Accessible HTML version

This page is an accessible HTML version of the PDF enrollment guide for State of Kansas employees and non-state employer groups. The content is organized with headings, lists, and data tables for easier screen-reader and keyboard navigation.

Source note: This HTML is based on the uploaded PDF and is intended as an accessible content version. The legal plan document (Benefit Description) governs in the event of any discrepancy.

What’s New

Action required:

  • Annual Open Enrollment period is October 1-31, 2025.
  • This is an Active Enrollment Year. All covered members must enroll for Plan Year 2026.
  • Members who have waived coverage will remain waived unless an enrollment is completed.

Changes for Plan Year 2026 (Open Enrollment begins October 1):

  • Rates for PY 2026: Employee rates will increase 2% effective 1/1/2026. Employer rates will increase 8% effective 7/1/2026. The rate chart appears in the rates section below.
  • Plan A: Deductible increases to $1,000 single and $2,000 family. Specialist office visit copay increases from $40 to $60.
  • Plans C and N: For coverage with dependents, the first deductible for an individual within the family becomes $3,400 to meet IRS regulation. The total family deductible remains $5,500.
  • Dental: Employee-only dental remains fully employer-paid. Dependent dental rates increase by 3.3%.
  • Dependent Care FSA: Maximum allowable contribution rises from $5,000 to $7,500.
  • GLP-1 anti-obesity medications: For prior authorizations issued or renewed on or after 1/1/2026, members must have a BMI of 35 or higher.
  • Flexible Spending Accounts: MetLife was awarded a three-year contract to manage FSAs. Options include healthcare FSA, dependent care FSA, limited purpose FSA, parking FSA, and mass transit FSA.

Helpful Tips

Online help

The SEHP website has additional information about your benefits package.

Need technical support?

Call the SEHP MAP Help Desk at 800-832-5337 from Oct. 1-31, 2025, Monday-Friday, 7 a.m. to 5 p.m. CT. After hours, email techsupport@hrissuite.com. Include your name, phone number, and an explanation of the issue.

Summary of Benefits and Coverage

The Summary of Benefits and Coverage (SBC) for each medical plan is available on the SEHP website. It explains how you and the plan share the cost of covered healthcare services. For complete terms, review the SEHP Benefit Description.

Acronyms

  • Flexible Spending Account (FSA)
  • Health Reimbursement Account (HRA)
  • Health Savings Account (HSA)
  • Membership Administration Portal (MAP)
  • Non State Employee Group (NSE)
  • Out of Pocket Maximum (OOP)
  • Preferred Provider Organization (PPO)
  • Qualified High Deductible Health Plan (QHDHP)
  • State Employee Health Plan (SEHP)
  • State of Kansas (SOK)
  • Summary of Benefits & Coverage (SBC)

Online references

Finding Answers

Ask your HR representative

SEHP works closely with state agencies’ HR representatives to provide accurate and helpful benefits information.

SEHP website

The SEHP website includes detailed Benefit Descriptions and ALEX, a tool for estimating out-of-pocket expenses under different plans.

Ask ALEX

ALEX walks you through available benefits, explains how they work, and helps compare health plan options based on your circumstances.

Contact SEHP

More ways to get information

SEHP offers webinars, in-person meetings, and Benefits Fairs. Dates and locations are available on the SEHP website.

Benefits fair dates

  • October 1, 2025, 9 a.m. - 1:30 p.m., Capitol Grounds South Steps. In case of inclement weather, the fair moves to the Capitol 1st Floor Rotunda.
  • October 15, 2025, 9 a.m. - 1:30 p.m., Capitol 1st Floor Rotunda.

Eligibility and Enrollment

Eligible employees

Newly hired or newly eligible employees have 31 days from their first day of work to elect and submit benefit elections. If you miss the deadline, you must wait until the next Open Enrollment unless you experience a qualifying event.

Eligible dependents

You may elect coverage for your lawful spouse and/or child(ren) or stepchild(ren) under age 26.

Dependent documentation

When enrolling dependents in SEHP for the first time, upload relationship documentation through the MAP Member Portal:

  • Spouses: marriage license
  • Children: birth certificate or hospital announcement

Documentation must be scanned and uploaded as a PDF. The upload section appears at the bottom of the member and family screen in the MAP Member Portal.

