.48 }, "text": "Telehealth through providers other than as mentioned above", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 4 }, { "id": "p21.6", "order": 13, "type": "text", "bbox": { "l": 32.88, "t": 356.88, "r": 380.88, "b": 304.8 }, "text": "Telehealth is also a covered benefit with any network provider that offers telehealth. You will be responsible for any cost-share, including your deductible, co-payment, and co-insurance, if you use a telehealth service other than a LivingWell Health Clinic, or LiveHealth Online.", "reading_order": 5 }, { "id": "p21.7", "order": 14, "type": "heading", "bbox": { "l": 34.08, "t": 296.88, "r": 124.08, "b": 282.96 }, "text": "24/7 NurseLine", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 6 }, { "id": "p21.8", "order": 15, "type": "text", "bbox": { "l": 32.88, "t": 273.84, "r": 382.8, "b": 195.36 }, "text": "If you have an emergency or questions for a nurse, you can call 24/7. The NurseLine provides you with accurate health information anytime of the day or night. You will receive one-on-one counseling with experienced nurses via a convenient toll-free number, 877-636-3720. A staff of experienced nurses is trained to address common healthcare concerns such as medical triage, education, access to healthcare, diet, social and family dynamics, and mental health issues.", "reading_order": 7 }, { "id": "p21.9", "order": 16, "type": "heading", "bbox": { "l": 34.32, "t": 189.84, "r": 194.16, "b": 177.36 }, "text": "Specifically, 24/7 NurseLine features:", "level": 3, "reading_order": 8 }, { "id": "p21.10", "order": 17, "type": "list", "bbox": { "l": 42.48, "t": 173.52, "r": 376.32, "b": 41.28 }, "text": "", "attrs": { "item_count": 5 }, "children": [ { "id": "p21.10.1", "order": 18, "type": "list_item", "bbox": { "l": 42.48, "t": 173.52, "r": 376.32, "b": 134.64 }, "text": "A skilled clinical team — a registered nurse (RN) who helps assess your systems, understands medical conditions, ensures you receive the right care in the right setting, and refers you to programs and tools appropriate for your condition;", "marker": "•", "reading_order": 0 }, { "id": "p21.10.2", "order": 19, "type": "list_item", "bbox": { "l": 42.72, "t": 130.8, "r": 302.4, "b": 117.84 }, "text": "Bilingual RNs, language lines, and hearing-impaired services;", "reading_order": 1 }, { "id": "p21.10.3", "order": 20, "type": "list_item", "bbox": { "l": 42.96, "t": 113.52, "r": 365.28, "b": 88.08 }, "text": "Access to the Audio Health Library, containing hundreds of audio tapes on a wide variety of health topics;", "marker": "-", "reading_order": 2 }, { "id": "p21.10.4", "order": 21, "type": "list_item", "bbox": { "l": 42.72, "t": 83.28, "r": 375.6, "b": 57.6 }, "text": "Proactive call backs within 24 to 48 hours, referrals to 911 emergency services, poison control, and identification of emergency or urgent care for children; and", "marker": "-", "reading_order": 3 }, { "id": "p21.10.5", "order": 22, "type": "list_item", "bbox": { "l": 42.48, "t": 53.28, "r": 231.6, "b": 41.28 }, "text": "Referrals to relevant community resources.", "marker": "•", "reading_order": 4 } ], "reading_order": 9 }, { "id": "p21.11", "order": 23, "type": "heading", "bbox": { "l": 407.28, "t": 577.2, "r": 513.12, "b": 564.72 }, "text": "Tobacco Cessation", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 10 }, { "id": "p21.12", "order": 24, "type": "heading", "bbox": { "l": 407.28, "t": 562.08, "r": 643.2, "b": 548.64 }, "text": "Over the Counter and Prescription Medications", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 11 }, { "id": "p21.13", "order": 25, "type": "text", "bbox": { "l": 406.8, "t": 540.72, "r": 704.64, "b": 515.28 }, "text": "You can get over-the-counter nicotine replacement therapies, without a prescription, at no cost if you meet all the following requirements:", "reading_order": 12 }, { "id": "p21.14", "order": 26, "type": "text", "bbox": { "l": 416.16, "t": 511.68, "r": 541.2, "b": 499.68 }, "text": "• You are a member of KEHP;", "reading_order": 13 }, { "id": "p21.15", "order": 27, "type": "text", "bbox": { "l": 416.16, "t": 494.88, "r": 739.44, "b": 469.2 }, "text": "You are a tobacco user (planholder and/or dependent), 18 years old or older, and listed as a tobacco user on the KEHP health insurance form.", "reading_order": 14 }, { "id": "p21.16", "order": 28, "type": "text", "bbox": { "l": 406.08, "t": 462, "r": 751.92, "b": 409.44 }, "text": "Call 888-581-8834 for more information about over-the-counter therapies. You can get prescription medications to help you with quitting tobacco as well! You need a prescription from your doctor and the medication needs to be on the preventive services list that you can find by visiting here.", "children": [ { "id": "p21.16.1", "order": 29, "type": "link", "bbox": { "l": 575.717, "t": 422.48, "r": 595.347, "b": 410.61 }, "text": "here.", "attrs": { "uri": "https://extranet.personnel.ky.gov/KEHP/ACA%20Preventive%20Services%20List.pdf", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 15 }, { "id": "p21.17", "order": 30, "type": "text", "bbox": { "l": 406.32, "t": 404.16, "r": 747.6, "b": 378.24 }, "text": "To take the first step and get more information about the programs available, visit here or call 844-402-5347.", "children": [ { "id": "p21.17.1", "order": 31, "type": "link", "bbox": { "l": 409.5, "t": 390.48, "r": 429.13, "b": 378.61 }, "text": "here", "attrs": { "uri": "https://www.anthem.com/content/dam/digital/docs/microsites/kehp/113025KYMENABS.pdf", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 16 }, { "id": "p21.18", "order": 32, "type": "heading", "bbox": { "l": 406.8, "t": 364.08, "r": 527.76, "b": 349.68 }, "text": "Freedom from Smoking", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 17 }, { "id": "p21.19", "order": 33, "type": "text", "bbox": { "l": 405.6, "t": 342.24, "r": 758.16, "b": 263.52 }, "text": "The American Lung Association has helped hundreds of thousands of people quit smoking through Freedom From Smoking. Available in small group clinics or online, Freedom From Smoking helps you develop a plan of action leading to a quit day and provides the support you need to remain smoke free. Based on current addiction and behavior change models, the program addresses the difficulties of quitting in a sensitive, supportive style and is backed by certified tobacco cessation counselors.", "reading_order": 18 }, { "id": "p21.20", "order": 34, "type": "text", "bbox": { "l": 406.56, "t": 258.72, "r": 749.76, "b": 232.56 }, "text": "Support is available in person, by phone, or through online chat. Visit lung.org/ffs or call 800-LUNGUSA (800-586-4872).", "children": [ { "id": "p21.20.1", "order": 35, "type": "link", "bbox": { "l": 695.926, "t": 257.98, "r": 747.164, "b": 246.11 }, "text": "lung.org/ffs", "attrs": { "uri": "http://lung.org/ffs", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 19 }, { "id": "p21.21", "order": 36, "type": "heading", "bbox": { "l": 407.28, "t": 218.64, "r": 506.16, "b": 204.24 }, "text": "Quit Now Kentucky", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 20 }, { "id": "p21.22", "order": 37, "type": "text", "bbox": { "l": 406.32, "t": 196.8, "r": 720.72, "b": 170.88 }, "text": "This phone-based service provides one-on-one help from a trained tobacco cessation counselor. To learn more, call 800-Quit-Now (800-784-8669).", "reading_order": 21 }, { "id": "p21.23", "order": 38, "type": "text", "bbox": { "l": 406.32, "t": 164.64, "r": 729.6, "b": 139.2 }, "text": "In addition to choosing one of the approved programs, these online tools and resources can help you live a tobacco-free life.", "reading_order": 22 }, { "id": "p21.24", "order": 39, "type": "list", "bbox": { "l": 415.68, "t": 136.08, "r": 749.28, "b": 79.44 }, "text": "", "attrs": { "item_count": 2 }, "children": [ { "id": "p21.24.1", "order": 40, "type": "list_item", "bbox": { "l": 415.68, "t": 136.08, "r": 749.28, "b": 109.68 }, "text": "The Centers for Disease Control and Prevention offers cessation tips, tools, and research on their How to Quit website at cdc.gov/tobacco/quit_smoking.", "marker": "•", "children": [ { "id": "p21.24.1.1", "order": 41, "type": "link", "bbox": { "l": 592.597, "t": 122.48, "r": 728.185, "b": 110.61 }, "text": "cdc.gov/tobacco/quit_smoking.", "attrs": { "uri": "https://www.cdc.gov/tobacco/about/how-to-quit.html#:~:text=Seek%20counseling%201%20Talk%20to%20a%20quit%20smoking,program.%205%20Use%20a%20mobile%20app%20like%20quitSTART", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 0 }, { "id": "p21.24.2", "order": 42, "type": "list_item", "bbox": { "l": 415.92, "t": 105.84, "r": 732.48, "b": 79.44 }, "text": "Visit smokefree.gov, a website dedicated to helping smokers quit. You can access helpful articles, tips, and apps, and build your own plan to quit.", "marker": "-", "children": [ { "id": "p21.24.2.1", "order": 43, "type": "link", "bbox": { "l": 446.709, "t": 105.48, "r": 509.729, "b": 93.61 }, "text": "smokefree.gov,", "attrs": { "uri": "http://smokefree.gov", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 1 } ], "reading_order": 23 }, { "id": "p21.25", "order": 44, "type": "text", "bbox": { "l": 405.84, "t": 72.96, "r": 723.6, "b": 46.56 }, "text": "For more information about these programs and resources to help you stop smoking, call 844-402-5347, Monday through Friday, 8 a.m. to 8 p.m. ET.", "reading_order": 24 }, { "id": "p21.26", "order": 45, "type": "footer", "bbox": { "l": 745.2, "t": 30.48, "r": 757.2, "b": 21.36 }, "text": "21", "attrs": { "block_label": "number" }, "reading_order": 25 } ] }, { "document_id": 13522, "page": 22, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 36, "counts_by_type": { "footer": 1, "heading": 6, "link": 4, "list": 3, "list_item": 11, "text": 11 }, "build_ms": 4, "items": [ { "id": "p22.1", "order": 1, "type": "heading", "bbox": { "l": 34.56, "t": 577.2, "r": 133.68, "b": 564.96 }, "text": "Diabetes Benefits", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p22.2", "order": 2, "type": "heading", "bbox": { "l": 34.32, "t": 560.4, "r": 60.48, "b": 548.64 }, "text": "Lark", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 1 }, { "id": "p22.3", "order": 3, "type": "text", "bbox": { "l": 33.6, "t": 538.8, "r": 382.8, "b": 487.92 }, "text": "The Kentucky Employees' Health Plan, through its medical vendor, Anthem, has partnered with Lark to offer a diabetes prevention program at no extra cost to you. After a brief survey, if you are determined to be at risk for type 2 diabetes and enroll in the Lark program, you will receive:", "reading_order": 2 }, { "id": "p22.4", "order": 4, "type": "list", "bbox": { "l": 42, "t": 483.84, "r": 359.04, "b": 390.48 }, "text": "", "attrs": { "item_count": 5 }, "children": [ { "id": "p22.4.1", "order": 5, "type": "list_item", "bbox": { "l": 42, "t": 483.84, "r": 327.36, "b": 472.08 }, "text": "Access to a customized program through a convenient mobile app.", "marker": "•", "reading_order": 0 }, { "id": "p22.4.2", "order": 6, "type": "list_item", "bbox": { "l": 42.72, "t": 467.04, "r": 348, "b": 442.56 }, "text": "24/7 coaching to help develop habits to lose weight, manage stress, eat healthier, sleep better, and increase activity.", "marker": "-", "reading_order": 1 }, { "id": "p22.4.3", "order": 7, "type": "list_item", "bbox": { "l": 42.96, "t": 437.04, "r": 227.76, "b": 425.52 }, "text": "Personalized feedback and daily check-ins.", "marker": "•", "reading_order": 2 }, { "id": "p22.4.4", "order": 8, "type": "list_item", "bbox": { "l": 42.48, "t": 420, "r": 359.04, "b": 407.76 }, "text": "Educational information about prediabetes and preventing type 2 diabetes.", "marker": "•", "reading_order": 3 }, { "id": "p22.4.5", "order": 9, "type": "list_item", "bbox": { "l": 42.72, "t": 402.96, "r": 195.84, "b": 390.48 }, "text": "Tips for managing everyday stress.", "reading_order": 4 } ], "reading_order": 3 }, { "id": "p22.5", "order": 10, "type": "text", "bbox": { "l": 33.6, "t": 383.28, "r": 376.8, "b": 357.36 }, "text": "Receive a free smart scale upon enrollment and a free Fitbit after reaching certain milestones. See if you qualify at lark.com/anthem.", "children": [ { "id": "p22.5.1", "order": 11, "type": "link", "bbox": { "l": 171.568, "t": 369.98, "r": 244.476, "b": 358.11 }, "text": "lark.com/anthem.", "attrs": { "uri": "http://lark.com/anthem", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 4 }, { "id": "p22.6", "order": 12, "type": "heading", "bbox": { "l": 34.08, "t": 343.44, "r": 73.68, "b": 330.48 }, "text": "DSMES", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 5 }, { "id": "p22.7", "order": 13, "type": "text", "bbox": { "l": 33.6, "t": 322.08, "r": 380.88, "b": 230.4 }, "text": "Diabetes Self-Management Education and Support (DSMES) is available to you if you have already been diagnosed with type 1 or type 2 diabetes by your health care provider. No deductible, no co-insurance, and no additional cost to you! DSMES is an educational program for diabetes self-care, as developed through evidence-based practices. DSMES can be taught in a group or an individual setting and can be offered in person or online. Services are typically provided by a registered dietitian or a certified diabetes educator.", "reading_order": 6 }, { "id": "p22.8", "order": 14, "type": "text", "bbox": { "l": 33.36, "t": 224.64, "r": 370.8, "b": 172.32 }, "text": "The DSMES program format includes weekly classes that focus on learning to eat healthier, being physically active, monitoring blood sugar levels, coping with the emotional side of diabetes, problem solving, reducing the risk for other health problems, and many other related topics.", "reading_order": 7 }, { "id": "p22.9", "order": 15, "type": "text", "bbox": { "l": 33.36, "t": 166.8, "r": 374.4, "b": 127.68 }, "text": "Ask your physician about how to find a DSMES provider near you or search the Diabetes Prevention and Control Program at the Cabinet for Health and Family Services website (chfs.ky.gov).", "children": [ { "id": "p22.9.1", "order": 16, "type": "link", "bbox": { "l": 36, "t": 153.48, "r": 374.523, "b": 141.61 }, "text": "Diabetes Prevention and Control Program at the Cabinet for Health and Family", "attrs": { "uri": "https://www.chfs.ky.gov/Pages/index.aspx", "action_type": "/URI" }, "reading_order": 0 }, { "id": "p22.9.2", "order": 17, "type": "link", "bbox": { "l": 36, "t": 140.48, "r": 165.428, "b": 128.61 }, "text": "Services website (chfs.ky.gov).", "attrs": { "uri": "https://www.chfs.ky.gov/Pages/index.aspx", "action_type": "/URI" }, "reading_order": 1 } ], "reading_order": 8 }, { "id": "p22.10", "order": 18, "type": "heading", "bbox": { "l": 408, "t": 577.2, "r": 492.48, "b": 564.24 }, "text": "Maternity Care", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 9 }, { "id": "p22.11", "order": 19, "type": "heading", "bbox": { "l": 407.28, "t": 560.88, "r": 535.68, "b": 546.96 }, "text": "Building Healthy Families", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 10 }, { "id": "p22.12", "order": 20, "type": "text", "bbox": { "l": 407.04, "t": 539.28, "r": 734.4, "b": 513.36 }, "text": "Your maternity program Building Healthy Families provides assistance beyond pregnancy and postpartum.", "reading_order": 11 }, { "id": "p22.13", "order": 21, "type": "text", "bbox": { "l": 406.8, "t": 507.12, "r": 745.44, "b": 455.76 }, "text": "Building Healthy Families makes it easier to find personalized, on-demand health support for your growing family. As you prepare for a new baby, navigate postpartum, and raise your family, you'll have the resources you need to help you thrive.", "reading_order": 12 }, { "id": "p22.14", "order": 22, "type": "text", "bbox": { "l": 407.04, "t": 449.28, "r": 753.36, "b": 411.12 }, "text": "With 24/7 access through the Sydney[p22.14.2] Health mobile app and anthem.com, you can take advantage of program resources anytime, at no extra cost to you. Benefits include:", "children": [ { "id": "p22.14.1", "order": 23, "type": "link", "bbox": { "l": 670.775, "t": 448.98, "r": 724.474, "b": 437.11 }, "text": "anthem.com,", "attrs": { "uri": "http://anthem.com", "action_type": "/URI" }, "reading_order": 0 }, { "id": "p22.14.2", "order": 24, "type": "text", "bbox": { "l": 407.04, "t": 449.28, "r": 753.36, "b": 411.12 }, "text": "^{SM}", "attrs": { "inline": true, "text_offset": 35, "text_span": 10, "bbox_estimated": true }, "reading_order": 1 } ], "reading_order": 13 }, { "id": "p22.15", "order": 25, "type": "list", "bbox": { "l": 416.16, "t": 407.28, "r": 756.72, "b": 321.84 }, "text": "", "attrs": { "item_count": 3 }, "children": [ { "id": "p22.15.1", "order": 26, "type": "list_item", "bbox": { "l": 416.4, "t": 407.28, "r": 730.32, "b": 381.6 }, "text": "A digital library to explore thousands of educational articles and videos on everything from family planning to early parenthood.", "marker": "-", "reading_order": 0 }, { "id": "p22.15.2", "order": 27, "type": "list_item", "bbox": { "l": 416.4, "t": 377.04, "r": 756.72, "b": 352.08 }, "text": "Tracking tools to monitor your prenatal health, as well as diaper changes, growth, and milestones once baby arrives.", "marker": "•", "reading_order": 1 }, { "id": "p22.15.3", "order": 28, "type": "list_item", "bbox": { "l": 416.16, "t": 347.04, "r": 743.76, "b": 321.84 }, "text": "Health support to chat with Care Coaches during pregnancy and connect with virtual lactation support, as needed.", "marker": "-", "reading_order": 2 } ], "reading_order": 14 }, { "id": "p22.16", "order": 29, "type": "text", "bbox": { "l": 406.56, "t": 314.4, "r": 736.8, "b": 282.48 }, "text": "A nurse will be available by phone throughout your pregnancy and postpartum.