{ "document_id": 13522, "page": 39, "width_pt": 792, "height_pt": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "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 }, { "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." }, { "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." }, { "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." }, { "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." }, { "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." }, { "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." }, { "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." }, { "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." } ] }, { "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." }, { "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" } } ] }, { "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." }, { "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 } }, { "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." } ] }, { "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. You may withdraw consent to obtain electronic records and notices by contacting your employer's insurance coordinator with the request and filling out any necessary form." }, { "id": "p39.5", "order": 19, "type": "footer", "bbox": { "l": 745.44, "t": 30.24, "r": 757.2, "b": 21.36 }, "text": "39", "attrs": { "block_label": "number" } } ], "excluded_furniture": { "first": [], "last": [] } }