Adding a newborn

SEHP automatically covers a newborn child of a covered member for the first 31 days from the date of birth. Coverage ends after that unless a request to add the newborn is submitted in the MAP Member Portal within 31 days, along with required documentation.

Qualifying events

If a primary member is enrolled on a pre-tax basis, a qualifying event is required for a mid-year coverage change. Recognized qualifying events include:

  • Marriage or divorce
  • Birth or adoption of a dependent
  • Death of a spouse or dependent
  • Gain or loss of group benefits for a spouse or dependent

A change must be consistent with the family status change and requested within 31 days of the event. Supporting documentation must be uploaded in MAP.

In the event of divorce, coverage for a former spouse and stepchild(ren) ends on the last day of the month in which the divorce is final. If the divorce is final on the first of the month, coverage ends on the last day of the previous month. A final divorce decree must be uploaded with the change request.

How to enroll

First-time users and password resets

  • Use Register Now if it is your first time or you forgot your password.
  • Use Sign In if you have already registered and know your password.

Enrollment process

  1. Open the Enrollments & Events tab to begin Plan Year 2026 enrollment.
  2. Confirm and submit benefit elections.
  3. A pending elections statement will be sent to your registered email.

You can log in as many times as needed during the enrollment period. Elections submitted by 11:59 p.m. on Oct. 31, 2025 become effective Jan. 1, 2026. Elections should be viewable in MAP by Dec. 31, 2025.

Use a personal email if possible in case you lose access to your state or business email.

Default or continuation rules

  • Medical coverage: All active SOK and NSE employees currently enrolled must re-enroll for 2026. If they do not, medical coverage defaults to Plan N with the current carrier and an HRA for employer contributions.
  • Voluntary prescription eyewear insurance only: Current members remain enrolled for 2026.
  • Dental only: Current members remain enrolled for 2026.
  • Voluntary benefits only: Current members remain enrolled for 2026.
  • FSAs: Members must enroll annually to keep the account active.
  • Waived benefits: Members remain waived.

Premium Assistance Program

The HealthyKIDS Program is a premium assistance initiative for eligible State of Kansas employees only. It helps subsidize premiums for dependent children under age 18 who are enrolled in SEHP. HealthyKIDS is not the KanCare or Medicaid program.

  • Eligibility depends in part on household income.
  • Annual application is required.
  • If applying mid-year due to a qualifying event, the application must be received within 31 days of the event.
  • Review the income guideline chart on the SEHP website.
  • To apply, log into MAP, open Enrollments & Events, and use the HealthyKIDS link in the green box at the bottom of the page.
  • Include monthly income for everyone living in the household.
  • If approved, dependent child premiums are adjusted to current HealthyKIDS premiums shown in the rate chart.

ALEX

www.myalex.com/kansassehp

ALEX is an online tool that guides you through available benefits, explains how they work, and helps compare health plan options based on your circumstances.

  1. Select basic options such as how many people will be covered and what kinds of medical claims you expect. Answers stay confidential.
  2. ALEX explains benefits, crunches the numbers, and makes recommendations based on your situation.
  3. Print or save your ALEX selections, then complete enrollment in the MAP Member Portal. You can also rerun ALEX with a different scenario.

ALEX is an educational tool. It is not an application for enrollment, and you still must complete your elections in the MAP Member Portal.

Personalized help

  • Contact the vendor using the customer service numbers in the contacts section.
  • Visit the SEHP website.
  • Contact SEHP at (785) 368-6361 or SEHPBenefits@ks.gov.
  • Non State Employer Group members may also speak with their benefits representative.

Medical Plans

Medical plan highlights

  • Plan A - traditional PPO plan
  • Plan C - QHDHP
  • Plan N - QHDHP
  • Plan J - meets requirements for J-1 Visa employees

All medical plans include prescription drug coverage, telemedicine options, and preferred lab benefits.

Medical plan coverage is provided through both Aetna and Blue Cross and Blue Shield of Kansas. Review each vendor’s provider network to determine the best access for you and your family.

  • Preventive services are covered at 100% of the allowed charge when using a network provider.
  • Prescription drug benefits are provided through CVS Caremark.
  • Preferred lab benefits are provided through QuestSelect, Stormont Vail Health, and The University of Kansas Health System.
  • Telehealth services are available through both medical provider networks and the HealthQuest Health Center.
  • The HealthQuest Health Center in downtown Topeka is available to anyone age 2 and older who is enrolled in Plans A, C, J, or N.