\nEnroll today:", "reading_order": 15 }, { "id": "p22.17", "order": 30, "type": "list", "bbox": { "l": 407.04, "t": 276.24, "r": 689.04, "b": 225.6 }, "text": "", "attrs": { "item_count": 3 }, "children": [ { "id": "p22.17.1", "order": 31, "type": "list_item", "bbox": { "l": 407.52, "t": 276.24, "r": 529.44, "b": 263.28 }, "text": "Log in to Sydney Health.", "marker": "1.", "reading_order": 0 }, { "id": "p22.17.2", "order": 32, "type": "list_item", "bbox": { "l": 407.04, "t": 257.28, "r": 661.68, "b": 244.32 }, "text": "Find Featured Programs at the bottom of the homepage.", "marker": "2.", "reading_order": 1 }, { "id": "p22.17.3", "order": 33, "type": "list_item", "bbox": { "l": 407.04, "t": 238.56, "r": 689.04, "b": 225.6 }, "text": "Select View All, then choose the Building Healthy Families tile.", "marker": "3.", "reading_order": 2 } ], "reading_order": 16 }, { "id": "p22.18", "order": 34, "type": "heading", "bbox": { "l": 406.8, "t": 211.44, "r": 631.68, "b": 197.76 }, "text": "Lactation Support through LiveHealth Online", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 17 }, { "id": "p22.19", "order": 35, "type": "text", "bbox": { "l": 406.56, "t": 189.84, "r": 757.92, "b": 137.76 }, "text": "Receive lactation support through LiveHealth Online. You'll have a live health visit with a lactation consultant or registered dietitian for personalized postpartum nutrition and lactation support. Contact LiveHealth Online for lactation and nutrition support at 888-548-3432.", "reading_order": 18 }, { "id": "p22.20", "order": 36, "type": "footer", "bbox": { "l": 34.8, "t": 29.76, "r": 46.8, "b": 20.64 }, "text": "22", "attrs": { "block_label": "number" }, "reading_order": 19 } ] }, { "document_id": 13522, "page": 23, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 48, "counts_by_type": { "footer": 2, "heading": 10, "link": 5, "list": 3, "list_item": 10, "text": 18 }, "build_ms": 5, "items": [ { "id": "p23.1", "order": 1, "type": "heading", "bbox": { "l": 34.8, "t": 577.68, "r": 144.48, "b": 547.44 }, "text": "Joint and Back Pain\nHinge Health [p23.1.1]", "attrs": { "block_label": "paragraph_title" }, "children": [ { "id": "p23.1.1", "order": 2, "type": "text", "bbox": { "l": 34.8, "t": 577.68, "r": 144.48, "b": 547.44 }, "text": "^{*}", "attrs": { "inline": true, "text_offset": 33, "text_span": 9, "bbox_estimated": true }, "reading_order": 0 } ], "level": 3, "reading_order": 0 }, { "id": "p23.2", "order": 3, "type": "text", "bbox": { "l": 33.12, "t": 539.28, "r": 379.92, "b": 499.92 }, "text": "Hinge Health is a virtual exercise therapy program designed to address back, knee, hip, neck, or shoulder pain. It's convenient and fits your schedule — it can be done anywhere, at any time.", "reading_order": 1 }, { "id": "p23.3", "order": 4, "type": "text", "bbox": { "l": 33.12, "t": 494.16, "r": 373.2, "b": 455.28 }, "text": "The Hinge Health program is available at no additional cost to you or your eligible dependents who are 18 or older, and enrolled in a KEHP medical plan. 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Call 855-869-2133 for details or go online at smartshopper.com for more information about earning cash and using this program.", "children": [ { "id": "p24.14.1", "order": 20, "type": "link", "bbox": { "l": 402, "t": 412.98, "r": 483.319, "b": 401.11 }, "text": "smartshopper.com", "attrs": { "uri": "http://smartshopper.com", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 13 }, { "id": "p24.15", "order": 21, "type": "heading", "bbox": { "l": 399.6, "t": 386.64, "r": 493.68, "b": 373.2 }, "text": "Wellness Rewards", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 14 }, { "id": "p24.16", "order": 22, "type": "heading", "bbox": { "l": 399.84, "t": 365.04, "r": 566.4, "b": 352.32 }, "text": "Castlight is the Plan's wellness partner!", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 15 }, { "id": "p24.17", "order": 23, "type": "text", "bbox": { "l": 398.4, "t": 345.6, "r": 745.68, "b": 266.88 }, "text": "You can earn up to $480 in premium discounts when you complete the LivingWell Promise by July 1. All you have to do is complete a Health Assessment to complete the Promise. You can also earn up to $200 and your spouse can earn up to $100 in LivingWell engagement rewards for activities like getting your annual preventive examination, getting other preventive examinations like a colonoscopy or a mammography, completing a dental screening, or participating in step challenges.", "reading_order": 16 }, { "id": "p24.18", "order": 24, "type": "text", "bbox": { "l": 399.12, "t": 261.84, "r": 738, "b": 222.48 }, "text": "The LivingWell program makes it easier to enjoy the little moments that add up to greater health. Tools are available to help you find providers to complete your examinations or connect you to programs that will earn rewards!", "reading_order": 17 }, { "id": "p24.19", "order": 25, "type": "text", "bbox": { "l": 399.6, "t": 216.72, "r": 640.56, "b": 190.56 }, "text": "Download the Castlight app to register in seconds or visit mycastlight.com/mybenefits.", "children": [ { "id": "p24.19.1", "order": 26, "type": "link", "bbox": { "l": 402, "t": 203.48, "r": 525.738, "b": 191.61 }, "text": "mycastlight.com/mybenefits.", "attrs": { "uri": "http://mycastlight.com/mybenefits", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 18 }, { "id": "p24.20", "order": 27, "type": "footer", "bbox": { "l": 34.8, "t": 29.76, "r": 47.28, "b": 20.64 }, "text": "24", "attrs": { "block_label": "number" }, "reading_order": 19 } ] }, { "document_id": 13522, "page": 25, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 32, "counts_by_type": { "footer": 1, "heading": 14, "text": 16, "title": 1 }, "build_ms": 4, "items": [ { "id": "p25.1", "order": 1, "type": "title", "bbox": { "l": 33.84, "t": 576.96, "r": 284.16, "b": 554.64 }, "text": "Terms You Should Know", "attrs": { "block_label": "doc_title" }, "level": 2, "reading_order": 0 }, { "id": "p25.2", "order": 2, "type": "heading", "bbox": { "l": 34.08, "t": 536.4, "r": 94.56, "b": 525.6 }, "text": "Co-insurance", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 1 }, { "id": "p25.3", "order": 3, "type": "text", "bbox": { "l": 33.12, "t": 525.12, "r": 366.24, "b": 488.64 }, "text": "Means your share of the cost for covered services that is a percentage of the Maximum Allowed Amount that you must pay. You pay the Co-insurance after you meet your Deductible.", "reading_order": 2 }, { "id": "p25.4", "order": 4, "type": "text", "bbox": { "l": 32.4, "t": 485.52, "r": 380.4, "b": 436.8 }, "text": "Example: Your plan has a 20% Co-insurance on an office visit amount of $100. In this case, your Co-insurance Cost-Share of the Maximum Allowed Amount would be $20, after you have met your Deductible. The plan would then cover the remaining 80% of the Maximum Allowed Amount, or $80.", "reading_order": 3 }, { "id": "p25.5", "order": 5, "type": "heading", "bbox": { "l": 34.32, "t": 432.48, "r": 90.48, "b": 421.44 }, "text": "Co-payment", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 4 }, { "id": "p25.6", "order": 6, "type": "text", "bbox": { "l": 32.64, "t": 421.44, "r": 376.56, "b": 384.24 }, "text": "Means a fixed-dollar amount that is your share of the cost for certain Covered Services. Co-payments do not apply to the Deductible but do apply to the Maximum Out-of-Pocket. Only the LivingWell PPO plan utilizes Co-payments.", "reading_order": 5 }, { "id": "p25.7", "order": 7, "type": "heading", "bbox": { "l": 34.08, "t": 380.64, "r": 85.44, "b": 369.84 }, "text": "Cost-Share", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 6 }, { "id": "p25.8", "order": 8, "type": "text", "bbox": { "l": 32.88, "t": 369.36, "r": 369.12, "b": 320.4 }, "text": "Means that portion of payment for Covered Services that is your responsibility. Depending on the plan you choose, Cost-Share includes your Deductible, Co-payments, and Co-insurance. Your Cost-Share may vary depending on whether you receive Covered Services from a Network or an Out-of-Network Provider.", "reading_order": 7 }, { "id": "p25.9", "order": 9, "type": "heading", "bbox": { "l": 34.32, "t": 316.8, "r": 113.76, "b": 306 }, "text": "Covered Services", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 8 }, { "id": "p25.10", "order": 10, "type": "text", "bbox": { "l": 32.88, "t": 305.28, "r": 368.88, "b": 268.56 }, "text": "Means medically necessary medical care and prescription drugs that are covered under your health plan. Please see the Medical Benefit Booklet and Summary Plan Description for your plan, for more information.", "reading_order": 9 }, { "id": "p25.11", "order": 11, "type": "heading", "bbox": { "l": 34.08, "t": 264.96, "r": 84.96, "b": 254.4 }, "text": "Deductible", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 10 }, { "id": "p25.12", "order": 12, "type": "text", "bbox": { "l": 32.88, "t": 253.2, "r": 375.12, "b": 192.96 }, "text": "Means the amount you must pay for Covered Services before your plan will begin to pay. After you have met your plan's Deductible, you will only be responsible for your Co-insurance and any applicable Co-payment. Some Covered Services, such as preventive care, will be covered by your plan at 100%, without regard to the Deductible.", "reading_order": 11 }, { "id": "p25.13", "order": 13, "type": "heading", "bbox": { "l": 34.08, "t": 188.4, "r": 81.84, "b": 177.6 }, "text": "Formulary", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 12 }, { "id": "p25.14", "order": 14, "type": "text", "bbox": { "l": 33.12, "t": 177.36, "r": 332.4, "b": 152.64 }, "text": "Means a list of prescription drugs covered by a plan offering prescription drug benefits.", "reading_order": 13 }, { "id": "p25.15", "order": 15, "type": "heading", "bbox": { "l": 33.84, "t": 148.8, "r": 153.12, "b": 138 }, "text": "Maximum Allowed Amount", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 14 }, { "id": "p25.16", "order": 16, "type": "text", "bbox": { "l": 32.64, "t": 137.28, "r": 384, "b": 76.8 }, "text": "Means the maximum dollar amount that the plan will pay for Covered Services provided by a Network or Out-of-Network Provider. The Maximum Allowed Amount may be established by a contract between Anthem or CVS Caremark with a Network Provider or by the plan's coverage rules as outlined in the Medical Benefit Booklets or the Summary Plan Descriptions.", "reading_order": 15 }, { "id": "p25.17", "order": 17, "type": "heading", "bbox": { "l": 33.84, "t": 72.96, "r": 142.8, "b": 62.16 }, "text": "Maximum Out-of-Pocket", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 16 }, { "id": "p25.18", "order": 18, "type": "text", "bbox": { "l": 32.64, "t": 61.2, "r": 370.32, "b": 36 }, "text": "Means the maximum amount that you will pay out of pocket for Covered Services under your plan during a given calendar year. When the Maximum Out-of-Pocket is reached, the plan will pay 100% of the Maximum Allowed Amount for Covered Services, and you are no longer responsible for any Cost-Share.", "reading_order": 17 }, { "id": "p25.19", "order": 19, "type": "text", "bbox": { "l": 405.36, "t": 537.12, "r": 724.8, "b": 512.4 }, "text": "reached, the plan will pay 100% of the Maximum Allowed Amount for Covered Services, and you are no longer responsible for any Cost-Share.", "reading_order": 18 }, { "id": "p25.20", "order": 20, "type": "heading", "bbox": { "l": 407.04, "t": 509.04, "r": 515.28, "b": 498.24 }, "text": "Medical Benefit Booklet", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 19 }, { "id": "p25.21", "order": 21, "type": "text", "bbox": { "l": 406.08, "t": 497.28, "r": 734.64, "b": 436.8 }, "text": "Means the document that lists the Covered Services for each plan offered by the KEHP as well as the rights and responsibilities of members of the health plan, including but not limited to Deductibles, Co-insurance, Co-payments, preauthorization requirements, coverage exclusions, and claim denial appeal procedures.", "reading_order": 20 }, { "id": "p25.22", "order": 22, "type": "heading", "bbox": { "l": 407.04, "t": 432.96, "r": 487.44, "b": 421.68 }, "text": "Network Provider", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 21 }, { "id": "p25.23", "order": 23, "type": "text", "bbox": { "l": 405.84, "t": 421.2, "r": 756, "b": 372.48 }, "text": "Means a physician, health professional, hospital, pharmacy, or other individual, organization, and/or facility that has entered into a contract, either directly or indirectly, with Anthem or Caremark, to provide Covered Services through negotiated reimbursement arrangements.", "reading_order": 22 }, { "id": "p25.24", "order": 24, "type": "heading", "bbox": { "l": 407.04, "t": 368.88, "r": 517.68, "b": 358.08 }, "text": "Out-of-Network Provider", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 23 }, { "id": "p25.25", "order": 25, "type": "text", "bbox": { "l": 405.84, "t": 356.88, "r": 757.92, "b": 309.12 }, "text": "Means a physician, health professional, hospital, pharmacy, or other health care provider that has not entered into a contract, either directly or indirectly, with Anthem or CVS Caremark, to provide Covered Services at the time such Covered Services are rendered.", "reading_order": 24 }, { "id": "p25.26", "order": 26, "type": "heading", "bbox": { "l": 407.28, "t": 305.04, "r": 481.44, "b": 293.52 }, "text": "Qualifying Event", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 25 }, { "id": "p25.27", "order": 27, "type": "text", "bbox": { "l": 406.08, "t": 293.28, "r": 753.6, "b": 244.56 }, "text": "Means a life event, such as marriage or birth of a child that, upon occurrence, will enable an employee to enroll in, change, or terminate health, life, dental, or vision insurance coverage outside the open enrollment period or the enrollment period for newly hired employees.", "reading_order": 26 }, { "id": "p25.28", "order": 28, "type": "heading", "bbox": { "l": 407.04, "t": 240.72, "r": 498.96, "b": 229.68 }, "text": "Statement of Health", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 27 }, { "id": "p25.29", "order": 29, "type": "text", "bbox": { "l": 405.6, "t": 228.96, "r": 755.28, "b": 156.48 }, "text": "Means a questionnaire that documents the overall health of an employee or an employee's spouse who is seeking to increase their optional life insurance coverage limits. The Statement of Health, sometimes referred to as an Evidence of Insurability questionnaire, is a form provided by MetLife, and is used by MetLife to evaluate the life insurance application when you elect coverage at a time other than an applicable open enrollment or as a new hire.", "reading_order": 28 }, { "id": "p25.30", "order": 30, "type": "heading", "bbox": { "l": 407.04, "t": 152.64, "r": 530.4, "b": 141.36 }, "text": "Summary Plan Descriptions", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 29 }, { "id": "p25.31", "order": 31, "type": "text", "bbox": { "l": 405.84, "t": 140.88, "r": 754.08, "b": 55.68 }, "text": "Means the document that lists the prescription drugs covered under each plan offered by the KEHP as well as the rights and responsibilities of members of the health plan, including but not limited to Deductibles, Co-insurance, Co-payments, preauthorization requirements, coverage exclusions, and claim denial appeal procedures. A Summary Plan Description is also available for Health Flexible Spending Accounts, Child and Adult Daycare Flexible Spending Accounts, and Health Reimbursement Arrangements.", "reading_order": 30 }, { "id": "p25.32", "order": 32, "type": "footer", "bbox": { "l": 745.2, "t": 30.48, "r": 757.44, "b": 21.36 }, "text": "25", "attrs": { "block_label": "number" }, "reading_order": 31 } ] }, { "document_id": 13522, "page": 26, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 6, "counts_by_type": { "figure": 1, "footer": 1, "heading": 1, "text": 3 }, "build_ms": 0, "items": [ { "id": "p26.1", "order": 1, "type": "heading", "bbox": { "l": 34.8, "t": 577.2, "r": 298.8, "b": 553.44 }, "text": "New Employee Deadlines", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p26.2", "order": 2, "type": "text", "bbox": { "l": 33.84, "t": 537.36, "r": 356.16, "b": 507.6 }, "text": "As a new full-time employee, you have 30 days from your date of hire to elect health, FSA, life, dental, and vision insurance.", "reading_order": 1 }, { "id": "p26.3", "order": 3, "type": "text", "bbox": { "l": 33.6, "t": 499.92, "r": 357.6, "b": 439.44 }, "text": "If you fail to make a health insurance election within the 30 days, you will be enrolled in a Waiver without an HRA. You will also be enrolled in Basic Life Insurance coverage if your employer participates in the Commonwealth's life insurance program.", "reading_order": 2 }, { "id": "p26.4", "order": 4, "type": "text", "bbox": { "l": 34.08, "t": 432.24, "r": 330, "b": 417.36 }, "text": "Dental and Vision coverage are not automatically assigned.", "reading_order": 3 }, { "id": "p26.5", "order": 5, "type": "figure", "bbox": { "l": 389.04, "t": 612, "r": 791.28, "b": 1.44 }, "text": "", "attrs": { "block_label": "image" }, "reading_order": 4 }, { "id": "p26.6", "order": 6, "type": "footer", "bbox": { "l": 34.8, "t": 29.76, "r": 46.8, "b": 20.64 }, "text": "26", "attrs": { "block_label": "number" }, "reading_order": 5 } ] }, { "document_id": 13522, "page": 27, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 25, "counts_by_type": { "footer": 1, "heading": 4, "list": 2, "list_item": 6, "text": 12 }, "build_ms": 3, "items": [ { "id": "p27.1", "order": 1, "type": "heading", "bbox": { "l": 34.8, "t": 577.2, "r": 217.44, "b": 552.72 }, "text": "Qualifying Events", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p27.2", "order": 2, "type": "text", "bbox": { "l": 34.08, "t": 536.88, "r": 379.2, "b": 472.32 }, "text": "KEHP is a federally regulated, Section 125 Cafeteria Plan, which enables you to pay your health, dental, and vision insurance premiums and your Flexible Spending Account contributions with pre-tax dollars. Under Cafeteria Plan rules, there are only three times you can change or cancel your benefit elections during the plan year:", "reading_order": 1 }, { "id": "p27.3", "order": 3, "type": "text", "bbox": { "l": 44.16, "t": 468.96, "r": 349.92, "b": 