Kansas Administrative Regulations › Agency 108 - STATE EMPLOYEES HEALTH CARE COMMISSION › Article 1 - ELIGIBILITY REQUIREMENTS › Section 108-1-4 - Local unit of government employee health care benefits plan

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 who is enrolled in the local unit plan.
(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 local unit plan 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) "Local unit" means
			 any of the following:
(A) Any county,
			 township, or city;
(B) any
			 community mental health center;
(C)
			 any groundwater management district, rural water-supply district, or public
			 wholesale water-supply district;
(D) any county extension council or extension
			 district;
(E) any hospital
			 established, maintained, and operated by a city of the first or second class, a
			 county, or a hospital district in accordance with applicable law;
(F)
(i) Any
			 city, county, or township public library created under the authority of K.S.A.
			 12-1215  et seq., and amendments thereto;
(ii) any regional library created under the
			 authority of K.S.A. 12-1231, and amendments thereto;
(iii) any library district created under the
			 authority of K.S.A. 12-1236, and amendments thereto;
(iv) the Topeka and Shawnee county library
			 district established under the authority of K.S.A. 12-1260  et seq., and
			 amendments thereto;
(v) the
			 Leavenworth and Leavenworth county library district established under the
			 authority of K.S.A. 12-1276, and amendments thereto;
(vi) any public library established by a
			 unified school district under the authority of K.S.A. 72-1418, and amendments
			 thereto; or
(vii) any regional
			 system of cooperating libraries established under the authority of K.S.A.
			 75-2547  et seq., and amendments thereto;
(G) any housing authority created pursuant to
			 K.S.A. 17-2337  et seq., and amendments thereto;
(H) any local environmental protection
			 program obtaining funds from the state water fund in accordance with K.S.A.
			 75-5657, and amendments thereto;
(I) any city-county, county, or multicounty
			 health board or department established pursuant to K.S.A. 65205, and amendments
			 thereto;
(J) any nonprofit
			 independent living agency, as defined in K.S.A. 65-5101  and amendments
			 thereto;
(K) the Kansas
			 guardianship program established pursuant to K.S.A. 74-9601  et seq., and
			 amendments thereto; or
(L) any
			 group of persons on the payroll of a county, township, city, special district
			 or other local governmental entity, public school district, licensed child care
			 facility operated by a not-for-profit corporation providing residential group
			 foster care for children and receiving reimbursement for all or part of this
			 care from the department for children and families, nonprofit community mental
			 health center pursuant to K.S.A. 19-4001  et seq. and amendments thereto,
			 nonprofit community facility for people with intellectual disability pursuant
			 to K.S.A. 19-4001  et seq. and amendments thereto, or nonprofit independent
			 living agency as defined in K.S.A. 65-5101  and amendments thereto.
(9) "Local unit employee" means
			 any individual who meets one or more of the following criteria:
(A) The individual is an appointed or
			 elective officer or employee of a qualified local unit whose employment is not
			 seasonal or temporary and whose employment requires at least 1,000 hours of
			 work per year.
(B) The individual
			 is an appointed or elective officer or employee who is employed concurrently by
			 two or more qualified local units in positions that involve similar or related
			 tasks and whose combined employment by the qualified local units is not
			 seasonal or temporary and requires at least 1,000 hours of work per
			 year.
(C) The individual is a
			 member of a board of county commissioners of a county that is a qualified local
			 unit, and the compensation paid for service on the board equals or exceeds
			 $5,000 per year.
(D) The individual
			 is a council member or commissioner of a city that is a qualified local unit,
			 and the compensation paid for service as a council member or commissioner
			 equals or exceeds $5,000 per year.
(10) "Local unit plan" means the local unit
			 employee health care benefits component of the health care benefits
			 program.
(11) "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.
(12) "Primary participant"
			 means any person enrolled in the local unit plan under subsection (b), a direct
			 bill participant under subsection (d), or a COBRA participant.
(13) "Qualified local unit" means a local
			 unit that meets the terms, conditions, limitations, exclusions, and other
			 provisions established by the commission for participation in the local unit
			 employee health care benefits component of the health care benefits program and
			 that has entered into a written agreement with the commission to participate in
			 the program.
(14) "Variable-hour
			 employee" means any local unit employee 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.