Blue Cross Blue Shield of Kansas

  • www.bcbsks.com/sok
  • All areas: 800-332-0307
  • Topeka: (785) 291-4185
  • Lucet - Behavioral Health: 800-952-5906
  • Lucet - Autism: Topeka (785) 233-1165; all areas 877-563-9347, option 2

Aetna

Plan A - Traditional PPO plan

Plan A uses a participating provider network. Costs are lower in network, but you may use non-network doctors, hospitals, and providers. Deductible, coinsurance, and copays apply until the out-of-pocket maximum is met. Network and non-network accumulators are separate. Preventive care is covered at 100% in network. Non-network providers may bill above the allowed charge, and you are responsible for those excess amounts. Prescription drugs have first-dollar coverage subject to coinsurance. Plan A members are not eligible for HealthQuest reward dollars, but they may earn the annual premium incentive discount.

Plan A benefit summary
Benefit summary Network Non-network
Deductible - Individual / Family $1,000 / $2,000 $1,000 / $2,000
Coinsurance (paid by member) 20% 50%
Out-of-pocket maximum - Individual / Family $5,250 / $10,500 $5,250 / $10,500
Preventive care $0 Deductible + coinsurance
Office visits - Primary care / Specialist / Urgent care / Telehealth / HealthQuest Health Center $20 / $60 / $50 / $10 / $0 Deductible + coinsurance
Emergency room visits $100 copay + deductible + coinsurance (copay waived if admitted within 24 hours) $100 copay + network deductible + 20% coinsurance* (copay waived if admitted within 24 hours)
Diagnostic lab services when using preferred lab providers 100% Deductible + coinsurance

* Must be a medical emergency; otherwise the non-network deductible and coinsurance apply.

Plan A prescription drug benefits
Tier Prescription type Paid by member
1 Generic 20% coinsurance
2 Preferred brand name 35% coinsurance
3 Specialty medications (see PrudentRx Solutions Program) 30% coinsurance
4 Non-preferred brand name 60% coinsurance
5 Discount tier 100% of discounted prescription cost
6 Anticancer oral 20% coinsurance - maximum of $100 per standard unit of therapy or 30-day supply
7 Special case 40% coinsurance to a maximum of $100 per standard unit of therapy or 30-day supply
Value Based Diabetes - Generic 10% coinsurance; maximum of $20 per 30-day supply
Value Based Diabetes - Preferred brand 20% coinsurance; maximum of $40 per 30-day supply
Value Based Asthma - Generic 10% coinsurance; maximum of $20 per 30-day supply
Value Based Asthma - Preferred brand 20% coinsurance; maximum of $40 per 30-day supply
Plan A semi-monthly rates for State of Kansas active employees (full time)
Coverage tier Rate
Employee only $40.70
Employee + spouse $242.02
Employee + child(ren) $129.09
Employee + family $423.71

If you have qualified for the full HealthQuest Rewards Program premium incentive discount, subtract $20 per pay period from the rates above. Non State members should check with their HR office for premium rates. HealthQuest reward dollars are not available for Plan A.

Plans C and N - Qualified High Deductible Health Plans

These plans usually have lower monthly premiums, but you pay the deductible before the plan starts to pay, except for eligible preventive care. A QHDHP can be combined with an HSA or HRA. Covered services are paid by the member until the deductible is met. After that, the member pays coinsurance until the out-of-pocket maximum is met. Once the OOP is met, covered services are paid at 100% of the allowed charge when received from a network provider. Network and non-network accumulators are separate. Non-network providers may bill above the allowed charge. Employees enrolled in Plans C and N are eligible to earn HealthQuest reward dollars and the annual premium incentive discount.