444 }, "text": "During the enrollment period when you first become eligible for benefits (see New Employee Deadlines);", "reading_order": 2 }, { "id": "p27.4", "order": 4, "type": "list", "bbox": { "l": 43.2, "t": 438.96, "r": 306.24, "b": 409.68 }, "text": "", "attrs": { "item_count": 2 }, "children": [ { "id": "p27.4.1", "order": 5, "type": "list_item", "bbox": { "l": 44.16, "t": 438.96, "r": 243.12, "b": 426.72 }, "text": "During the annual Open Enrollment period; or", "marker": "•", "reading_order": 0 }, { "id": "p27.4.2", "order": 6, "type": "list_item", "bbox": { "l": 43.2, "t": 422.16, "r": 306.24, "b": 409.68 }, "text": "If you experience a life event, referred to as a Qualifying Event.", "marker": "•", "reading_order": 1 } ], "reading_order": 3 }, { "id": "p27.5", "order": 7, "type": "heading", "bbox": { "l": 35.28, "t": 399.84, "r": 184.56, "b": 386.88 }, "text": "What is a Qualifying Event?", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 4 }, { "id": "p27.6", "order": 8, "type": "text", "bbox": { "l": 37.2, "t": 383.28, "r": 333.84, "b": 354.72 }, "text": "A Qualifying Event is a life-changing event or a change in status such as:\n• Marriage", "reading_order": 5 }, { "id": "p27.7", "order": 9, "type": "text", "bbox": { "l": 43.68, "t": 349.92, "r": 163.2, "b": 337.44 }, "text": "• Having or adopting a child", "reading_order": 6 }, { "id": "p27.8", "order": 10, "type": "text", "bbox": { "l": 44.16, "t": 332.64, "r": 87.6, "b": 321.12 }, "text": "Divorce", "reading_order": 7 }, { "id": "p27.9", "order": 11, "type": "text", "bbox": { "l": 43.68, "t": 315.84, "r": 206.4, "b": 303.84 }, "text": "Loss of other group health insurance", "reading_order": 8 }, { "id": "p27.10", "order": 12, "type": "text", "bbox": { "l": 43.44, "t": 298.56, "r": 182.88, "b": 286.32 }, "text": "Court order requiring coverage", "reading_order": 9 }, { "id": "p27.11", "order": 13, "type": "text", "bbox": { "l": 43.92, "t": 282, "r": 246.72, "b": 269.76 }, "text": "Spouse has a different Open Enrollment period", "reading_order": 10 }, { "id": "p27.12", "order": 14, "type": "text", "bbox": { "l": 34.56, "t": 262.08, "r": 384.24, "b": 210.24 }, "text": "Other less common qualifying events may apply. If you are unsure whether you have experienced a qualifying event that will allow you to change your insurance benefits, contact your Insurance Coordinator or Human Resource Generalist for additional information.", "reading_order": 11 }, { "id": "p27.13", "order": 15, "type": "heading", "bbox": { "l": 35.04, "t": 201.36, "r": 301.2, "b": 188.64 }, "text": "What You Need to Know About Qualifying Events", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 12 }, { "id": "p27.14", "order": 16, "type": "text", "bbox": { "l": 34.08, "t": 184.32, "r": 378.48, "b": 93.36 }, "text": "Qualifying events can be complicated, and at times, difficult to understand. There are restrictions on the types of changes you can make due to federal qualifying event rules. For instance, a change in a life event or status may not entitle you to change the amount you contribute to a Flexible Spending Account. For that reason, it is very important that you be aware of the following rules and contact your Insurance Coordinator or Human Resource Generalist as quickly as possible after experiencing a qualifying event:", "reading_order": 13 }, { "id": "p27.15", "order": 17, "type": "list", "bbox": { "l": 34.56, "t": 479.52, "r": 752.4, "b": 49.2 }, "text": "", "attrs": { "item_count": 4 }, "children": [ { "id": "p27.15.1", "order": 18, "type": "list_item", "bbox": { "l": 37, "t": 87.47320000000002, "r": 374.8252, "b": 75.60320000000002 }, "text": "Any change in your plan option or coverage level must be consistent with the qualifying event you have experienced. For example, you cannot request to remove a dependent from your plan due to birth or adoption.", "marker": "1.", "reading_order": 0 }, { "id": "p27.15.2", "order": 19, "type": "list_item", "bbox": { "l": 34.56, "t": 68.52, "r": 375.84, "b": 49.2 }, "text": "Qualifying Events have strict deadlines. Qualifying events require that you complete the Employee Benefits Enrollment Change Form and submit it to your Insurance Coordinator or Human Resource Generalist within 30 calendar days of the event date, in most cases.", "marker": "2.", "attrs": { "bbox_estimated": true }, "reading_order": 1 }, { "id": "p27.15.3", "order": 20, "type": "list_item", "bbox": { "l": 407.28, "t": 479.52, "r": 747.36, "b": 426.96 }, "text": "All qualifying events (except death) require supporting documentation. The supporting documentation required for a Qualifying Event will depend on the type of Qualifying Event. Supporting documentation must be submitted together with the Employee Benefits Enrollment Change Form.", "marker": "3.", "reading_order": 2 }, { "id": "p27.15.4", "order": 21, "type": "list_item", "bbox": { "l": 407.52, "t": 421.2, "r": 752.4, "b": 382.32 }, "text": "If you do not sign and date the required Employee Benefits Enrollment Change Form within the deadline, you will not be permitted to make the requested change until the next Open Enrollment period.", "marker": "4.", "reading_order": 3 } ], "reading_order": 14 }, { "id": "p27.16", "order": 22, "type": "text", "bbox": { "l": 407.28, "t": 376.32, "r": 747.6, "b": 350.4 }, "text": "Contact your Insurance Coordinator or Human Resource Generalist for questions, assistance, and additional information about Qualifying Events.", "reading_order": 15 }, { "id": "p27.17", "order": 23, "type": "heading", "bbox": { "l": 407.76, "t": 342, "r": 668.88, "b": 328.56 }, "text": "Qualifying Events and Other Insurance Benefits", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 16 }, { "id": "p27.18", "order": 24, "type": "text", "bbox": { "l": 407.76, "t": 324.72, "r": 756.72, "b": 272.88 }, "text": "In general, a qualifying event that permits a change in health insurance will also permit a change in dental and vision insurance. Likewise, a qualifying event that permits a change in health insurance will, in most instances, permit a change in life insurance including making a change to or adding optional insurance coverage.", "reading_order": 17 }, { "id": "p27.19", "order": 25, "type": "footer", "bbox": { "l": 745.44, "t": 30.48, "r": 756.48, "b": 21.36 }, "text": "27", "attrs": { "block_label": "number" }, "reading_order": 18 } ] }, { "document_id": 13522, "page": 28, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 64, "counts_by_type": { "footer": 2, "footnote": 6, "header": 1, "heading": 1, "link": 1, "list": 1, "list_item": 3, "table": 2, "table_cell": 40, "text": 6, "title": 1 }, "build_ms": 18, "items": [ { "id": "p28.1", "order": 1, "type": "header", "bbox": { "l": 619.68, "t": 577.92, "r": 743.28, "b": 562.32 }, "text": "No rate changes for 2025!", "attrs": { "block_label": "header" }, "level": 2, "reading_order": 0 }, { "id": "p28.2", "order": 2, "type": "title", "bbox": { "l": 31.92, "t": 576.96, "r": 394.08, "b": 553.92 }, "text": "Anthem Optional Dental Insurance", "attrs": { "block_label": "doc_title" }, "level": 2, "reading_order": 1 }, { "id": "p28.3", "order": 3, "type": "text", "bbox": { "l": 32.64, "t": 537.36, "r": 309.6, "b": 401.76 }, "text": "You may choose optional employer-sponsored, employee-paid, dental insurance administered by Anthem. Dental benefits make it easier and more affordable to care for your mouth — and smile. Regular dental checkups help your dentist keep your teeth and gums healthy and catch potential issues earlier, when they're easier to treat. Good oral health can also help improve overall health and reduce the risk of diabetes, heart disease, and other serious health conditions. [p28.3.1]", "children": [ { "id": "p28.3.1", "order": 4, "type": "text", "bbox": { "l": 32.64, "t": 537.36, "r": 309.6, "b": 401.76 }, "text": "¹", "attrs": { "inline": true, "text_offset": 467, "text_span": 9, "bbox_estimated": true }, "reading_order": 0 } ], "reading_order": 2 }, { "id": "p28.4", "order": 5, "type": "heading", "bbox": { "l": 33.36, "t": 394.08, "r": 145.44, "b": 381.12 }, "text": "Your dental plan includes:", "level": 3, "reading_order": 3 }, { "id": "p28.5", "order": 6, "type": "list", "bbox": { "l": 41.04, "t": 369.12, "r": 272.16, "b": 296.64 }, "text": "", "attrs": { "item_count": 3 }, "children": [ { "id": "p28.5.1", "order": 7, "type": "list_item", "bbox": { "l": 41.04, "t": 369.12, "r": 249.84, "b": 356.4 }, "text": "Access to a large number of dentists in the plan.", "marker": "•", "reading_order": 0 }, { "id": "p28.5.2", "order": 8, "type": "list_item", "bbox": { "l": 42, "t": 352.32, "r": 272.16, "b": 326.16 }, "text": "An extra cleaning if you're pregnant, have diabetes, or another qualifying condition.", "reading_order": 1 }, { "id": "p28.5.3", "order": 9, "type": "list_item", "bbox": { "l": 42, "t": 322.56, "r": 261.36, "b": 296.64 }, "text": "A benefit for a brush biopsy that can help diagnose oral cancer.", "marker": "-", "reading_order": 2 } ], "reading_order": 4 }, { "id": "p28.6", "order": 10, "type": "text", "bbox": { "l": 41.52, "t": 292.32, "r": 289.92, "b": 253.44 }, "text": "No out-of-pocket costs for most preventive and diagnostic services, including regular cleanings and X-rays, when you see a dentist in the plan's network.", "reading_order": 5 }, { "id": "p28.7", "order": 11, "type": "text", "bbox": { "l": 42, "t": 249.36, "r": 258.96, "b": 210.48 }, "text": "- Easy-to-use online tools, including a Dental Health Assessment, Dental Cost Estimator, and Ask a Dental Hygienist.", "reading_order": 6 }, { "id": "p28.8", "order": 12, "type": "text", "bbox": { "l": 41.04, "t": 206.16, "r": 299.04, "b": 155.76 }, "text": "• Teledentistry, 24 hours a day, 7 days a week, 365 days a year.\nUsing technology and telecommunications, employees can get dental care remotely, without the need to go to a dentist's office.", "reading_order": 7 }, { "id": "p28.9", "order": 13, "type": "table", "bbox": { "l": 333.36, "t": 520.8, "r": 755.04, "b": 260.88 }, "text": "", "attrs": { "block_label": "table", "n_rows": 9, "n_cols": 4, "integrity": { "cells_checked": 35, "cells_flagged": 6, "flags": [ { "row": 0, "col": 1, "coverage": 0.5, "text": "Bronze ²" }, { "row": 0, "col": 2, "coverage": 0.5, "text": "Silver ²" }, { "row": 0, "col": 3, "coverage": 0.5, "text": "Gold ²" }, { "row": 1, "col": 1, "coverage": 0.5, "text": "In/Out-of-Network ³" }, { "row": 1, "col": 2, "coverage": 0.5, "text": "In/Out-of-Network ³" }, { "row": 1, "col": 3, "coverage": 0.5, "text": "In/Out-of-Network ³" } ] } }, "children": [ { "id": "p28.9.1", "order": 14, "type": "table_cell", "bbox": { "l": 333.36, "t": 520.8, "r": 438.78, "b": 494.808 }, "text": "", "attrs": { "row": 0, "col": 0, "rowspan": 1, "colspan": 1, "column_header": true, "header_source": "pdf" }, "reading_order": 0 }, { "id": "p28.9.2", "order": 15, "type": "table_cell", "bbox": { "l": 438.78, "t": 520.8, "r": 544.2, "b": 494.808 }, "text": "Bronze ²", "attrs": { "row": 0, "col": 1, "rowspan": 1, "colspan": 1, "column_header": true, "header_source": "pdf" }, "reading_order": 1 }, { "id": "p28.9.3", "order": 16, "type": "table_cell", "bbox": { "l": 544.2, "t": 520.8, "r": 649.62, "b": 494.808 }, "text": "Silver ²", "attrs": { "row": 0, "col": 2, "rowspan": 1, "colspan": 1, "column_header": true, "header_source": "pdf" }, "reading_order": 2 }, { "id": "p28.9.4", "order": 17, "type": "table_cell", "bbox": { "l": 649.62, "t": 520.8, "r": 755.04, "b": 494.808 }, "text": "Gold ²", "attrs": { "row": 0, "col": 3, "rowspan": 1, "colspan": 1, "column_header": true, "header_source": "pdf" }, "reading_order": 3 }, { "id": "p28.9.5", "order": 18, "type": "table_cell", "bbox": { "l": 337.38, "t": 493.1133, "r": 434.928, "b": 481.0433 }, "text": "Your Dental Plan at a Glance", "attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 4 }, { "id": "p28.9.6", "order": 19, "type": "table_cell", "bbox": { "l": 438.78, "t": 494.808, "r": 544.2, "b": 468.816 }, "text": "In/Out-of-Network ³", "attrs": { "row": 1, "col": 1, "rowspan": 1, "colspan": 1 }, "reading_order": 5 }, { "id": "p28.9.7", "order": 20, "type": "table_cell", "bbox": { "l": 544.2, "t": 494.808, "r": 649.62, "b": 468.816 }, "text": "In/Out-of-Network ³", "attrs": { "row": 1, "col": 2, "rowspan": 1, "colspan": 1 }, "reading_order": 6 }, { "id": "p28.9.8", "order": 21, "type": "table_cell", "bbox": { "l": 649.62, "t": 494.808, "r": 755.04, "b": 468.816 }, "text": "In/Out-of-Network ³", "attrs": { "row": 1, "col": 3, "rowspan": 1, "colspan": 1 }, "reading_order": 7 }, { "id": "p28.9.9", "order": 22, "type": "table_cell", "bbox": { "l": 337.38, "t": 467.89009999999996, "r": 419.838, "b": 439.32529999999997 }, "text": "Annual Benefit Maximum ⁴\nAnnual Deductible", "attrs": { "row": 2, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 8 }, { "id": "p28.9.10", "order": 23, "type": "table_cell", "bbox": { "l": 520.4674, "t": 467.6001, "r": 537.7474, "b": 439.62530000000004 }, "text": "750\n50", "attrs": { "row": 2, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 9 }, { "id": "p28.9.11", "order": 24, "type": "table_cell", "bbox": { "l": 607.1829, "t": 467.6001, "r": 630.5529, "b": 439.62530000000004 }, "text": "1,000\n50", "attrs": { "row": 2, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 10 }, { "id": "p28.9.12", "order": 25, "type": "table_cell", "bbox": { "l": 698.6891, "t": 467.6001, "r": 721.5591, "b": 439.62530000000004 }, "text": "1,500\n50", "attrs": { "row": 2, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 11 }, { "id": "p28.9.13", "order": 26, "type": "table_cell", "bbox": { "l": 337.38, "t": 433.0555, "r": 474.675, "b": 409.5455 }, "text": "Orthodontia\\n(only for children through the age of 18)", "attrs": { "row": 3, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 12 }, { "id": "p28.9.14", "order": 27, "type": "table_cell", "bbox": { "l": 509.8456, "t": 426.7655, "r": 548.3576, "b": 415.8455 }, "text": "Not covered", "attrs": { "row": 3, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 13 }, { "id": "p28.9.15", "order": 28, "type": "table_cell", "bbox": { "l": 599.606, "t": 426.7655, "r": 638.117, "b": 415.8455 }, "text": "Not covered", "attrs": { "row": 3, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 14 }, { "id": "p28.9.16", "order": 29, "type": "table_cell", "bbox": { "l": 698.3306, "t": 426.7655, "r": 721.9166, "b": 415.8455 }, "text": "1,500", "attrs": { "row": 3, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 15 }, { "id": "p28.9.17", "order": 30, "type": "table_cell", "bbox": { "l": 337.38, "t": 402.6394, "r": 405.356, "b": 379.12940000000003 }, "text": "Diagnostic and\\nPreventive Services", "attrs": { "row": 4, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 16 }, { "id": "p28.9.18", "order": 31, "type": "table_cell", "bbox": { "l": 500.1006, "t": 401.3494, "r": 555.3776, "b": 380.4294 }, "text": "100%/100% of allowable amount ³", "attrs": { "row": 4, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 17 }, { "id": "p28.9.19", "order": 32, "type": "table_cell", "bbox": { "l": 589.8609, "t": 401.3494, "r": 645.1379, "b": 380.4294 }, "text": "100%/100% of allowable amount ³", "attrs": { "row": 4, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 18 }, { "id": "p28.9.20", "order": 33, "type": "table_cell", "bbox": { "l": 681.1172, "t": 401.3494, "r": 736.3942, "b": 380.4294 }, "text": "100%/100% of allowable amount ³", "attrs": { "row": 4, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 19 }, { "id": "p28.9.21", "order": 34, "type": "table_cell", "bbox": { "l": 337.38, "t": 367.1966, "r": 387.087, "b": 355.6866 }, "text": "Basic Services", "attrs": { "row": 5, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 20 }, { "id": "p28.9.22", "order": 35, "type": "table_cell", "bbox": { "l": 500.1006, "t": 343.4371, "r": 555.3776, "b": 322.5171 }, "text": "50%/50% of allowable amount ³", "attrs": { "row": 5, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 21 }, { "id": "p28.9.23", "order": 36, "type": "table_cell", "bbox": { "l": 589.8609, "t": 343.4371, "r": 645.1379, "b": 322.5171 }, "text": "80%/80% of allowable amount ³", "attrs": { "row": 5, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 22 }, { "id": "p28.9.24", "order": 37, "type": "table_cell", "bbox": { "l": 681.1172, "t": 343.4371, "r": 736.3942, "b": 322.5171 }, "text": "80%/80% of allowable amount ³", "attrs": { "row": 5, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 23 }, { "id": "p28.9.25", "order": 38, "type": "table_cell", "bbox": { "l": 337.38, "t": 338.7271, "r": 409.906, "b": 327.2171 }, "text": "Oral Surgery (Simple)", "attrs": { "row": 6, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 24 }, { "id": "p28.9.26", "order": 39, "type": "table_cell", "bbox": { "l": 500.1006, "t": 371.9066, "r": 555.3776, "b": 350.9866 }, "text": "50%/50% of allowable amount ³", "attrs": { "row": 6, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 25 }, { "id": "p28.9.27", "order": 40, "type": "table_cell", "bbox": { "l": 589.8609, "t": 371.9066, "r": 645.1379, "b": 350.9866 }, "text": "80%/80% of allowable amount ³", "attrs": { "row": 6, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 26 }, { "id": "p28.9.28", "order": 41, "type": "table_cell", "bbox": { "l": 681.1172, "t": 371.9066, "r": 736.3942, "b": 350.9866 }, "text": "80%/80% of allowable amount ³", "attrs": { "row": 6, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 27 }, { "id": "p28.9.29", "order": 42, "type": "table_cell", "bbox": { "l": 337.3799, "t": 314.8602, "r": 447.7869, "b": 283.3502 }, "text": "Major Services ⁵\\n(including Complex Oral Surgery,\\nPorcelain Crowns, and Implants)", "attrs": { "row": 7, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 28 }, { "id": "p28.9.30", "order": 43, "type": "table_cell", "bbox": { "l": 509.8456, "t": 304.5702, "r": 548.3566, "b": 293.6502 }, "text": "Not covered", "attrs": { "row": 7, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 29 }, { "id": "p28.9.31", "order": 44, "type": "table_cell", "bbox": { "l": 589.8609, "t": 309.5702, "r": 645.1379, "b": 288.6502 }, "text": "50%/50% of allowable amount ³", "attrs": { "row": 7, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 30 }, { "id": "p28.9.32", "order": 45, "type": "table_cell", "bbox": { "l": 681.1172, "t": 309.5702, "r": 736.3942, "b": 288.6502 }, "text": "50%/50% of allowable amount ³", "attrs": { "row": 7, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 31 }, { "id": "p28.9.33", "order": 46, "type": "table_cell", "bbox": { "l": 337.38, "t": 275.0303, "r": 430.719, "b": 263.5203 }, "text": "Annual Maximum Carryover", "attrs": { "row": 8, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 32 }, { "id": "p28.9.34", "order": 47, "type": "table_cell", "bbox": { "l": 509.8456, "t": 274.7403, "r": 548.3576, "b": 263.8203 }, "text": "Not covered", "attrs": { "row": 8, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 33 }, { "id": "p28.9.35", "order": 48, "type": "table_cell", "bbox": { "l": 599.606, "t": 274.7403, "r": 638.117, "b": 263.8203 }, "text": "Not covered", "attrs": { "row": 8, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 34 }, { "id": "p28.9.36", "order": 49, "type": "table_cell", "bbox": { "l": 697.0385, "t": 274.7403, "r": 723.2015, "b": 263.8203 }, "text": "Covered", "attrs": { "row": 8, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 35 } ], "reading_order": 8 }, { "id": "p28.10", "order": 50, "type": "table", "bbox": { "l": 332.16, "t": 217.2, "r": 756.48, "b": 137.52 }, "text": "", "attrs": { "block_label": "table", "n_rows": 1, "n_cols": 4, "integrity": { "cells_checked": 4, "cells_flagged": 0 } }, "children": [ { "id": "p28.10.1", "order": 51, "type": "table_cell", "bbox": { "l": 337.3799, "t": 213.66140000000001, "r": 419.1146, "b": 138.92239999999998 }, "text": "Monthly Rates\nEmployee only\nEmployee + spouse\nEmployee + child(ren)\nFamily", "attrs": { "row": 0, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true, "column_header": true, "header_source": "pdf" }, "reading_order": 0 }, { "id": "p28.10.2", "order": 52, "type": "table_cell", "bbox": { "l": 494.9303, "t": 213.66140000000001, "r": 519.1103, "b": 139.2224 }, "text": "Bronze\n$14.08\n$25.68\n$33.40\n$49.28", "attrs": { "row": 0, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 1 }, { "id": "p28.10.3", "order": 53, "type": "table_cell", "bbox": { "l": 602.6282, "t": 213.66140000000001, "r": 626.6932, "b": 139.2224 }, "text": "Silver\n$21.40\n$40.62\n$45.92\n$68.26", "attrs": { "row": 0, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 2 }, { "id": "p28.10.4", "order": 54, "type": "table_cell", "bbox": { "l": 699.0657, "t": 213.66140000000001, "r": 726.8167, "b": 139.2224 }, "text": "Gold\n$28.40\n$54.90\n$70.00\n$102.10", "attrs": { "row": 0, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 3 } ], "reading_order": 9 }, { "id": "p28.11", "order": 55, "type": "footnote", "bbox": { "l": 377.76, "t": 255.6, "r": 712.56, "b": 241.44 }, "text": "No waiting periods for basic or major services. Up to 24-month waiting period missing tooth clause. [p28.11.1]", "attrs": { "block_label": "vision_footnote" }, "children": [ { "id": "p28.11.1", "order": 56, "type": "text", "bbox": { "l": 377.76, "t": 255.6, "r": 712.56, "b": 241.44 }, "text": "⁵", "attrs": { "inline": true, "text_offset": 100, "text_span": 10, "bbox_estimated": true }, "reading_order": 0 } ], "reading_order": 10 }, { "id": "p28.12", "order": 57, "type": "footnote", "bbox": { "l": 39.84, "t": 83.28, "r": 352.8, "b": 73.68 }, "text": "1 Oral Health Foundation. The importance of a healthy smile (accessed October 2021): dentalhealth.org.", "attrs": { "block_label": "footnote" }, "children": [ { "id": "p28.12.1", "order": 58, "type": "link", "bbox": { "l": 297.533, "t": 82.536, "r": 349.755, "b": 74.227 }, "text": "dentalhealth.org.", "attrs": { "uri": "http://dentalhealth.org", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 11 }, { "id": "p28.13", "order": 59, "type": "footnote", "bbox": { "l": 39.84, "t": 74.64, "r": 299.04, "b": 66.24 }, "text": "2 In-network rates for each tier, out-of-network reimbursement limitations may apply.", "attrs": { "block_label": "footnote" }, "reading_order": 12 }, { "id": "p28.14", "order": 60, "type": "footnote", "bbox": { "l": 39.12, "t": 66.96, "r": 335.76, "b": 58.56 }, "text": "3 Difference in charged amount and out-of-network allowable amount can result in balance billing.", "attrs": { "block_label": "footnote" }, "reading_order": 13 }, { "id": "p28.15", "order": 61, "type": "footnote", "bbox": { "l": 40.08, "t": 58.8, "r": 654.24, "b": 49.2 }, "text": "4 Dental services exceeding annual benefit maximum(s) are not Covered Services in compliance with applicable state law(s) and participating provider discounts may not apply. Please contact your dentist to", "attrs": { "block_label": "footnote" }, "reading_order": 14 }, { "id": "p28.16", "order": 62, "type": "footnote", "bbox": { "l": 41.28, "t": 49.92, "r": 505.68, "b": 41.28 }, "text": "determine available discounts prior to obtaining services. 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"order": 56, "type": "table_cell", "bbox": { "l": 342.9001, "t": 347.837, "r": 380.0501, "b": 336.327 }, "text": "Disposable", "attrs": { "row": 6, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 24 }, { "id": "p29.9.26", "order": 57, "type": "table_cell", "bbox": { "l": 501.4448, "t": 347.547, "r": 552.0878, "b": 336.627 }, "text": "150 allowance", "attrs": { "row": 6, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 25 }, { "id": "p29.9.27", "order": 58, "type": "table_cell", "bbox": { "l": 592.5496, "t": 347.547, "r": 643.1926, "b": 336.627 }, "text": "150 allowance", "attrs": { "row": 6, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 26 }, { "id": "p29.9.28", "order": 59, "type": "table_cell", "bbox": { "l": 684.4114, "t": 347.547, "r": 734.6664, "b": 336.627 }, "text": "175 allowance", "attrs": { "row": 6, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 27 }, { "id": "p29.9.29", "order": 60, "type": "table_cell", "bbox": { "l": 342.9001, "t": 326.0816, "r": 412.8611, "b": 295.4052 }, "text": "Medically necessary\nFrequency", "attrs": { "row": 7, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 28 }, { "id": "p29.9.30", "order": 61, "type": "table_cell", "bbox": { "l": 504.0198, "t": 325.7916, "r": 549.5108, "b": 314.8716 }, "text": "Covered in full", "attrs": { "row": 7, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 29 }, { "id": "p29.9.31", "order": 62, "type": "table_cell", "bbox": { "l": 595.1245, "t": 325.7916, "r": 640.6155, "b": 314.8716 }, "text": "Covered in full", "attrs": { "row": 7, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 30 }, { "id": "p29.9.32", "order": 63, "type": "table_cell", "bbox": { "l": 686.7928, "t": 325.7916, "r": 732.2838, "b": 314.8716 }, "text": "Covered in full", "attrs": { "row": 7, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 31 }, { "id": "p29.9.33", "order": 64, "type": "table_cell", "bbox": { "l": 342.9001, "t": 287.456, "r": 384.6081, "b": 275.946 }, "text": "Examination", "attrs": { "row": 8, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 32 }, { "id": "p29.9.34", "order": 65, "type": "table_cell", "bbox": { "l": 505.2903, "t": 292.166, "r": 548.2483, "b": 271.246 }, "text": "Once every calendar year", "attrs": { "row": 8, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 33 }, { "id": "p29.9.35", "order": 66, "type": "table_cell", "bbox": { "l": 596.395, "t": 292.166, "r": 639.352, "b": 271.246 }, "text": "Once every calendar year", "attrs": { "row": 8, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 34 }, { "id": "p29.9.36", "order": 67, "type": "table_cell", "bbox": { "l": 688.0634, "t": 292.166, "r": 731.0204, "b": 271.246 }, "text": "Once every calendar year", "attrs": { "row": 8, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 35 }, { "id": "p29.9.37", "order": 68, "type": "table_cell", "bbox": { "l": 342.9001, "t": 261.956, "r": 427.8441, "b": 250.44600000000003 }, "text": "Lenses or contact lenses", "attrs": { "row": 9, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 36 }, { "id": "p29.9.38", "order": 69, "type": "table_cell", "bbox": { "l": 505.2903, "t": 266.666, "r": 548.2483, "b": 245.74599999999998 }, "text": "Once every calendar year", "attrs": { "row": 9, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 37 }, { "id": "p29.9.39", "order": 70, "type": "table_cell", "bbox": { "l": 596.395, "t": 266.666, "r": 639.352, "b": 245.74599999999998 }, "text": "Once every calendar year", "attrs": { "row": 9, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 38 }, { "id": "p29.9.40", "order": 71, "type": "table_cell", "bbox": { "l": 688.0634, "t": 266.666, "r": 731.0204, "b": 245.74599999999998 }, "text": "Once every calendar year", "attrs": { "row": 9, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 39 }, { "id": "p29.9.41", "order": 72, "type": "table_cell", "bbox": { "l": 342.9001, "t": 235.95600000000002, "r": 363.8261, "b": 224.44600000000003 }, "text": "Frame", "attrs": { "row": 10, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 40 }, { "id": "p29.9.42", "order": 73, "type": "table_cell", "bbox": { "l": 502.1837, "t": 240.666, "r": 551.3487, "b": 219.74599999999998 }, "text": "Once every two calendar years", "attrs": { "row": 10, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 41 }, { "id": "p29.9.43", "order": 74, "type": "table_cell", "bbox": { "l": 593.2885, "t": 240.666, "r": 642.4535, "b": 219.74599999999998 }, "text": "Once every two calendar years", "attrs": { "row": 10, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 42 }, { "id": "p29.9.44", "order": 75, "type": "table_cell", "bbox": { "l": 688.0634, "t": 240.666, "r": 731.0204, "b": 219.74599999999998 }, "text": "Once every calendar year", "attrs": { "row": 10, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 43 } ], "reading_order": 8 }, { "id": "p29.10", "order": 76, "type": "table", "bbox": { "l": 338.16, "t": 198, "r": 756.48, "b": 108.24 }, "text": "", "attrs": { "block_label": "table", "n_rows": 1, "n_cols": 4, "integrity": { "cells_checked": 4, "cells_flagged": 0 } }, "children": [ { "id": "p29.10.1", "order": 77, "type": "table_cell", "bbox": { "l": 342.8999, "t": 190.83460000000002, "r": 434.7164, "b": 109.55520000000001 }, "text": "Monthly Rates\nEmployee only\nEmployee + spouse\nEmployee + child(ren)\nFamily", "attrs": { "row": 0, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 0 }, { "id": "p29.10.2", "order": 78, "type": "table_cell", "bbox": { "l": 514.4672, "t": 190.83460000000002, "r": 538.6462, "b": 111.35520000000002 }, "text": "Bronze\n$5.52\n$10.94\n$11.22\n$16.64", "attrs": { "row": 0, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 1 }, { "id": "p29.10.3", "order": 79, "type": "table_cell", "bbox": { "l": 606.5873, "t": 190.83460000000002, "r": 630.2433, "b": 111.35520000000002 }, "text": "Silver\n$6.46\n$12.80\n$13.12\n$19.48", "attrs": { "row": 0, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 2 }, { "id": "p29.10.4", "order": 80, "type": "table_cell", "bbox": { "l": 698.1232, "t": 190.83460000000002, "r": 721.8752, "b": 111.35520000000002 }, "text": "Gold\n$13.12\n$26.14\n$26.80\n$39.82", "attrs": { "row": 0, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 3 } ], "reading_order": 9 }, { "id": "p29.11", "order": 81, "type": "footnote", "bbox": { "l": 32.4, "t": 62.16, "r": 525.84, "b": 45.36 }, "text": "1 American Optometric Association, Evidence-Based Clinical Practice Guideline, Comprehensive Adult Eye and Vision Examination 2015 (accessed July 2023): aoa.org.\n2 Zelis Network360® data, January 2023.", "attrs": { "block_label": "footnote" }, "children": [ { "id": "p29.11.1", "order": 82, "type": "link", "bbox": { "l": 499.765, "t": 60.812, "r": 523.401, "b": 52.503 }, "text": "aoa.org.", "attrs": { "uri": "https://www.aoa.org/?sso=y", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 10 }, { "id": "p29.12", "order": 83, "type": "footnote", "bbox": { "l": 33.6, "t": 45.36, "r": 290.64, "b": 35.76 }, "text": "3 In-network rates for each tier, out-of-network reimbursement limitations may apply.", "attrs": { "block_label": "footnote" }, "reading_order": 11 }, { "id": "p29.13", "order": 84, "type": "footer", "bbox": { "l": 745.2, "t": 30.72, "r": 757.2, "b": 21.12 }, "text": "29", "attrs": { "block_label": "number" }, "reading_order": 12 } ] }, { "document_id": 13522, "page": 30, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 57, "counts_by_type": { "footer": 1, "heading": 3, "table": 2, "table_cell": 44, "text": 7 }, "build_ms": 11, "items": [ { "id": "p30.1", "order": 1, "type": "heading", "bbox": { "l": 34.56, "t": 577.68, "r": 320.16, "b": 554.64 }, "text": "Life Insurance with MetLife", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p30.2", "order": 2, "type": "text", "bbox": { "l": 33.12, "t": 536.64, "r": 380.64, "b": 446.4 }, "text": "As a Commonwealth of Kentucky public employee, your participating employer provides $20,000 of basic life insurance coverage to eligible employees at no cost to you. In addition to the free $20,000 of life coverage, you have the option to purchase additional life insurance for you and your eligible dependents. The basic and optional employee term life insurance plans also provide accidental death and dismemberment (AD&D) benefits, providing additional financial protection in the event of death or injury caused by certain events.", "reading_order": 1 }, { "id": "p30.3", "order": 3, "type": "text", "bbox": { "l": 33.12, "t": 441.12, "r": 374.64, "b": 416.16 }, "text": "During open enrollment, you can add or make changes to your optional employee and dependent life insurance plan(s) without a Statement of Health.\nOutside of open enrollment, you can add or increase optional life insurance. A Statement of Health will be required for Optional Life Insurance for the employee or spouse if outside of Open Enrollment.", "reading_order": 2 }, { "id": "p30.4", "order": 4, "type": "text", "bbox": { "l": 406.08, "t": 495.36, "r": 718.08, "b": 482.16 }, "text": "Dependents over the age of 26 are not eligible for dependent coverage.", "reading_order": 3 }, { "id": "p30.5", "order": 5, "type": "text", "bbox": { "l": 406.08, "t": 476.64, "r": 750.96, "b": 450.24 }, "text": "Check with your employer to see if they participate in the Commonwealth's life insurance program.", "reading_order": 4 }, { "id": "p30.6", "order": 6, "type": "text", "bbox": { "l": 406.8, "t": 444.24, "r": 715.2, "b": 419.28 }, "text": "Remember to keep your life insurance beneficiary information updated in KHRIS ESS.", "reading_order": 5 }, { "id": "p30.7", "order": 7, "type": "heading", "bbox": { "l": 33.6, "t": 393.12, "r": 245.52, "b": 378.96 }, "text": "Optional Life Insurance for Employees", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 6 }, { "id": "p30.8", "order": 8, "type": "text", "bbox": { "l": 33.12, "t": 374.4, "r": 604.56, "b": 361.44 }, "text": "As an employee, if you desire to purchase additional life insurance in addition to the free $20,000, you can select from the options below:", "reading_order": 7 }, { "id": "p30.9", "order": 9, "type": "table", "bbox": { "l": 35.28, "t": 354.96, "r": 755.28, "b": 240 }, "text": "", "attrs": { "block_label": "table", "n_rows": 2, "n_cols": 6, "integrity": { "cells_checked": 7, "cells_flagged": 0 } }, "children": [ { "id": "p30.9.1", "order": 10, "type": "table_cell", "bbox": { "l": 306.9271, "t": 349.4446, "r": 485.5731, "b": 337.3746 }, "text": "Employee Coverage Options and Monthly Premiums", "attrs": { "row": 0, "col": 0, "rowspan": 1, "colspan": 6, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "reading_order": 0 }, { "id": "p30.9.2", "order": 11, "type": "table_cell", "bbox": { "l": 67.494, "t": 330.716, "r": 125.423, "b": 242.6033 }, "text": "Age\n16 – 29\n30 – 39\n40 – 59\nAges 60 and over", "attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 1 }, { "id": "p30.9.3", "order": 12, "type": "table_cell", "bbox": { "l": 201.875, "t": 330.716, "r": 230.875, "b": 242.9033 }, "text": "$10,000\n$0.92\n$1.94\n$4.28\n$6.98", "attrs": { "row": 1, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 2 }, { "id": "p30.9.4", "order": 13, "type": "table_cell", "bbox": { "l": 321.7917, "t": 330.716, "r": 350.7917, "b": 242.9033 }, "text": "$25,000\n$2.28\n$4.86\n$10.70\n$17.48", "attrs": { "row": 1, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 3 }, { "id": "p30.9.5", "order": 14, "type": "table_cell", "bbox": { "l": 441.7084, "t": 330.716, "r": 470.7084, "b": 242.9033 }, "text": "$50,000\n$4.60\n$9.72\n$21.40\n$34.96", "attrs": { "row": 1, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 4 }, { "id": "p30.9.6", "order": 15, "type": "table_cell", "bbox": { "l": 559.3751, "t": 330.716, "r": 592.8751, "b": 242.9033 }, "text": "$100,000\n$9.18\n$19.44\n$42.80\n$69.90", "attrs": { "row": 1, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 5 }, { "id": "p30.9.7", "order": 16, "type": "table_cell", "bbox": { "l": 679.2917, "t": 330.716, "r": 712.7917, "b": 242.9033 }, "text": "$150,000\n$13.76\n$29.16\n$64.20\n$104.86", "attrs": { "row": 1, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 6 } ], "reading_order": 8 }, { "id": "p30.10", "order": 17, "type": "heading", "bbox": { "l": 33.6, "t": 222.72, "r": 250.32, "b": 209.04 }, "text": "Optional Life Insurance for Dependents", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 9 }, { "id": "p30.11", "order": 18, "type": "text", "bbox": { "l": 33.12, "t": 203.76, "r": 594, "b": 191.52 }, "text": "As an employee, you may purchase life insurance on your spouse and dependents. You can select from the available plan options below:", "reading_order": 10 }, { "id": "p30.12", "order": 19, "type": "table", "bbox": { "l": 35.28, "t": 184.56, "r": 