Kansas Administrative Regulations › Agency 108 - STATE EMPLOYEES HEALTH CARE COMMISSION › Article 1 - ELIGIBILITY REQUIREMENTS › Section 108-1-1 - Eligibility

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Definitions. Each of the following terms,
			 as used in this regulation, shall have the meaning specified in this
			 subsection:
(1) "Active participant" means any
			 person enrolled in the health care benefits program.
(2) "Child" means any of the following:
(A) A natural son or daughter of a primary
			 participant;
(B) a lawfully adopted
			 son or daughter of a primary participant. The term "lawfully adopted" shall
			 include those instances in which a primary participant has filed the petition
			 for adoption with the court, has a placement agreement for adoption, or has
			 been granted legal custody;
(C) a
			 stepchild of a primary participant. However, if the natural or adoptive parent
			 of the stepchild is divorced from the primary participant, the stepchild shall
			 no longer qualify;
(D) a child of
			 whom the primary participant has legal custody; or
(E) a grandchild, if at least one of the
			 following conditions is met:
(i) The primary
			 participant has legal custody of the grandchild or has lawfully adopted the
			 grandchild;
(ii) the grandchild
			 lives in the home of the primary participant and is the child of a covered
			 eligible dependent child, and the primary participant provides more than 50
			 percent of the support for the grandchild; or
(iii) the grandchild is the child of a
			 covered eligible dependent child and is considered to reside with the primary
			 participant even when the grandchild or eligible dependent child is temporarily
			 absent due to special circumstances including education of the covered eligible
			 dependent child, and the primary participant provides more than 50 percent of
			 the support for the grandchild.
(3) "COBRA" means the consolidated omnibus
			 budget reconciliation act,  public law 99-272, as amended.
(4) "Commission" means the Kansas state
			 employees health care commission.
(5) "Direct bill participant" means any
			 person enrolled in the health care benefits program pursuant to subsections
			 (d), (e), and (h).
(6) "Eligible
			 dependent child" means any dependent child who meets one of the following
			 criteria:
(A) The child is under 26 years of
			 age.
(B) The child is aged 26 or
			 older, has a permanent and total disability, and has continuously maintained
			 group coverage as an eligible dependent child of the primary participant before
			 attaining the age of 26. The child shall be chiefly dependent on the primary
			 participant for support.
(7) "Health care benefits program" means the
			 state of Kansas health care benefits program established by the
			 commission.
(8) "Permanent and
			 total disability" means that an individual is unable to engage in any
			 substantial gainful activity by reason of any medically determinable physical
			 or mental impairment that can be expected to result in death or has lasted or
			 can be expected to last for a continuous period of at least 12 months. An
			 individual shall not be considered to have a permanent and total disability
			 unless that person furnishes proof of the permanent and total disability in the
			 form and manner, and at the times, that the health care benefits program may
			 require.
(9) "Primary participant"
			 means any person enrolled in the health care benefits program under subsection
			 (b), a direct bill participant under subsection (d), or a COBRA
			 participant.
(10) "Variable-hour
			 employee" means any officer or employee of a state agency for whom, at the date
			 of hire, it cannot be determined that the employee is reasonably expected to
			 work at least 1,000 hours per year.