Plan C and Plan N benefit summary
Benefit summary Plan C network Plan C non-network Plan N network Plan N non-network
Deductible - Individual / Family $2,750* / $5,500 $2,750* / $5,500 $2,750* / $5,500 $2,750* / $5,500
Coinsurance (paid by member) 10% 50% 35% 50%
Out-of-pocket maximum - Individual / Family $4,500 / $9,000 $4,500 / $9,000 $6,650 / $13,300 $6,650 / $13,300
Preventive care $0 Deductible + coinsurance $0 Deductible + coinsurance
Office visits - Primary care / Specialist / Urgent care / Telehealth Deductible + coinsurance Deductible + coinsurance Deductible + coinsurance Deductible + coinsurance
HealthQuest Health Center $40**   $40**  
Emergency room visits Deductible + coinsurance Network deductible + coinsurance*** Deductible + coinsurance Network deductible + coinsurance***
Diagnostic lab services when using preferred lab providers Deductible then covered at 100% Deductible + coinsurance Deductible then covered at 100% Deductible + coinsurance

* For employee plus dependent coverage, an individual within the family has a $3,400 deductible; the overall family deductible remains $5,500. ** $40 fee until the deductible has been met, then services are covered at 100%. *** Must be a medical emergency; otherwise the non-network deductible and coinsurance apply.

Plans C and N prescription drug benefits
Tier Prescription type Paid by member
1 Generic Deductible then 20% coinsurance
2 Preferred brand name Deductible then 35% coinsurance
3 Specialty medications (see PrudentRx Solutions Program) Deductible then 30% coinsurance
4 Non-preferred brand name Deductible then 60% coinsurance
5 Discount tier 100% of discounted prescription cost
6 Anticancer oral Deductible then 20% coinsurance
Plan C and Plan N semi-monthly rates for State of Kansas active employees (full time)
Coverage tier Plan C Plan N
Employee only $35.90 $23.72
Employee + spouse $126.16 $85.99
Employee + child(ren) $66.32 $44.80
Employee + family $212.50 $153.17

Employees earning the required number of HealthQuest credits may receive the premium incentive discount and up to $500 in HRA/HSA reward dollars.

Plan J

Plan J meets federal requirements for employees with J-1 Visas, but it is available to all members. Services are paid by the member until the deductible is met. After that, the plan shares costs through coinsurance until the OOP is met. Network and non-network accumulators are separate. Preventive care is covered at 100% in network. Plan J includes an HRA. Employees on Plan J are eligible to earn HealthQuest reward dollars and an annual premium incentive discount.

Plan J benefit summary
Benefit summary Network Non-network
Deductible - Individual / Family $500 / $1,000 $1,000 / $2,000
Coinsurance (paid by member) 25% 50%
Out-of-pocket maximum - Individual / Family $7,350 / $14,700 $10,000 / $20,000
Preventive care $0 Deductible + coinsurance
Office visits - Primary care / Specialist / Urgent care / Telehealth Deductible + coinsurance Deductible + coinsurance
HealthQuest Health Center $40*  
Emergency room visits Deductible + coinsurance Network deductible + coinsurance**
Diagnostic lab services when using preferred lab providers Deductible then covered at 100% Deductible + coinsurance

* $40 fee until the deductible has been met, then services are covered at 100%. ** Must be a medical emergency; otherwise the non-network deductible and coinsurance apply.

Plan J prescription drug benefits
Tier Prescription type Paid by member
1 Generic Deductible then 20% coinsurance
2 Preferred brand name Deductible then 35% coinsurance
3 Specialty medications (see PrudentRx Solutions Program) Deductible then 30% coinsurance
4 Non-preferred brand name Deductible then 60% coinsurance
5 Discount tier 100% of discounted prescription cost
6 Anticancer oral Deductible then 20% coinsurance
Plan J semi-monthly rates for State of Kansas active employees (full time)
Coverage tier Rate
Employee only $53.61
Employee + spouse $156.45
Employee + child(ren) $93.10
Employee + family $268.05

Employees earning the required number of HealthQuest credits may receive the premium incentive discount and up to $500 in HRA/HSA reward dollars.

Medical plan benefits summary
Benefit type Plan A Plan C Plan N Plan J
Network deductible $1,000 single / $2,000 family $2,750 single / $3,400/$5,500 family* $2,750 single / $3,400/$5,500 family* $500 single / $1,000 family
Network coinsurance 20% 10% 35% 25%
Network OOP maximum $5,250 single / $10,500 family $4,500 single / $9,000 family $6,650 single / $13,300 family $7,350 single / $14,700 family
Non-network deductible $1,000 single / $2,000 family $2,750 single / $3,400/$5,500 family* $2,750 single / $3,400/$5,500 family* $1,000 single / $2,000 family
Non-network coinsurance 50% 50% 50% 50%
Non-network OOP maximum $5,250 single / $10,500 family $4,500 single / $9,000 family $6,650 single / $13,300 family $10,000 single / $20,000 family

* For employee plus family member coverage, an individual within the family has a $3,400 deductible and the overall family deductible is $5,500. Network and non-network OOP maximums accumulate separately. Non-network providers may bill above allowed charges.