754.8, "b": 40.32 }, "text": "", "attrs": { "block_label": "table", "n_rows": 5, "n_cols": 9, "integrity": { "cells_checked": 37, "cells_flagged": 0 } }, "children": [ { "id": "p30.12.1", "order": 20, "type": "table_cell", "bbox": { "l": 304.8973, "t": 178.00599999999997, "r": 487.8533, "b": 165.93599999999998 }, "text": "Dependent Coverage Options and Monthly Premiums", "attrs": { "row": 0, "col": 0, "rowspan": 1, "colspan": 9, "bbox_refit": true, "column_header": true, "header_source": "pdf" }, "reading_order": 0 }, { "id": "p30.12.2", "order": 21, "type": "table_cell", "bbox": { "l": 59.4991, "t": 157.223, "r": 93.4732, "b": 116.906 }, "text": "Qualified Dependent\nSpouse", "attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 1 }, { "id": "p30.12.3", "order": 22, "type": "table_cell", "bbox": { "l": 139.4713, "t": 157.223, "r": 173.4454, "b": 117.17599999999999 }, "text": "Dependent Option 1\n$10,000", "attrs": { "row": 1, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 2 }, { "id": "p30.12.4", "order": 23, "type": "table_cell", "bbox": { "l": 219.4436, "t": 157.223, "r": 253.4177, "b": 117.17599999999999 }, "text": "Dependent Option 2\n$20,000", "attrs": { "row": 1, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 3 }, { "id": "p30.12.5", "order": 24, "type": "table_cell", "bbox": { "l": 299.4158, "t": 157.223, "r": 333.3899, "b": 117.17599999999999 }, "text": "Dependent Option 3\n$50,000", "attrs": { "row": 1, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 4 }, { "id": "p30.12.6", "order": 25, "type": "table_cell", "bbox": { "l": 379.388, "t": 157.223, "r": 413.3621, "b": 117.17599999999999 }, "text": "Dependent Option 4\n$10,000", "attrs": { "row": 1, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 5 }, { "id": "p30.12.7", "order": 26, "type": "table_cell", "bbox": { "l": 459.3603, "t": 157.223, "r": 493.3344, "b": 117.17599999999999 }, "text": "Dependent Option 5\n$20,000", "attrs": { "row": 1, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 6 }, { "id": "p30.12.8", "order": 27, "type": "table_cell", "bbox": { "l": 539.3325, "t": 157.223, "r": 573.3066, "b": 117.17599999999999 }, "text": "Dependent Option 6\n$50,000", "attrs": { "row": 1, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 7 }, { "id": "p30.12.9", "order": 28, "type": "table_cell", "bbox": { "l": 619.3047, "t": 157.223, "r": 653.2788, "b": 117.17599999999999 }, "text": "Dependent Option 7\n$0", "attrs": { "row": 1, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 8 }, { "id": "p30.12.10", "order": 29, "type": "table_cell", "bbox": { "l": 699.2769, "t": 157.223, "r": 733.251, "b": 117.17599999999999 }, "text": "Dependent Option 8\n$0", "attrs": { "row": 1, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true }, "reading_order": 9 }, { "id": "p30.12.11", "order": 30, "type": "table_cell", "bbox": { "l": 59.6386, "t": 108.01499999999999, "r": 93.3337, "b": 88.65599999999995 }, "text": "Child under 6 months", "attrs": { "row": 2, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 10 }, { "id": "p30.12.12", "order": 31, "type": "table_cell", "bbox": { "l": 145.7049, "t": 103.25400000000002, "r": 167.2113, "b": 93.42600000000004 }, "text": "$2,500", "attrs": { "row": 2, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 11 }, { "id": "p30.12.13", "order": 32, "type": "table_cell", "bbox": { "l": 225.6771, "t": 103.25400000000002, "r": 247.1835, "b": 93.42600000000004 }, "text": "$2,500", "attrs": { "row": 2, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 12 }, { "id": "p30.12.14", "order": 33, "type": "table_cell", "bbox": { "l": 305.8744, "t": 103.25400000000002, "r": 326.9308, "b": 93.42600000000004 }, "text": "$2,500", "attrs": { "row": 2, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 13 }, { "id": "p30.12.15", "order": 34, "type": "table_cell", "bbox": { "l": 392.4312, "t": 103.25400000000002, "r": 400.3152, "b": 93.42600000000004 }, "text": "$0", "attrs": { "row": 2, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 14 }, { "id": "p30.12.16", "order": 35, "type": "table_cell", "bbox": { "l": 472.4035, "t": 103.25400000000002, "r": 480.2875, "b": 93.42600000000004 }, "text": "$0", "attrs": { "row": 2, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 15 }, { "id": "p30.12.17", "order": 36, "type": "table_cell", "bbox": { "l": 552.4207, "t": 103.25400000000002, "r": 560.2147, "b": 93.42600000000004 }, "text": "$0", "attrs": { "row": 2, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 16 }, { "id": "p30.12.18", "order": 37, "type": "table_cell", "bbox": { "l": 625.5383, "t": 103.25400000000002, "r": 647.0447, "b": 93.42600000000004 }, "text": "$2,500", "attrs": { "row": 2, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 17 }, { "id": "p30.12.19", "order": 38, "type": "table_cell", "bbox": { "l": 705.5105, "t": 103.25400000000002, "r": 727.0169, "b": 93.42600000000004 }, "text": "$2,500", "attrs": { "row": 2, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 18 }, { "id": "p30.12.20", "order": 39, "type": "table_cell", "bbox": { "l": 54.1127, "t": 84.26499999999999, "r": 98.8598, "b": 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"rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 34, "counts_by_type": { "figure": 1, "footer": 1, "footnote": 4, "heading": 3, "link": 2, "table": 1, "table_cell": 9, "text": 12, "title": 1 }, "build_ms": 7, "items": [ { "id": "p31.1", "order": 1, "type": "title", "bbox": { "l": 35.04, "t": 577.68, "r": 283.44, "b": 553.92 }, "text": "Deferred Compensation", "attrs": { "block_label": "doc_title" }, "level": 2, "reading_order": 0 }, { "id": "p31.2", "order": 2, "type": "heading", "bbox": { "l": 33.6, "t": 536.88, "r": 206.88, "b": 523.2 }, "text": "Put this benefit to work for you", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 1 }, { "id": "p31.3", "order": 3, "type": "heading", "bbox": { "l": 33.84, "t": 511.92, "r": 249.36, "b": 498.72 }, "text": "What is Kentucky Deferred Compensation?", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 2 }, { "id": "p31.4", "order": 4, "type": "text", "bbox": { "l": 33.84, "t": 495.36, "r": 290.16, "b": 446.88 }, "text": "Kentucky Deferred Compensation (KDC) is a tax-deferred retirement savings plan offered to all state employees, public school employees, university employees, and employees of local political subdivisions that have elected to participate.", "reading_order": 3 }, { "id": "p31.5", "order": 5, "type": "figure", "bbox": { "l": 327.12, "t": 555.36, "r": 407.28, "b": 447.84 }, "text": "", "attrs": { "block_label": "image" }, "children": [ { "id": "p31.5.1", "order": 6, "type": "text", "bbox": { "l": 330.48, "t": 481.44, "r": 403.2, "b": 469.92 }, "text": "Anniversary", "reading_order": 0 }, { "id": "p31.5.2", "order": 7, "type": "text", "bbox": { "l": 329.76, "t": 465.6, "r": 404.88, "b": 451.44 }, "text": "Kentucky's official supplemental retirement plan", "reading_order": 1 }, { "id": "p31.5.3", "order": 8, "type": "link", "bbox": { "l": 320, "t": 559.05, "r": 413.64, "b": 441.92 }, "text": "", "attrs": { "uri": "https://www.kentuckyplans.com/rsc-web-preauth/index.html", "action_type": "/URI" }, "reading_order": 2 } ], "reading_order": 4 }, { "id": "p31.6", "order": 9, "type": "heading", "bbox": { "l": 34.08, "t": 432.96, "r": 120.48, "b": 419.28 }, "text": "Why participate?", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 5 }, { "id": "p31.7", "order": 10, "type": "text", "bbox": { "l": 33.6, "t": 416.4, "r": 288.72, "b": 331.68 }, "text": "Chances are Social Security benefits, plus your state and other system retirement, will not provide enough income to maintain your current standard of living. By contributing to a supplemental retirement plan, you consistently save with the goal of having additional income at retirement. KDC helps bridge the gap between what you'll collect from your pension and what you need for retirement.", "reading_order": 6 }, { "id": "p31.8", "order": 11, "type": "text", "bbox": { "l": 33.6, "t": 326.64, "r": 287.52, "b": 302.16 }, "text": "Easy contributing — Contribute as little as $30 per month or $15 per pay.", "reading_order": 7 }, { "id": "p31.9", "order": 12, "type": "text", "bbox": { "l": 33.12, "t": 299.76, "r": 291.36, "b": 275.04 }, "text": "Convenient — Contributions are automatically deducted from your paycheck.", "reading_order": 8 }, { "id": "p31.10", "order": 13, "type": "text", "bbox": { "l": 33.12, "t": 272.16, "r": 289.68, "b": 247.92 }, "text": "Tax advantages — No federal or state income taxes on pre-tax contributions and earnings until the money is paid to you.", "reading_order": 9 }, { "id": "p31.11", "order": 14, "type": "text", "bbox": { "l": 34.08, "t": 245.28, "r": 284.64, "b": 221.04 }, "text": "Low cost — As a KY State Government program, there is no profit incentive, and savings are passed on to participants.", "reading_order": 10 }, { "id": "p31.12", "order": 15, "type": "text", "bbox": { "l": 34.08, "t": 218.64, "r": 266.88, "b": 194.4 }, "text": "Accessible — Manage your account online anytime, day or night.", "reading_order": 11 }, { "id": "p31.13", "order": 16, "type": "text", "bbox": { "l": 33.84, "t": 191.76, "r": 292.56, "b": 167.76 }, "text": "Personal service — Local Retirement Specialists are available across the Commonwealth.", "reading_order": 12 }, { "id": "p31.14", "order": 17, "type": "text", "bbox": { "l": 33.36, "t": 164.4, "r": 292.8, "b": 151.68 }, "text": "Easy enrollment — Only one form and a few minutes to begin.\nAnniversary\nKentucky's official supplemental\nretirement plan", "reading_order": 13 }, { "id": "p31.15", "order": 18, "type": "table", "bbox": { "l": 319.44, "t": 430.08, "r": 757.2, "b": 150 }, "text": "", "attrs": { "block_label": "table", "n_rows": 3, "n_cols": 3, "integrity": { "cells_checked": 9, "cells_flagged": 3, "flags": [ { "row": 2, "col": 0, "coverage": 0.08, "text": "Invest in the fund that's closest to the year in which you …" }, { "row": 2, "col": 1, "coverage": 0.43, "text": "Define your investment goals and strategy.Select funds from…" }, { "row": 2, "col": 2, "coverage": 0.49, "text": "Professional investment managers select funds from KDC's li…" } ] } }, "children": [ { "id": "p31.15.1", "order": 19, "type": "table_cell", "bbox": { "l": 342.7452, "t": 393.43809999999996, "r": 413.244, "b": 378.71410000000003 }, "text": "Help me do it ¹", "attrs": { "row": 0, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "heuristic" }, "reading_order": 0 }, { "id": "p31.15.2", "order": 20, "type": "table_cell", "bbox": { "l": 490.9491, "t": 393.43809999999996, "r": 554.1519, "b": 378.71410000000003 }, "text": "Do it myself", "attrs": { "row": 0, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "heuristic" }, "reading_order": 1 }, { "id": "p31.15.3", "order": 21, "type": "table_cell", "bbox": { "l": 648.7281, "t": 391.18809999999996, "r": 711.3921, "b": 376.46410000000003 }, "text": "Do it for me ²", "attrs": { "row": 0, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "heuristic" }, "reading_order": 2 }, { "id": "p31.15.4", "order": 22, "type": "table_cell", "bbox": { "l": 333.7326, "t": 372.51009999999997, "r": 426.1887, "b": 350.6671 }, "text": "Target Date Retirement Funds from Vanguard", "attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 3 }, { "id": "p31.15.5", "order": 23, "type": "table_cell", "bbox": { "l": 486.6049, "t": 366.2301, "r": 558.496, "b": 355.1871 }, "text": "Your own strategy", "attrs": { "row": 1, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 4 }, { "id": "p31.15.6", "order": 24, "type": "table_cell", "bbox": { "l": 632.7682, "t": 366.14009999999996, "r": 731.8564, "b": 355.0971 }, "text": "Nationwide ProAccount $ ^{\\textregistered} $", "attrs": { "row": 1, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true }, "reading_order": 5 }, { "id": "p31.15.7", "order": 25, "type": "table_cell", "bbox": { "l": 319.44, "t": 243.36, "r": 465.36, "b": 150 }, "text": "Invest in the fund that's closest to the year in which you expect to retire or take a distribution.The fund is managed, automatically rebalanced, and designed to become gradually more conservative as the selected date approaches.", "attrs": { "row": 2, "col": 0, "rowspan": 1, "colspan": 1 }, "reading_order": 6 }, { "id": "p31.15.8", "order": 26, "type": "table_cell", "bbox": { "l": 465.36, "t": 243.36, "r": 611.28, "b": 150 }, "text": "Define your investment goals and strategy.Select funds from KDC's Investment Guide.Use the My Investment Planner $ ^{SM} $ tool for free investment recommendations that are right for you. ²Opt for automatic rebalancing to keep investments in line with your goals.Spend the time and energy to manage your own investments.", "attrs": { "row": 2, "col": 1, "rowspan": 1, "colspan": 1 }, "reading_order": 7 }, { "id": "p31.15.9", "order": 27, "type": "table_cell", "bbox": { "l": 611.28, "t": 243.36, "r": 757.2, "b": 150 }, "text": "Professional investment managers select funds from KDC's lineup based on your age, risk tolerance, and investment goals.These managers actively manage your account according to the information you provide.Wilshire, a leading provider of investment products and services, actively manages your account, including periodic rebalancing according to the information you provide.Pay for this service through an additional asset management fee deducted from your account balance each quarter", "attrs": { "row": 2, "col": 2, "rowspan": 1, "colspan": 1 }, "reading_order": 8 } ], "reading_order": 14 }, { "id": "p31.16", "order": 28, "type": "text", "bbox": { "l": 33.36, "t": 113.52, "r": 568.32, "b": 101.04 }, "text": "Employees can enroll anytime. Let us help. Call 800-542-2667 or 502-573-7925 or find us online at kentuckydcp.ky.gov.", "children": [ { "id": "p31.16.1", "order": 29, "type": "link", "bbox": { "l": 474.164, "t": 113.638, "r": 562.963, "b": 101.368 }, "text": "kentuckydcp.ky.gov.", "attrs": { "uri": "http://kentuckydcp.ky.gov", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 15 }, { "id": "p31.17", "order": 30, "type": "footnote", "bbox": { "l": 32.4, "t": 90.48, "r": 743.28, "b": 76.32 }, "text": "1 The Vanguard Target Retirement Funds Invest in a wide variety of underlying funds to help reduce investment risk. Their expense ratio represents a weighted average of the expense ratios and any fees charged by the underlying mutual funds in which the Vanguard Target Retirement Funds invest. The Vanguard Target Retirement Funds do not change any expenses or fees of their own. Like other funds, Vanguard Target Retirement Funds are subject to market risk and loss. Loss of principle can occur at any time, including before, at or after the target date. There is no guarantee that target date funds will provide enough income for retirement.", "attrs": { "block_label": "footnote" }, "reading_order": 16 }, { "id": "p31.18", "order": 31, "type": "footnote", "bbox": { "l": 33.12, "t": 75.6, "r": 740.64, "b": 61.68 }, "text": "2 Investment advice for Nationalwide ProAccount is provided to plan participants by Nationwide Investment Advisors LLC (NIA), an SEC-registered investment advisory. NIA has retained Wilshire Associates as the Independent Financial Expert for Nationwide ProAccount. Wilshire Associates is not an affiliate of NIA or KDC. Nationwide Investment Advisor LLC (NIA) is not affiliated with Wilshire Associates or KDC.", "attrs": { "block_label": "footnote" }, "reading_order": 17 }, { "id": "p31.19", "order": 32, "type": "footnote", "bbox": { "l": 36, "t": 61.68, "r": 474.72, "b": 53.76 }, "text": "Investing involves market risk, including possible loss of principal. No investment strategy or program can guarantee a profit or avoid loss. Actual results will vary depending on your investment and market experience.", "attrs": { "block_label": "footnote" }, "reading_order": 18 }, { "id": "p31.20", "order": 33, "type": "footnote", "bbox": { "l": 36.72, "t": 54, "r": 608.64, "b": 37.68 }, "text": "KDC Retirement Specialists are Registered Representatives of Nationwide Investment Services Corporation (NISC), member FINRA. Nationwide representatives cannot offer investment, tax, or legal advice. You should consult your own counsel before making retirement plan decisions. NRM-17372KY-KY (08/19)", "attrs": { "block_label": "footnote" }, "reading_order": 19 }, { "id": "p31.21", "order": 34, "type": "footer", "bbox": { "l": 745.44, "t": 30.48, "r": 757.44, "b": 21.12 }, "text": "31", "attrs": { "block_label": "number" }, "reading_order": 20 } ] }, { "document_id": 13522, "page": 32, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 17, "counts_by_type": { "figure": 1, "footer": 1, "heading": 5, "link": 4, "text": 6 }, "build_ms": 1, "items": [ { "id": "p32.1", "order": 1, "type": "heading", "bbox": { "l": 34.56, "t": 577.68, "r": 247.44, "b": 554.64 }, "text": "Contact Information", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p32.2", "order": 2, "type": "heading", "bbox": { "l": 33.84, "t": 537.12, "r": 216.72, "b": 522.72 }, "text": "Support During Open Enrollment", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 1 }, { "id": "p32.3", "order": 3, "type": "text", "bbox": { "l": 34.08, "t": 518.4, "r": 320.4, "b": 492.96 }, "text": "Department of Employee Insurance (DEI) Open Enrollment Hotline 888-581-8834 OR 502-564-6534", "reading_order": 2 }, { "id": "p32.4", "order": 4, "type": "text", "bbox": { "l": 33.84, "t": 483.6, "r": 316.56, "b": 457.2 }, "text": "Extended hours and the five phone options below are only available during Open Enrollment: October 7 to October 25.", "reading_order": 3 }, { "id": "p32.5", "order": 5, "type": "heading", "bbox": { "l": 34.08, "t": 444, "r": 266.88, "b": 431.28 }, "text": "Open Enrollment Hours for Assistance (Eastern Time)", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 4 }, { "id": "p32.6", "order": 6, "type": "text", "bbox": { "l": 34.08, "t": 426, "r": 269.52, "b": 387.12 }, "text": "Monday, Oct. 7 to Friday, Oct. 11, 7:30 a.m. to 4:30 p.m.