Section 2.39.300. Eligibility and coverage.

	(a)  A new law benefit recipient who elects to purchase major medical insurance under AS 14.25.168(d) or AS 39.35.535(c) may purchase that insurance on (1) an individual, (2) an individual plus spouse, (3) an individual plus children, or (4) a family basis, by applying for coverage in accordance with 2 AAC 39.310.  
	(b)  An alternate payee who elects major medical insurance under AS 14.25.168(c), AS 22.25.090(d), or AS 39.35.535(d) may purchase that insurance on an individual or an individual plus children basis.  
	(c)  Individual major medical insurance covers the benefit recipient or alternate payee only. Individual plus spouse major medical insurance covers the benefit recipient and spouse. Individual plus children major medical insurance covers the benefit recipient or alternate payee, and all eligible dependent children. Family major medical insurance covers the benefit recipient, the benefit recipient's spouse, and all eligible dependent children.  
	(d)  A peace officer or firefighter may elect major medical insurance coverage as a disabled member under AS 39.35.535(c)(2)(B), if all of the following apply:  
		(1) the peace officer or firefighter is eligible for normal retirement benefit under AS 39.35.370(a)(2), but has not yet elected normal retirement;  
		(2) the peace officer or firefighter has less than 25 years of credited service as a peace officer or firefighter;  
		(3) the peace officer or firefighter becomes eligible for but has not elected an occupational disability benefit under AS 39.35.410(h);  
		(4) the administrator has determined that the police officer or firefighter is eligible for medical benefits under AS 39.35.535(c)(2)(B).  
	(e)  A peace officer or firefighter may apply to the administrator for a determination of eligibility for medical benefits under AS 39.35.535(c)(2)(B) before employment is terminated. A determination by the administrator finding eligibility for medical benefits under AS 39.35.535(c)(2)(B) is void if the employee fails to terminate employment within 30 days of the date of the determination. Additionally, the following standards apply:  
		(1) A peace officer or firefighter who fails to file an application for medical benefits under AS 39.35.535(c)(2)(B) within the time established by this section forfeits the right to apply, unless the person demonstrates to the administrator there are extraordinary circumstances that prevented the person from meeting the deadline. Extraordinary circumstances may include being adjudged as incompetent or confined to a hospital, but do not include lack of information or mere neglect.  
		(2) If a final determination granting medical benefits under AS 39.35.535(c)(2)(B) is not made in time to pay the benefit when due, a retroactive payment shall be made to cover the period of deferment.  
	(f)  The administrator shall determine eligibility for medical benefits under AS 39.35.535(c)(2)(B) for a peace officer or firefighter who is eligible for but has not elected occupational disability benefits, and appoint the eligible peace officer or firefighter to normal retirement. The administrator requires medical documentation substantiating both the disability and causation. The administrator may require the peace officer or firefighter to provide additional information and to submit to an examination by one or more physicians of the administrator's choosing at the division's expense. Additionally, the following standards apply:  
		(1) A peace officer or firefighter electing medical insurance coverage as a disabled member who is appointed to normal retirement AS 39.35.535(c)(2)(B) must establish eligibility by  
			(A) terminating employment because of the peace officer's or firefighter's  occupational disability; and  
			(B) filing an application for medical benefits under AS 39.35.535(c)(2)(B) within 90 days of the date of termination of employment.  
		(2) Eligibility for medical benefits under AS 39.35.535(c)(2)(B) ceases when a peace officer or firefighter recovers from an occupational injury or illness before reaching age 60. The administrator may, in the administrator's discretion, require a member to submit to an examination by one or more physicians of the administrator's choosing at the division's expense no more frequently than every two years.  

Authorities

14.25.168;22.25.027;22.25.090;39.30.090;39.35.005;39.35.370;39.35.410;39.35.535

Notes

Reference

2 AAC 39.265
2 AAC 39.399

Authority

AS 14.25.168 AS 22.25.027 AS 22.25.090 AS 39.30.090 AS 39.35.005 AS 39.35.370 AS 39.35.410 AS 39.35.535

History

Eff. 2/1/93, Register 125; am 7/9/2010, Register 195