General comparison chart for selected medical services
Medical service Plan A network Plan A non-network Plans C/J/N network Plans C/J/N non-network
Inpatient services Deductible + coinsurance Deductible + coinsurance Deductible + coinsurance Deductible + coinsurance
Emergency room visit $100 copay + deductible + coinsurance (copay waived if admitted within 24 hours) $100 copay + network deductible + 20% coinsurance (copay waived if admitted within 24 hours)* Network deductible + coinsurance Network deductible + coinsurance*
Mental health (mental illness, alcoholism, drug abuse, substance abuse) Same coverage as medical services Same coverage as medical services Same coverage as medical services Same coverage as medical services
Autism services (subject to limitations and preapproval) Deductible + coinsurance Deductible + coinsurance Deductible + coinsurance Deductible + coinsurance
Hearing aids ($5,000 maximum per 3 years) Deductible + coinsurance Deductible + coinsurance Deductible + coinsurance Deductible + coinsurance
PCP office visit $20 copayment Deductible + coinsurance Deductible + coinsurance Deductible + coinsurance
Specialist $60 copayment Deductible + coinsurance Deductible + coinsurance Deductible + coinsurance
Urgent care $50 copayment Deductible + coinsurance Deductible + coinsurance Deductible + coinsurance
Telehealth $10 copayment Deductible + coinsurance Deductible + coinsurance Deductible + coinsurance
HealthQuest Health Center $0 N/A $40 until deductible met, then $0 N/A
Well woman exam Covered in full Deductible + coinsurance Covered in full Deductible + coinsurance
Well man exam Covered in full Deductible + coinsurance Covered in full Deductible + coinsurance
Well baby and child Covered in full Deductible + coinsurance Covered in full Deductible + coinsurance
Vision visit (first visit of year, regardless of diagnosis) Covered in full Deductible + coinsurance Covered in full Deductible + coinsurance
Routine hearing exam Covered in full Deductible + coinsurance Covered in full Deductible + coinsurance
Colonoscopy Covered in full Deductible + coinsurance Covered in full Deductible + coinsurance
Mammogram Covered in full Deductible + coinsurance Covered in full Deductible + coinsurance
Preventive lab Covered in full Deductible + coinsurance Covered in full Deductible + coinsurance
Immunizations Covered in full Covered in full to age six, otherwise deductible + coinsurance Covered in full Covered in full to age six, otherwise deductible + coinsurance

* Must be a medical emergency; otherwise the non-network deductible and coinsurance apply.

Prescription Drug Benefits

When you elect medical coverage, you automatically receive prescription drug coverage through CVS Caremark. The cost is included in the health plan rates. The Preferred Drug List is the same for all plans, but your share of cost depends on the plan you choose.

  • Customer Service / Caremark Connect: 800-294-6324
  • TDD: 800-863-5488
  • Specialty Pharmacy: 800-237-2767
  • PrudentRx: 800-578-4403
  • Website: www.caremark.com

After creating an account at Caremark, you can find the Preferred Drug List under Plan and Benefits and use the Check Drug Cost tool.

Specialty medicine

Specialty and biotech drugs are available exclusively through CVS Caremark Specialty Pharmacy. CVS Caremark works with PrudentRx to enroll members in manufacturer copay assistance programs.

  • Members on Plan A may receive specialty medications at no cost when using PrudentRx.
  • Members on Plans C, J, and N may receive specialty medicine at no cost once the deductible has been met.

Prescription savings

Rx Savings Solutions is a free service for SEHP members that helps identify lower-cost prescription options.

Preferred Lab Benefits

The Preferred Lab Benefit is included with all SEHP medical plans and is offered through QuestSelect, Stormont Vail Health, and The University of Kansas Health System.

The benefit is voluntary. If you use another lab, lab coverage still exists through your medical plan, but normal plan benefits apply.