\nMonday, Oct. 14 to Friday, Oct. 18, 7:30 a.m. to 6:00 p.m.\nMonday, Oct. 21 to Friday, Oct. 25, 7:30 a.m. to 8:00 p.m.", "reading_order": 5 }, { "id": "p32.7", "order": 7, "type": "text", "bbox": { "l": 34.32, "t": 369.12, "r": 376.08, "b": 260.88 }, "text": "You can choose from one of these five options:\nOption 1: Kentucky Public Pensions Authority\nOption 2: KHRIS User ID and password reset\nOption 3: Benefit questions for Anthem (medical, dental, and vision), HealthEquity, or CVS Caremark\nOption 4: Technical assistance such as browser or compatibility errors\nOption 5: Department of Employee Insurance (DEI) for all other inquiries", "reading_order": 6 }, { "id": "p32.8", "order": 8, "type": "heading", "bbox": { "l": 34.08, "t": 246.72, "r": 119.52, "b": 234.72 }, "text": "Website Addresses", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 7 }, { "id": "p32.9", "order": 9, "type": "text", "bbox": { "l": 33.84, "t": 229.44, "r": 238.08, "b": 177.12 }, "text": 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"b": 581.04 }, "text": "35", "attrs": { "block_label": "number" }, "level": 2, "reading_order": 0 }, { "id": "p35.2", "order": 2, "type": "text", "bbox": { "l": 447.6, "t": 571.44, "r": 755.04, "b": 545.28 }, "text": "KEHP is committed to helping you achieve your best health. Incentives for participating in KEH wellness program are available to all persons who enroll in a KEHP health insurance plan and spouse. If you are unable to participate in any of the health-related activities, or you think you", "reading_order": 1 }, { "id": "p35.3", "order": 3, "type": "text", "bbox": { "l": 38.64, "t": 564.48, "r": 390.96, "b": 525.84 }, "text": "Your plan, as required by WHCRA, provides benefits for mastectomy-related services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy, including lymphedema. For more information regarding this coverage, please refer to your Medical Benefit Booklet or go to kehp.ky.gov (Resources/Docs, Forms, and Legal Notices link)", "reading_order": 2 }, { "id": "p35.4", "order": 4, "type": "text", "bbox": { "l": 422.64, "t": 540.48, "r": 756.96, "b": 500.4 }, "text": "Additional incentives in the form of gift cards, consumer goods, and other prizes may be available for employees who participate in certain health-related activities such as walking challenges or quitting smoking. In addition, KEHP offers discounted, monthly employee premium contribution rates to non-tobacco users. Each KEHP member has at least one opportunity per Plan Year to qualify for the monthly premium contribution discount.", "reading_order": 3 }, { "id": "p35.5", "order": 5, "type": "text", "bbox": { "l": 146.88, "t": 521.28, "r": 390.48, "b": 512.16 }, "text": "D. THE WOMEN'S HEALTH AND CANCER RIGHTS ACT OF 1998 (WHCRA)", "reading_order": 4 }, { "id": "p35.6", "order": 6, "type": "link", "bbox": { "l": 115.326, "t": 512.684, "r": 156.205, "b": 503.188 }, "text": "kehp.ky.gov.", "attrs": { "uri": "http://kehp.ky.gov", "action_type": "/URI" }, "reading_order": 5 }, { "id": "p35.7", "order": 7, "type": "text", "bbox": { "l": 50.16, "t": 508.56, "r": 392.88, "b": 482.16 }, "text": "coverage under KEHP due to a qualifying event. The KEHP's third-party COBRA administrator is HealthEquity. To learn more about COBRA and your rights under COBRA, please refer to the Medical Booklet or go to kehp.ky.gov (Resources/Docs, Forms, and Legal Notices link).", "reading_order": 6 }, { "id": "p35.8", "order": 8, "type": "text", "bbox": { "l": 405.12, "t": 496.08, "r": 756.24, "b": 398.64 }, "text": "LivingWell is KEHP's voluntary wellness program available to all persons who enroll in a KEHP health insurance plan and their enrolled spouse. The program is administered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease. Those federal rules include the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others. If you choose to participate in the wellness program, you will be asked to complete a voluntary health assessment (or \"HA\") that asks a series of questions about your health-related activities and behaviors and whether you have or had certain medical conditions (e.g., cancer, diabetes, or heart disease). You are not required to complete the HA. However, employees who choose to participate in the LivingWell wellness program will receive an incentive in the form of discounted employee premium contributions for the employee's health insurance coverage. Although you are not required to complete the HA, only employees who do so will receive the discounted health insurance premiums.", "reading_order": 7 }, { "id": "p35.9", "order": 9, "type": "text", "bbox": { "l": 36, "t": 485.52, "r": 391.92, "b": 434.64 }, "text": "COBRA continuation coverage is a continuation of KEHP coverage when it would otherwise end because of a life event, also called a “qualifying event.” After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” Qualified beneficiaries may elect to continue their coverage under the plan for a prescribed period of time on a self-pay basis. Each qualified beneficiary has 60 days to choose whether or not to elect COBRA coverage, beginning from the later of the date the election notice is provided, or the date on which the qualified beneficiary would otherwise lose", "reading_order": 8 }, { "id": "p35.10", "order": 10, "type": "text", "bbox": { "l": 105.6, "t": 429.6, "r": 390.96, "b": 420 }, "text": "C. THE CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT OF 1986 (COBRA)", "reading_order": 9 }, { "id": "p35.11", "order": 11, "type": "text", "bbox": { "l": 45.84, "t": 415.44, "r": 390.96, "b": 390.72 }, "text": "If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact the Department of Employee Insurance, Member Services Branch at (888) 581-8834 or (502) 564-6534.", "reading_order": 10 }, { "id": "p35.12", "order": 12, "type": "heading", "bbox": { "l": 580.56, "t": 393.12, "r": 755.52, "b": 384.24 }, "text": "B. WELLNESS PROGRAM DISCLOSURE AND NOTICE", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 11 }, { "id": "p35.13", "order": 13, "type": "text", "bbox": { "l": 44.16, "t": 386.4, "r": 393.12, "b": 360.48 }, "text": "You may not be discriminated against in employment because of the medical information you provide as part of participating in the LivingWell wellness program, nor may you be subjected to retaliation if you choose not to participate.", "reading_order": 12 }, { "id": "p35.14", "order": 14, "type": "text", "bbox": { "l": 405.84, "t": 379.92, "r": 756.48, "b": 299.52 }, "text": "If you or your children are eligible for Medicaid or the Children's Health Insurance Program (CHIP) and you're eligible for health coverage from your employer, Kentucky may have a premium assistance program that can help pay for coverage using funds from the state's Medicaid or CHIP programs. If you or your dependent(s) are eligible for premium assistance under Medicaid or CHIP, as well as eligible for health insurance coverage through KEEP, your employer must allow you to enroll in KEEP if you aren't already enrolled. This is called a \"special enrollment\" opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. In addition, you may enroll in KEEP if you or your dependent's Medicaid or CHIP coverage is terminated because of loss of eligibility. An employee must request this special enrollment within 60 days of the loss of coverage. You can find more information and the required CHIP notice at kehp.ky.gov (Resources/Docs, Forms, and Legal Notices link).", "reading_order": 13 }, { "id": "p35.15", "order": 15, "type": "text", "bbox": { "l": 35.76, "t": 356.16, "r": 392.16, "b": 330.48 }, "text": "Appropriate precautions will be taken to avoid any data breach. In the event a data breach occurs involving information you provide in connection with the wellness program, we will notify you as soon as it is feasible after discovery of the breach.", "reading_order": 14 }, { "id": "p35.16", "order": 16, "type": "text", "bbox": { "l": 42, "t": 326.64, "r": 390.96, "b": 300.48 }, "text": "In addition, all medical information obtained through the wellness program will be maintained separate from your personnel records; information stored electronically will be encrypted; and no information you provide as part of the wellness program will be used in making any employment decision.", "reading_order": 15 }, { "id": "p35.17", "order": 17, "type": "heading", "bbox": { "l": 506.4, "t": 293.76, "r": 756.72, "b": 283.92 }, "text": "3. CHIPRA Special Enrollment Provision – Premium Assistance Eligibility", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 16 }, { "id": "p35.18", "order": 18, "type": "text", "bbox": { "l": 41.04, "t": 289.68, "r": 392.4, "b": 215.52 }, "text": "Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness program. You will not be asked or required to waive the confidentiality of your health information as a condition of participating in the wellness program or receiving an incentive. Anyone who receives your information for purposes of providing you services as part of the wellness program will abide by the same confidentiality requirement. The only individuals who may receive your personally identifiable health information are persons employed by Castlight (KEHP's wellness administrator) and Anthem (KEHP's third-party medical administrator). This may include nurses in Anthem's disease management program or health coaches. Disclosure of your personally identifiable health information to these persons is necessary in order to provide you with", "children": [ { "id": "p35.18.1", "order": 19, "type": "link", "bbox": { "l": 127.383, "t": 241.164, "r": 167.95, "b": 231.668 }, "text": "kehp.ky.gov", "attrs": { "uri": "http://kehp.ky.gov", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 17 }, { "id": "p35.19", "order": 20, "type": "text", "bbox": { "l": 401.28, "t": 279.84, "r": 757.92, "b": 255.36 }, "text": "If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your new dependent(s). However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.", "reading_order": 18 }, { "id": "p35.20", "order": 21, "type": "text", "bbox": { "l": 404.64, "t": 226.32, "r": 756.96, "b": 170.16 }, "text": "If you decline enrollment for yourself or your eligible dependent(s) (including your spouse) because of other health insurance or group health plan coverage (regardless of whether the coverage was obtained inside or outside of a Marketplace), you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents' other coverage). However, you must request enrollment within 30 days after your or your dependents' other coverage ends (or after the employer stops contributing toward the other coverage).", "reading_order": 19 }, { "id": "p35.21", "order": 22, "type": "text", "bbox": { "l": 48, "t": 210.48, "r": 392.88, "b": 170.88 }, "text": "disclose any of your personal information either publicly or to your employer, except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies you that is provided in connection with the wellness program will not be provided to your supervisors or managers and may never be used to make decisions regarding your employment.", "reading_order": 20 }, { "id": "p35.22", "order": 23, "type": "text", "bbox": { "l": 49.44, "t": 172.08, "r": 389.04, "b": 155.28 }, "text": "that does not identify any individual in order to design programs based on health risks\nthe workplace and that are aimed at improving the health of KEHP members. KEHP will nev", "reading_order": 21 }, { "id": "p35.23", "order": 24, "type": "text", "bbox": { "l": 37.68, "t": 165.12, "r": 760.8, "b": 74.64 }, "text": "Under the Health Insurance Portability and Accountability Act (HIPAA), you have “special enrollment” rights\nif you have a loss of other coverage or you gain a new dependent. In addition, you may qualify for a special\nenrollment in KEHP under the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA).\nunable to meet a standard to earn an incentive under the LivingWell wellness program, you may request a reasonable accommodation or an alternative standard. Contact the Department of Employee Insurance, Member Services Branch at (888) 581-8834 or (502) 564-6534 and we will work with you (and, if you wish, with your doctor) to find a wellness program with the same incentive that is right for you in light of your health status.", "children": [ { "id": "p35.23.1", "order": 25, "type": "link", "bbox": { "l": 456.367, "t": 113.164, "r": 496.934, "b": 103.668 }, "text": "kehp.ky.gov", "attrs": { "uri": "http://kehp.ky.gov", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 22 }, { "id": "p35.24", "order": 26, "type": "text", "bbox": { "l": 39.84, "t": 160.32, "r": 390.96, "b": 120.72 }, "text": "Protections from Disclosure of Medical Information: KEHP is required by law to maintain the privacy and security of your personally identifiable health information. KEHP does not collect or retain personal health or medical information through its LivingWell wellness program unless it is part of an audit, compliance, payment, operations, or customer service review; however, KEHP may receive and use aggregate information that does not identify any individual in order to design programs based on health risks", "reading_order": 23 }, { "id": "p35.25", "order": 27, "type": "heading", "bbox": { "l": 586.32, "t": 122.16, "r": 756.24, "b": 112.08 }, "text": "A. NOTICE ABOUT SPECIAL ENROLLMENT RIGHTS", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 24 }, { "id": "p35.26", "order": 28, "type": "text", "bbox": { "l": 408.24, "t": 107.52, "r": 756.48, "b": 74.4 }, "text": "As a member of the Kentucky Employees' Health Plan (KEHP), you have certain legal rights. Several of those rights are summarized below. Please read these provisions carefully. To find out more information, you may contact the Department of Employee Insurance, Member Services Branch at (888) 581-8834 or (502) 564-6534 or visit kehp.ky.gov.", "reading_order": 25 }, { "id": "p35.27", "order": 29, "type": "link", "bbox": { "l": 575.685, "t": 61.284, "r": 616.252, "b": 51.788 }, "text": "kehp.ky.gov", "attrs": { "uri": "http://kehp.ky.gov", "action_type": "/URI" }, "reading_order": 26 }, { "id": "p35.28", "order": 30, "type": "heading", "bbox": { "l": 613.44, "t": 58.8, "r": 754.56, "b": 35.04 }, "text": "Legal Notices", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 27 } ] }, { "document_id": 13522, "page": 36, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 13, "counts_by_type": { "footer": 1, "heading": 5, "link": 2, "text": 5 }, "build_ms": 3, "items": [ { "id": "p36.1", "order": 1, "type": "heading", "bbox": { "l": 33.6, "t": 536.88, "r": 327.6, "b": 527.52 }, "text": "E. NEWBORNS' AND MOTHERS' HEALTH PROTECTION ACT OF 1996 (NEWBORNS' ACT)", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 0 }, { "id": "p36.2", "order": 2, "type": "text", "bbox": { "l": 33.12, "t": 522.48, "r": 386.88, "b": 465.36 }, "text": "Under federal law, group health plans generally may not restrict benefits for a hospital stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 (or 96, as applicable) hours. In any case, health insurance plans may not require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 (or 96) hours.", "reading_order": 1 }, { "id": "p36.3", "order": 3, "type": "heading", "bbox": { "l": 34.08, "t": 460.56, "r": 125.04, "b": 451.92 }, "text": "F. HIPAA PRIVACY NOTICE", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 2 }, { "id": "p36.4", "order": 4, "type": "text", "bbox": { "l": 33.12, "t": 446.4, "r": 390.96, "b": 365.04 }, "text": "KEHP gathers and collects demographic information about its members such as name, address, and social security numbers. This information is referred to as individually identifiable health information and is protected by HIPAA and related privacy and security regulations. HIPAA requires KEHP to maintain the privacy of your protected health information (PHI) and notify you following a breach of unsecured PHI. In addition, KEHP is required to provide to its members a copy of its Notice of Privacy Practices (NPP) outlining how KEHP may use and disclose your PHI to carry out treatment, payment, or health care operations, or for any other purposes that are permitted or required by law. The NPP also informs members about their rights regarding their PHI and how to file a complaint if a member believes their rights have been violated. KEHP's Notice of Privacy Practices and associated forms may be obtained by visiting kehp.ky.gov (Resources/Docs, Forms, and Legal Notices link).", "children": [ { "id": "p36.4.1", "order": 5, "type": "link", "bbox": { "l": 35.68, "t": 374.864, "r": 76.2473, "b": 365.368 }, "text": "kehp.ky.gov", "attrs": { "uri": "http://kehp.ky.gov", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 3 }, { "id": "p36.5", "order": 6, "type": "heading", "bbox": { "l": 33.12, "t": 360.72, "r": 355.68, "b": 351.6 }, "text": "G. KEHP PRESCRIPTION DRUG COVERAGE AND MEDICARE-NOTICE OF CREDITABLE COVERAGE", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 4 }, { "id": "p36.6", "order": 7, "type": "text", "bbox": { "l": 32.88, "t": 346.56, "r": 390.24, "b": 313.2 }, "text": "KEHP has determined that KEHP's prescription drug coverage is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.", "reading_order": 5 }, { "id": "p36.7", "order": 8, "type": "heading", "bbox": { "l": 33.6, "t": 309.36, "r": 302.64, "b": 300 }, "text": "H. NOTICE OF AVAILABILITY OF SUMMARY OF BENEFITS AND COVERAGE (SBC)", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 6 }, { "id": "p36.8", "order": 9, "type": "text", "bbox": { "l": 33.12, "t": 294.48, "r": 390.96, "b": 205.68 }, "text": "As an employee or retiree, the health benefits available to you represent a significant component of your compensation/retirement package. Those benefits also provide important protection for you and your