Preferred lab vendor benefits

  • Plan A: Covered outpatient lab services are paid at 100% of the allowable charge when using a preferred lab vendor.
  • Plans C, J, and N: After the deductible is met, covered outpatient lab services are paid at 100% of the allowed charge when using a preferred lab vendor.

QuestSelect

  • www.questselect.com
  • Phone: 800-646-7788
  • Collection sites throughout Kansas and nationwide
  • Present your Quest card or SEHP medical ID card and request Preferred Lab Benefits
  • Bring required lab orders from your physician
  • Your doctor’s office can arrange specimen pickup using the number on the Quest ID card
  • Create a My Quest account to receive lab results online

Stormont Vail Health / Cotton O’Neil

  • www.stormontvail.org
  • Phone: 800-637-4716
  • Topeka: (785) 354-1150
  • You do not have to be a Cotton O’Neil patient to use specified locations
  • Bring required lab orders before you go to the lab
  • Present your SEHP medical plan ID card
  • All Cotton O’Neil patients can have blood drawn at their own physician’s office
  • Create a MyChart account to receive lab results online

The University of Kansas Health System

  • www.kansashealthsystem.com/lab
  • Phone: 866-358-5227
  • Several locations are available in northeast Kansas
  • You do not have to be a patient to use specified locations
  • Same-day collection and testing and walk-in services are available; no appointment is necessary
  • Bring required lab orders before you go
  • Present your SEHP medical plan ID card
  • Create a MyChart account to review lab results online

Dental

The SEHP dental plan is provided through Delta Dental of Kansas.

The single dental plan offers two coverage levels:

  • Enhanced benefit if you received at least one dental exam or cleaning in the past 12 months.
  • Basic benefit if you did not receive at least one dental exam or cleaning in the past 12 months.

New enrollees automatically receive the enhanced benefit for their first 12 months. Delta Dental PPO and Delta Dental Premier networks are both available. Highest benefit levels are available through Delta Dental PPO. Non-network providers may bill above the allowed charge.

Dental benefits summary
Service / network option Delta Dental PPO Delta Dental Premier Non-network
Enhanced benefit - Diagnostic & preventive services 100% 100% 100%*
Enhanced benefit - Basic restorative services 80% 60% 60%*
Enhanced benefit - Major restorative services 50% 50% 50%
Enhanced benefit - Implant coverage 50% 50% 50%*
Basic benefit - Diagnostic & preventive services 100% 100% 100%*
Basic benefit - Basic restorative services 50% 50% 50%*
Basic benefit - Major restorative services 40% 30% 30%*
Basic benefit - Implant coverage 40% 30% 30%*
Dental plan limits
Annual benefit maximum Deductible Orthodontia lifetime benefit maximum
$2,000 per member $50 per person per plan year (family max $150); deductible does not apply to diagnostic and preventive services 50% coinsurance up to $1,500 per member
Plan Year 2026 dental semi-monthly rates for State of Kansas active employees (full time)
Employee only Employee + spouse Employee + child(ren) Employee + family
$0.00 $10.30 $8.24 $18.57

* Non-network dentists may charge above the allowed charge. This is a summary only; the Benefit Booklet and contract govern coverage.

Voluntary Prescription Eyewear Insurance

SEHP members can choose between two Surency voluntary prescription eyewear plans: Basic and Enhanced.

Surency also offers discounts through Glasses.com, ContactsDirect.com, and EyeMed.

Voluntary prescription eyewear insurance semi-monthly rates
Coverage tier Basic Enhanced
Employee only $1.94 $3.88
Employee + spouse $3.99 $7.89
Employee + child(ren) $3.61 $7.12
Employee + family $5.57 $11.04
Enhanced plan progressive lenses
Progressive type In-network member cost (includes lens copay)
Standard progressive $25 copay
Premium progressive - Tier 1 $25 copay
Premium progressive - Tier 2 $25 copay
Premium progressive - Tier 3 $25 copay
Premium progressive - Tier 4 $25 copay, $165 allowance

Note: Regardless of reason or diagnosis, your first eye visit each year is covered at 100% if you are enrolled in an SEHP medical plan and use a network provider. Present your medical ID card at the visit. If you are not enrolled in an SEHP medical plan, the voluntary prescription eyewear plan covers an eye exam.