family in the case of illness or injury. KEHP offers a variety of health coverage options, and choosing the option that is right for you and your family is an important decision. To help you make an informed health coverage choice, KEHP publishes a Summary of Benefits and Coverage (SBC). For easier comparison, the SBC summarizes important information about your health coverage options in a standard format. The SBCs are only a summary. You should consult KEHP's Summary Plan Descriptions and Medical Benefit Booklets to determine the governing contractual provisions of the coverage. KEHP's SBCs are available on KEHP's website at kehp.ky.gov (Resources/Docs, Forms, and Legal Notices link). A paper copy is also available, free of charge, by contacting the Department of Employee Insurance, Member Services Branch at (888) 581-8834 or (502) 564-6534.", "children": [ { "id": "p36.8.1", "order": 10, "type": "link", "bbox": { "l": 71.2393, "t": 231.104, "r": 111.807, "b": 221.608 }, "text": "kehp.ky.gov", "attrs": { "uri": "http://kehp.ky.gov", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 7 }, { "id": "p36.9", "order": 11, "type": "heading", "bbox": { "l": 33.6, "t": 201.12, "r": 236.4, "b": 192.48 }, "text": "I. WAIVER HEALTH REIMBURSEMENT ARRANGEMENT (HRA)", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 8 }, { "id": "p36.10", "order": 12, "type": "text", "bbox": { "l": 33.36, "t": 186.96, "r": 390.72, "b": 33.84 }, "text": "If an employer participates in the Waiver Health Reimbursement Arrangement (HRA) program through KEHP, an employee may elect to waive KEHP health insurance coverage and choose a Waiver HRA that is funded by the employer, up to $2,100 a year. There are two Waiver HRA options: the Waiver General Purpose HRA and the Waiver Limited Purpose HRA. An employee is eligible for the Waiver General Purpose HRA only if the employee, and the employee's spouse and dependents, if applicable, have other group health plan coverage. An employee that elects a Waiver General Purpose HRA must attest that the employee and, if applicable, the employee's spouse and dependents are enrolled in another group health plan that provides minimum value. A \"group health plan\" refers to coverage provided by an employer, an employer organization, or a union. A \"group health plan\" does not include individual policies purchased through the Marketplace or governmental plans such as TRICARE, Veteran's Benefits, Medicare, or Medicaid. A group health plan that provides \"minimum value\" means the plan pays at least 60% of the total allowed cost of covered benefits/services and participants or members in the plan are required to pay no more than 40% of the total allowed cost of covered benefits/services. An employee that elects a Waiver General Purpose HRA and that ceases to be covered under another group health plan that provides minimum value is required to notify KEHP within 30 days of the date that the other group health plan coverage ceased. In this event, coverage under the Waiver General Purpose HRA will be terminated, and the employee may elect a KEHP health insurance plan option or the Waiver Limited Purpose HRA. Each employee is permitted to permanently opt out of and waive future reimbursements from the Waiver General Purpose HRA at least annually during open enrollment.", "reading_order": 9 }, { "id": "p36.11", "order": 13, "type": "footer", "bbox": { "l": 35.04, "t": 29.04, "r": 46.56, "b": 21.36 }, "text": "36", "attrs": { "block_label": "number" }, "reading_order": 10 } ] }, { "document_id": 13522, "page": 37, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 14, "counts_by_type": { "footer": 1, "list": 1, "list_item": 9, "text": 2, "title": 1 }, "build_ms": 3, "items": [ { "id": "p37.1", "order": 1, "type": "title", "bbox": { "l": 34.56, "t": 576.96, "r": 354.24, "b": 555.12 }, "text": "KEHP Tobacco Use Declaration", "attrs": { "block_label": "doc_title" }, "level": 2, "reading_order": 0 }, { "id": "p37.2", "order": 2, "type": "text", "bbox": { "l": 33.12, "t": 536.88, "r": 755.76, "b": 465.84 }, "text": "The Commonwealth of Kentucky is committed to fostering and promoting wellness and health in the workforce. As part of KEHP's LivingWell wellness program, KEHP offers a monthly discount in health insurance premium contribution rates for non-tobacco users. You are eligible for the non-tobacco-user premium contribution rates provided you certify, during the health insurance enrollment process, that you or any other person over the age of 18 to be covered under your plan has not regularly used tobacco within the past six months. \"Regularly\" means tobacco has been used four or more times per week on average excluding religious or ceremonial uses. \"Tobacco\" means all tobacco products including, but not limited to, cigarettes, pipes, chewing tobacco, snuff, dip, cigars, and any other tobacco products regardless of the method of use. \"KEHP Health Insurance Enrollment Application\" refers to any method of enrolling in KEHP health insurance coverage including submitting a paper application, completing and submitting an application online, or enrolling in KEHP health insurance coverage through an online enrollment system such as KHRIS.", "reading_order": 1 }, { "id": "p37.3", "order": 3, "type": "text", "bbox": { "l": 33.6, "t": 460.56, "r": 728.16, "b": 439.92 }, "text": "Whether you complete your KEHP health insurance enrollment online or submit a paper application, you are required to certify that all attestations regarding tobacco use are accurate. By completing the enrollment process, you certify the following:", "reading_order": 2 }, { "id": "p37.4", "order": 4, "type": "list", "bbox": { "l": 32.88, "t": 434.64, "r": 757.44, "b": 106.32 }, "text": "", "attrs": { "item_count": 9 }, "children": [ { "id": "p37.4.1", "order": 5, "type": "list_item", "bbox": { "l": 33.36, "t": 434.64, "r": 724.32, "b": 404.4 }, "text": "I have truthfully answered all questions in my KEHP Health Insurance Enrollment Application regarding tobacco use by me, my spouse, and my dependents 18 years of age and over. My KEHP Health Insurance Enrollment Application accurately reflects the use of tobacco products in the past six months regarding myself and persons to be covered as a spouse or dependent under my insurance plan.", "marker": "1.", "reading_order": 0 }, { "id": "p37.4.2", "order": 6, "type": "list_item", "bbox": { "l": 33.6, "t": 398.88, "r": 715.68, "b": 378.24 }, "text": "If I am completing my KEHP Health Insurance Enrollment Application during open enrollment, I understand that the tobacco-user premium contribution rates will apply beginning January 1, 2025, if I answered \"Yes\" to the tobacco use question.", "marker": "2.", "reading_order": 1 }, { "id": "p37.4.3", "order": 7, "type": "list_item", "bbox": { "l": 33.12, "t": 372.96, "r": 751.92, "b": 342 }, "text": "If I am completing my KEHP Health Insurance Enrollment Application as a newly hired employee, I understand that the tobacco-user premium contribution rates will apply beginning on the first day of the second month after my hire date, if I answered \"Yes\" to the tobacco use question for non-commonwealth paid employees and up to the first day of hire for commonwealth paid employees.", "marker": "3.", "reading_order": 2 }, { "id": "p37.4.4", "order": 8, "type": "list_item", "bbox": { "l": 33.36, "t": 337.2, "r": 739.68, "b": 315.84 }, "text": "I understand that it is my responsibility to notify KEHP of any changes in my tobacco use or that of my spouse or a dependent covered under my insurance plan, including notification to KEHP if all tobacco users become ineligible for coverage or are otherwise terminated during the Plan Year. Notification shall be made by completing a Tobacco Use Change Form.", "marker": "4.", "reading_order": 3 }, { "id": "p37.4.5", "order": 9, "type": "list_item", "bbox": { "l": 32.88, "t": 310.8, "r": 754.56, "b": 270 }, "text": "I understand that if I or a spouse or dependent to be covered under my insurance plan currently use tobacco products and stop using tobacco products during the Plan year, I will be eligible for the discount non-tobacco premium contribution rates on the first day of the month following the signature date on the Tobacco Use Change Form certifying that neither I nor my spouse/dependent(s) regularly used tobacco products during the six months prior to completion of the Tobacco Use Change Form. Both cross-reference planholders must sign the Tobacco Use Change Form.", "marker": "5.", "reading_order": 4 }, { "id": "p37.4.6", "order": 10, "type": "list_item", "bbox": { "l": 33.84, "t": 265.2, "r": 757.44, "b": 234.72 }, "text": "I understand that if I answered \"No\" to the tobacco use question, and either I or a spouse or dependent covered under my insurance plan becomes a regular tobacco user at any time, I must notify KEHP and my contribution rates will be adjusted to the tobacco-user premium contribution rates on the first day of the month following the signature date on the Tobacco Use Change Form.", "marker": "6.", "reading_order": 5 }, { "id": "p37.4.7", "order": 11, "type": "list_item", "bbox": { "l": 33.84, "t": 229.2, "r": 752.88, "b": 198.24 }, "text": "I understand that the tobacco use question is a part of my KEHP application for health insurance coverage. Any person who knowingly, and with the intent to defraud, files an application for insurance containing any materially false information, or who conceals, for the purpose of misleading, information concerning any fact material to the application, commits a fraudulent insurance act which is a crime.", "marker": "7.", "reading_order": 6 }, { "id": "p37.4.8", "order": 12, "type": "list_item", "bbox": { "l": 33.6, "t": 193.44, "r": 739.44, "b": 161.76 }, "text": "I understand that if I fail to answer the tobacco use questions truthfully, KEHP may adjust my contribution rates retroactively to apply the applicable higher tobacco-user premium contribution rates. Upon written notification, I will pay to KEHP the difference between the tobacco-user and the non-tobacco user premium contribution rates for the period for which I falsely certified eligibility for the non-tobacco user premium contribution rates.", "marker": "8.", "reading_order": 7 }, { "id": "p37.4.9", "order": 13, "type": "list_item", "bbox": { "l": 32.88, "t": 157.68, "r": 756.48, "b": 106.32 }, "text": "The KEHP offers monthly discounted premium contribution rates to non-tobacco users as a part of its LivingWell wellness program. Each KEHP member has at least one opportunity per Plan Year to qualify for the discount. KEHP is committed to helping you achieve your best health. Rewards for participating in a wellness program are available to all employees. If you think you might be unable to meet a standard for a reward under this wellness program, you might qualify for an opportunity to earn the same reward by different means. Contact the Department of Employee Insurance at (888) 581-8834 or (502) 564-6534 and we will work with you (and, if you wish, with your doctor) to find a wellness program with the same reward that is right for you in light of your health status.", "marker": "9.", "reading_order": 8 } ], "reading_order": 3 }, { "id": "p37.5", "order": 14, "type": "footer", "bbox": { "l": 745.44, "t": 30.48, "r": 756.96, "b": 21.36 }, "text": "37", "attrs": { "block_label": "number" }, "reading_order": 4 } ] }, { "document_id": 13522, "page": 38, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 25, "counts_by_type": { "header": 1, "heading": 1, "list": 3, "list_item": 11, "text": 8, "title": 1 }, "build_ms": 11, "items": [ { "id": "p38.1", "order": 1, "type": "header", "bbox": { "l": 745.2, "t": 591.36, "r": 756.48, "b": 581.52 }, "text": "38", "attrs": { "block_label": "number" }, "level": 2, "reading_order": 0 }, { "id": "p38.2", "order": 2, "type": "list", "bbox": { "l": 40.56, "t": 568.32, "r": 758.88, "b": 477.36 }, "text": "", "attrs": { "item_count": 3 }, "children": [ { "id": "p38.2.1", "order": 3, "type": "list_item", "bbox": { "l": 40.56, "t": 534.96, "r": 390.48, "b": 494.64 }, "text": "HRA CARRYOVER. Waiver HRAs: Unused amounts up to and including $2,100 remaining in your Waiver HRA at the end of the Plan Year may be carried over to the next Plan Year provided you are eligible to elect an HRA. CDHP Integrated HRAs: Unused amounts up to and including $7,500 remaining in your CDHP Integrated HRA at the end of the Plan Year may be carried over to the next Plan Year. You must elect the same type of HRA in a subsequent Plan Year for the funds to carry over.", "marker": "O.", "reading_order": 0 }, { "id": "p38.2.2", "order": 4, "type": "list_item", "bbox": { "l": 404.88, "t": 568.32, "r": 758.88, "b": 519.84 }, "text": "DEDUCTION FROM EARNINGS. When you enroll in insurance coverage (health, dental, vision, or life) or an FSA, you authorize your employer to deduct from your earnings the amount required to cover your employee contribution to the FSA and insurance coverage you elected, including any arrears you may owe. Deductions for FSA and the employee contributions to health, dental, and vision insurance are made on a pre-tax basis unless you sign a Post-Tax Request Form. Deductions for life insurance premiums are made on a post-tax basis.", "marker": "H.", "reading_order": 1 }, { "id": "p38.2.3", "order": 5, "type": "list_item", "bbox": { "l": 40.56, "t": 489.6, "r": 391.68, "b": 477.36 }, "text": "; Waiver General Purpose HRA at least annually at open enrollment.", "reading_order": 2 } ], "reading_order": 1 }, { "id": "p38.3", "order": 6, "type": "text", "bbox": { "l": 37.92, "t": 481.92, "r": 392.64, "b": 443.76 }, "text": "to be covered under another group health plan that provides minimum value, you agree to notify KEHP within 30 days of the date that the other group health plan coverage ceased. In this event, coverage under the Waiver General Purpose HRA will be terminated and you may elect a KEHP health insurance plan option or the Waiver Limited Purpose HRA. Unused funds remaining in the Waiver General Purpose HRA upon termination are forfeited. You are permitted to permanently opt out of and waive future reimbursements", "reading_order": 2 }, { "id": "p38.4", "order": 7, "type": "text", "bbox": { "l": 38.88, "t": 465.84, "r": 387.36, "b": 406.08 }, "text": ".arketplace or governmental plans such as TRICARE, Veteran's Benefits, Medicare, or Medicaid. A group health plan that provides “minimum value” means the plan pays at least 60% of the total allowed cost of covered benefits/services and participants or members in the plan are required to pay no more than 40% of the total allowed cost of covered benefits/services. If you elect a Waiver General Purpose HRA and cease to be covered under another group health plan that provides minimum value, you agree to notify KEHP within 30 days of the date that the other group health plan coverage ceased. In this event, coverage under the Waiver General Purpose HRA will be terminated and you may elect a KEHP health insurance plan option", "reading_order": 3 }, { "id": "p38.5", "order": 8, "type": "text", "bbox": { "l": 37.68, "t": 427.68, "r": 389.52, "b": 402 }, "text": "... group mean plan\" does not include individual policies purchased through the\nmental plans such as TRICARE, Veteran's Benefits, Medicare, or Medicaid. A group\nvides \"minimum value\" means the plan has at least one cost of", "reading_order": 4 }, { "id": "p38.6", "order": 9, "type": "list", "bbox": { "l": 38.16, "t": 485.76, "r": 757.44, "b": 376.8 }, "text": "", "attrs": { "item_count": 2 }, "children": [ { "id": "p38.6.1", "order": 10, "type": "list_item", "bbox": { "l": 38.16, "t": 410.16, "r": 389.52, "b": 376.8 }, "text": "WAIVER GENERAL PURPOSE HRA RULES. If you elect a Waiver General Purpose HRA, you declare that you and your spouse and dependents, if applicable, are enrolled in another group health plan that provides minimum value. A \"group health plan\" refers to coverage provided by an employer, an employer organization, or a union. A \"group health plan\" does not include individual policies purchased through the", "marker": "N.", "reading_order": 0 }, { "id": "p38.6.2", "order": 11, "type": "list_item", "bbox": { "l": 402.72, "t": 485.76, "r": 757.44, "b": 444.48 }, "text": "DEPENDENT ELIGIBILITY. You certify that each enrolled dependent meets the dependent eligibility requirements as set forth in the SPDs, MBBs, and CoCs. DEI will require supporting documentation to verify the eligibility of any dependent enrolled or requesting to be enrolled in benefits. Spouses and step-children may be subject to periodic re-verification upon notice to you. Your failure to properly document dependent eligibility will result in the termination of the unverified dependent from your insurance plan(s).", "marker": "F.", "reading_order": 1 } ], "reading_order": 5 }, { "id": "p38.7", "order": 12, "type": "text", "bbox": { "l": 400.56, "t": 439.92, "r": 759.12, "b": 416.4 }, "text": "employment by either spouse/planholder. NOTE: Effective 1/1/2025, there will not be new cross-reference plans offered for newly eligible enrollees. Planholders with existing eligibility for cross-reference plans may have such eligibility extended past 1/1/2025.", "reading_order": 6 }, { "id": "p38.8", "order": 13, "type": "list", "bbox": { "l": 39.12, "t": 429.84, "r": 757.92, "b": 208.08 }, "text": "", "attrs": { "item_count": 6 }, "children": [ { "id": "p38.8.1", "order": 14, "type": "list_item", "bbox": { "l": 406.8, "t": 429.84, "r": 757.2, "b": 374.64 }, "text": "CROSS-REFERENCE. The cross-reference payment option for health insurance may be available to spouses who are both eligible to participate in KEHP and have at least one dependent. If your spouse and you are eligible and elect the cross-reference payment option for health insurance, you are planholders with family coverage. Upon a loss of eligibility by either spouse, the remaining planholder will default to a parent-plus coverage level. The cross-reference payment option ceases upon loss of eligibility or employment by either spouse/planholder. NOTE: Effective 1/1/2025, there will not be new cross-reference plans offered for newly eligible enrollees. Planholders with existing eligibility for cross-reference plans ma", "marker": "E.", "reading_order": 0 }, { "id": "p38.8.2", "order": 15, "type": "list_item", "bbox": { "l": 41.52, "t": 372, "r": 754.32, "b": 326.64 }, "text": "THIRD PARTY ADMINISTRATORS. DEL uses third parties, including Anthem, CVS/Caremark, HealthEquity, Castlight, SmartShopper, and Metropolitan Life Insurance Company (MetLife) to provide certain administrative functions. DEI may communicate with you directly or through these third parties about your insurance coverage, your benefits, or health-related products or services provided by or included in the Commonwealth's group health, dental, vision, or life insurance plans.", "marker": "D.", "reading_order": 1 }, { "id": "p38.8.3", "order": 16, "type": "list_item", "bbox": { "l": 39.6, "t": 371.28, "r": 389.52, "b": 314.4 }, "text": "WAIVING HEALTH INSURANCE COVERAGE. If you elect to waive KEHP health insurance coverage, with a without a Waiver Health Reimbursement Arrangement (HRA), you are doing so voluntarily. If your employer participates in the Waiver HRA program, there are two options available: the Waiver General Purpose HRA and the Waiver Limited Purpose HRA. You understand that you will be eligible for the Waiver General Purpose HRA only if you have other group health plan coverage. You further understand that your spouse and eligible dependents, if applicable, cannot be covered under the Waiver General Purpose HRA unless your spouse and dependents also have other group health plan coverage.", "marker": "M.", "reading_order": 2 }, { "id": "p38.8.4", "order": 17, "type": "list_item", "bbox": { "l": 402.24, "t": 324.24, "r": 757.92, "b": 250.32 }, "text": "PLAN INFORMATION. You have read and understood the 2025 Benefits Selection Guide (BSG). Plan rules and limitations are contained in the KEHP Summary Plan Descriptions (SPD) or Medical Benefit Booklets (MBB) and the Summary of Benefits and Coverage (SBC). Life, dental, and vision insurance rules and limitations are outlined in Certificates of Coverage (CoC). All benefits for your eligible dependents and you will be provided in accordance with the rules and limitations in the SPDs, MBBs, BSG, SBCs, and CoCs. You will abide by all terms and conditions governing participation, membership, and receipt of services from the plan(s) in which you have enrolled and as set forth in the SPD, MBB, and CoC. In the event of a conflict between the terms of coverage stated in the SPDs, the MBBs, the BSG, the SBCs, and the CoCs, the terms of coverage stated in the SPDs or MBBs and CoCs will govern.", "marker": "C.", "reading_order": 3 }, { "id": "p38.8.5", "order": 18, "type": "list_item", "bbox": { "l": 39.12, "t": 317.76, "r": 748.8, "b": 251.76 }, "text": "HEALTHEQUITY HEALTHCARE CARD. HealthEquity will administer FSAs and HRAs for the 2025 Plan Year and will issue a HealthEquity Healthcare Card to you for the payment of eligible Healthcare FSA and HRAA expenses. Your HealthEquity Healthcare Card will be suspended if requested claim verification is not sent to HealthEquity within ninety (90) days after the card swipe. You agree to follow all rules and guidelines established by the Plan concerning the HealthEquity Healthcare Card. The Plan reserves the right to deny access to the card, require repayment, deduct/withhold from your paycheck, and offset your Healthcare FSA or HRA if you fail to verify a claim.", "marker": "L.", "reading_order": 4 }, { "id": "p38.8.6", "order": 19, "type": "list_item", "bbox": { "l": 40.08, "t": 248.16, "r": 390.96, "b": 208.08 }, "text": "reimburse you for eligible expenses that are incurred during the subsequent Plan Year. You may use the Healthcare FSA carry over amounts whether or not you elect a Healthcare FSA for the subsequent Plan Year. Amounts over $640 remaining in your Healthcare FSA at the end of the Plan Year are forfeited. All funds remaining in a Healthcare FSA account where there have been no new contribution elections for two consecutive Plan Years will be forfeited.", "reading_order": 5 } ], "reading_order": 7 }, { "id": "p38.9", "order": 20, "type": "text", "bbox": { "l": 60, "t": 208.56, "r": 389.04, "b": 174.72 }, "text": "K. HEALTHCARE FSA ELECTION AND CARRYOVER. You may elect to contribute up to $3,200 into a Healthcare FSA for Plan Year 2025 to pay for eligible health care expenses not paid for by your health insurance plan. Unused amounts of at least $50 and up to a maximum of $640 remaining in your Healthcare FSA at the end of the Plan Year will carry over to the next Plan Year and may be used to", "reading_order": 8 }, { "id": "p38.10", "order": 21, "type": "heading", "bbox": { "l": 410.16, "t": 177.12, "r": 753.84, "b": 166.32 }, "text": "A. PLAN YEAR. The 2025 Plan Year begins January 1, 2025 and ends at midnight on December 31, 2025.", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 9 }, { "id": "p38.11", "order": 22, "type": "text", "bbox": { "l": 39.36, "t": 170.88, "r": 389.28, "b": 104.16 }, "text": "J. CHILD AND ADULT DAYCARE FSA ELECTION AND CARRYOVER. If you choose a Child and Adult Daycare FSA, you are eligible to seek reimbursement, as authorized by 26 U.S.C. Sections 21 and 129, for dependent care expenses. You may elect to contribute up to $2,500 (or $5,000 in the case of an Employee who is married and filing jointly) into a Child and Adult Daycare FSA for Plan Year 2025. The Child and Adult Daycare FSA may only reimburse eligible dependent care expenses that are incurred during the applicable coverage period. Funds in your Child and Adult Daycare FSA may only be used to reimburse eligible child and adult daycare expenses and may not be refunded upon termination of the FSA for any reason. Funds contributed into a Child and Adult Daycare FSA will not carryover to the next plan year.", "reading_order": 10 }, { "id": "p38.12", "order": 23, "type": "text", "bbox": { "l": 405.36, "t": 161.04, "r": 754.8, "b": 97.44 }, "text": "An Employee and Retiree (where applicable) may affix a signature to a paper copy of the KEHP Health Insurance Enrollment Application, the Group Life Insurance Application, the Group Dental or Vision Applications, or an electronic version of the applications. By typing your name on an electronic application or by logging in and using your unique KHRIS User ID and enrolling through the Employee Self-Service portal, you are agreeing to conduct enrollment in life, health, dental, and vision insurance coverage by electronic means, thereby creating a legal and binding contract, as well as consenting to receiving any and all records or disclosures in electronic form at the election of DEI or your employer as described in Section 4A below. By affixing your signature in either manner, you understand and agree that:", "reading_order": 11 }, { "id": "p38.13", "order": 24, "type": "text", "bbox": { "l": 38.88, "t": 120, "r": 768.72, "b": 73.44 }, "text": "ald Retiree (Wiere applicable) may allx a sagiature to a paper copy of title KEHP Healtil\n\nthe Group Dental or Vision\n\nsome on an electronic application\nI. PRIORITY OF PAYMENTS. Any moneys submitted to DEI that you intend to be used to fund your FSA or pay for insurance premium contributions may first be used to pay other priority debts that may be due and owing, such as taxes and child support.", "reading_order": 12 }, { "id": "p38.14", "order": 25, "type": "title", "bbox": { "l": 530.64, "t": 56.64, "r": 754.56, "b": 34.8 }, "text": "Terms and Conditions", "attrs": { "block_label": "doc_title" }, "level": 2, "reading_order": 13 } ] }, { "document_id": 13522, "page": 39, "width": 792, "height": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 792, "height_pt": 612, "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 19, "counts_by_type": { "footer": 1, "link": 1, "list": 2, "list_item": 13, "text": 1, "title": 1 }, "build_ms": 4, "items": [ { "id": "p39.1", "order": 1, "type": "title", "bbox": { "l": 34.56, "t": 577.2, "r": 262.08, "b": 554.88 }, "text": "Terms and Conditions", "attrs": { "block_label": "doc_title" }, "level": 2, "reading_order": 0 }, { "id": "p39.2", "order": 2, "type": "list", "bbox": { "l": 33.12, "t": 537.12, "r": 391.92, "b": 222 }, "text": "", "attrs": { "item_count": 8 }, "children": [ { "id": "p39.2.1", "order": 3, "type": "list_item", "bbox": { "l": 33.12, "t": 537.12, "r": 385.2, "b": 486.72 }, "text": "WAIVER HRA/FSA FUNDS AFTER TERMINATION. You may use funds remaining in a Waiver HRA or FSA after termination to reimburse you for eligible expenses incurred during the coverage period and prior to termination of the HRA or FSA. Upon termination of employment, including retirement, the remaining amounts in a Waiver HRA and FSA are forfeited, except that you may be reimbursed for any eligible expenses incurred prior to the last day of the last pay period worked, provided that you file a claim by March 31 following the close of the Plan Year in which the expense was incurred.", "marker": "P.", "reading_order": 0 }, { "id": "p39.2.2", "order": 4, "type": "list_item", "bbox": { "l": 33.12, "t": 482.88, "r": 389.28, "b": 424.8 }, "text": "HRA AND FSA EXPENSE REIMBURSEMENT. An HRA and/or Healthcare FSA may only reimburse you for medical expenses, as authorized by 26 U.S.C. Sections 105(b) and 213(d), that are incurred during the applicable coverage period. Federal law now permits you to use your HealthEquity card to pay for over-the-counter (OTC) medications, drugs, menstrual care products, and certain personal protective equipment such as face masks, hand sanitizer, and sanitizing wipes. The Waiver Limited Purpose HRA may only reimburse you for eligible dental and vision expenses. If you have an FSA and an HRA, funds for eligible expenses will be reimbursed from your FSA first before being reimbursed from your HRA.", "marker": "Q.", "reading_order": 1 }, { "id": "p39.2.3", "order": 5, "type": "list_item", "bbox": { "l": 33.12, "t": 420.96, "r": 384.72, "b": 403.2 }, "text": "HRA AND FSA RUN-OUT PERIOD. You have a 90-day run-out period (until March 31) for reimbursement of eligible FSA and HRA expenses incurred during the period of coverage.", "marker": "R.", "reading_order": 2 }, { "id": "p39.2.4", "order": 6, "type": "list_item", "bbox": { "l": 33.12, "t": 398.88, "r": 387.12, "b": 365.04 }, "text": "MINIMUM ESSENTIAL COVERAGE. KEHP provides plan options that, under the Affordable Care Act, constitute minimum essential coverage that is affordable and provides a minimum value. As such, by receiving an offer of coverage through your employer, neither you, your spouse, nor your dependent(s) are eligible for a health insurance premium tax credit if purchasing insurance through the Marketplace.", "marker": "S.", "reading_order": 3 }, { "id": "p39.2.5", "order": 7, "type": "list_item", "bbox": { "l": 33.12, "t": 360.72, "r": 383.76, "b": 335.52 }, "text": "COORDINATION OF KEHP HEALTH PLANS AND MEDICARE COVERAGE. In general, the three KEHP plan options and the Waiver General Purpose HRA must pay primary to Medicare. The Waiver Limited Purpose HRA pays secondary to Medicare.", "marker": "T.", "reading_order": 4 }, { "id": "p39.2.6", "order": 8, "type": "list_item", "bbox": { "l": 33.36, "t": 331.2, "r": 390.72, "b": 297.6 }, "text": "LIVINGWELL PROMISE. Federal law allows KEHP to reward members who participate in the KEHP's LivingWell wellness program. In 2025, all four KEHP health plans are a part of the KEHP's LivingWell wellness program and require completion of the LivingWell Promise in order to receive premium discounts in Plan Year 2026.", "marker": "U.", "reading_order": 5 }, { "id": "p39.2.7", "order": 9, "type": "list_item", "bbox": { "l": 33.36, "t": 293.28, "r": 370.08, "b": 267.84 }, "text": "If you fulfilled your LivingWell Promise in 2024, you will receive a monthly premium discount of up to $40.00 in 2025. If you did not fulfill your LivingWell Promise, you will not receive a monthly premium discount in 2025.", "reading_order": 6 }, { "id": "p39.2.8", "order": 10, "type": "list_item", "bbox": { "l": 33.12, "t": 263.04, "r": 391.92, "b": 222 }, "text": "If you elect a KEHP health plan in 2025, you must complete a Health Assessment provided by Castlight between January 1, 2025, and July 1, 2025, to receive a premium discount in 2026. If you are a new employee with a hire date after January 1, 2025 and you choose a LivingWell plan option outside of open enrollment, you will not be required to complete the LivingWell Promise to receive the premium discount in 2026.", "reading_order": 7 } ], "reading_order": 1 }, { "id": "p39.3", "order": 11, "type": "list", "bbox": { "l": 33.12, "t": 217.44, "r": 390.72, "b": 45.6 }, "text": "", "attrs": { "item_count": 5 }, "children": [ { "id": "p39.3.1", "order": 12, "type": "list_item", "bbox": { "l": 33.36, "t": 217.44, "r": 383.52, "b": 167.28 }, "text": "INSURANCE DEPENDENT ELECTIONS AND PREMIUM REFUND. It is your responsibility to timely notify DEI that either your dependent or your spouse is no longer eligible for life insurance coverage. (See the eligibility provisions CoC for more information on eligibility). “Timely” notice means that you advised DEI that a dependent or spouse is no longer eligible for insurance coverage within 90 days of the loss of eligibility. Upon notice that a dependent or spouse is no longer eligible for insurance coverage, DEI will refund your premium back to the date that eligibility ceased, up to a maximum of 90 days.", "marker": "V.", "reading_order": 0 }, { "id": "p39.3.2", "order": 13, "type": "list_item", "bbox": { "l": 33.36, "t": 163.44, "r": 371.52, "b": 121.2 }, "text": "HIPAA. You have rights under HIPAA regarding the protection of your health information. KEHP will comply with the HIPAA Privacy and Security rules, and uses and disclosures of your protected health information will be in accordance with federal law. KEHP may use and disclose such information to business associates or other third parties only in accordance with KEHP's Notice of Privacy Practices available at kehp.ky.gov (Resources/Docs, Forms, and Legal Notices link).", "marker": "W.", "children": [ { "id": "p39.3.2.1", "order": 14, "type": "link", "bbox": { "l": 75.3193, "t": 131.224, "r": 115.887, "b": 121.728 }, "text": "kehp.ky.gov", "attrs": { "uri": "http://kehp.ky.gov", "action_type": "/URI" }, "reading_order": 0 } ], "reading_order": 1 }, { "id": "p39.3.3", "order": 15, "type": "list_item", "bbox": { "l": 36, "t": 117.28399999999999, "r": 372.7629, "b": 107.78800000000001 }, "text": "FRAUD WARNING. Any person who knowingly, and with the intent to defraud, files an application for insurance containing any materially false information", "marker": "X.", "reading_order": 2 }, { "id": "p39.3.4", "order": 16, "type": "list_item", "bbox": { "l": 33.36, "t": 108.36, "r": 375.12, "b": 99.6 }, "text": "ACKNOWLEDGEMENT. You have fully read these Terms and Conditions, the KEHP Legal Notices, and the KEHP Tobacco Use Declaration. Your signature on the KEHP Health Insurance Enrollment Application, the Group Dental or Vision Applications, the Group Life Insurance Application, or your electronic signature used for online enrollment certifies that all information provided during this enrollment opportunity is correct to the best of your knowledge.", "marker": "Y.", "attrs": { "bbox_estimated": true }, "reading_order": 3 }, { "id": "p39.3.5", "order": 17, "type": "list_item", "bbox": { "l": 33.12, "t": 95.28, "r": 390.72, "b": 45.6 }, "text": "(including a forged signature or incorrect signature date), or conceals, for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act which is a crime. You can be held responsible for any fraudulent act that you could have prevented while acting within your duties related to obtaining employer-sponsored health, dental, vision, and life insurance, and it may be used to reduce or deny a claim or to terminate your coverage. Information contained in your life insurance benefit elections, if incorrect or misleading, may void the policy effective as of the date of issuance.\nZ. EXCEPTIONS MAY APPLY. Exceptions may apply to employees of certain employers participating in KEHP's health plan and the Commonwealth's group dental, vision, and life insurance benefits. Exceptions may also apply to TRS, KPPA, KCTCS, LRP, and JRP retirees. Please refer to the participation rules of your employer or retirement system for further information.", "reading_order": 4 } ], "reading_order": 2 }, { "id": "p39.4", "order": 18, "type": "text", "bbox": { "l": 398.88, "t": 452.88, "r": 756, "b": 354.96 }, "text": "AA. CONSENT TO ELECTRONIC DISCLOSURES. You consent to receiving any and all communications, including records, disclosures, or coverage information (or any portion of the same) in electronic form, including by email or through KHRIS, at the election of DEI, the Insurance Coordinator/Human Resource Generalist communicating on DEI's behalf, or a vendor utilized by DEI or your employer for the administration of your insurance benefits. You may still receive paper documents from time to time, or may be required to complete and sign paper documents. You also acknowledge that you may print or save any electronic communication or agreement for your records and later review. You must have access to a computer and web browser that is sufficiently up to date to access the KEHP/KHRIS website and access to an email that accepts external email. You may request a paper copy of any electronic record or disclosure by contacting your employer's insurance coordinator. A fee may be charged for each paper copy. 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