Prescription eyewear benefits summary
Service or item Basic plan: network Enhanced plan: network Non-network
Eye exam, M.D. or O.D. (subject to $50 copayment) Covered in full after copayment Covered in full after copayment Up to $38*
Frame (subject to $25 materials copayment) Up to $100 retail* Up to $150 retail* Basic: up to $45*; Enhanced: up to $78*
Single vision lens, pair Covered in full after copayment Covered in full after copayment Up to $31*
Bifocal lenses, pair Covered in full after copayment Covered in full after copayment Up to $51*
Trifocal lenses, pair Covered in full after copayment Covered in full after copayment Up to $64*
Lenticular lenses, pair Covered in full after copayment Covered in full after copayment Up to $80*
Progressive lenses, pair Not covered See tier chart above Not covered
High index lenses, pair Not covered Covered up to $116 retail* Not covered
Polycarbonate lenses, pair Member pays up to $40 Covered in full Not covered
Scratch coat Member pays up to $15 Covered in full Not covered
UV coat Member pays up to $15 Covered in full Not covered
Elective/cosmetic retail contact lenses Covered up to $150 retail* Covered up to $150 retail* Covered up to $105*
When medically necessary contact lenses Covered in full Covered in full Covered up to $105*
Standard contacts (contact lens exam fitting fee: $35 copayment) Covered in full after copayment Covered in full after copayment Not covered
Specialty contacts 10% off retail price minus $55 allowance 10% off retail price minus $55 allowance Not covered
Frequency - Eye exam Covered once every calendar year    
Frequency - Frames Covered once every calendar year    
Frequency - Frame lenses Covered once every calendar year unless contact lenses have been elected    
Frequency - Contact lenses Covered once every calendar year unless frame lenses have been elected    

* You are responsible for charges above the allowance. ** Standard contacts fit and up to two follow-up visits after a comprehensive exam. *** Specialty contacts fit and up to two follow-up visits after a comprehensive exam.

Voluntary Benefits

MetLife offers three supplemental voluntary insurance plans to SEHP members: Accident, Critical Illness, and Hospital Indemnity.

Non State Group Members should check with their employer about availability.

Accident insurance

MetLife pays benefits directly to you, not the healthcare provider. More than 150 covered injuries are included, such as fractures, eye injuries, and broken teeth.

Critical illness insurance

MetLife pays a lump sum directly to you for covered serious conditions such as cancer, stroke, and heart attack. More than 30 critical conditions are covered.

Hospital indemnity insurance

Provides a direct lump-sum payment if you or a family member becomes hospitalized. Two plans are available: Low Plan and High Plan. Covered services include admissions for hospital stays and inpatient rehabilitation benefits.

Questions About Claims

If you have questions or concerns about claims:

  • Read the Benefit Description for a detailed summary of benefits, limitations, rights, appeals, and grievances.
  • Review the provider network for each plan to confirm provider access.
  • Call the customer service number on the back of your insurance card.
  • Have claim notices and Explanation of Benefits documents ready.
  • Document calls, dates, notes, and written correspondence.

SEHP does not process individual claims, but Health Plan Operations can help mediate between you and your insurance provider. Contact SEHPBenefits@ks.gov or (785) 368-6361.

Flexible Spending Accounts

Flexible Spending Accounts (FSAs) through MetLife let you use pre-tax dollars to pay for eligible out-of-pocket expenses, including deductibles, copays, dependent or adult day care, and commuting costs such as mass transit and work parking.

Five account types are available: Healthcare, Limited Purpose, Parking, Dependent Care, and Mass Transit. Elections are made each October for the upcoming plan year and take effect January 1.

The maximum allowable contribution to a Dependent Care FSA increased from $5,000 to $7,500.

Employees who terminate coverage mid-year have 90 days after contributions end or employment terminates to submit claims for expenses incurred while coverage was active.

Flexible spending account payroll limits - State employees only
Category Healthcare FSA Limited Purpose FSA Dependent Care Commuter FSAs
IRS maximum total $3,400 $3,400 Family maximum $7,500 Monthly maximum $340 for each account
Employee bi-weekly payroll deduction Minimum $8.00; Maximum $141.66 Minimum $8.00; Maximum $141.66 Minimum $16.00; Maximum $312.50* Minimum $8.00; Maximum $170.00
Regent academic year payroll deductions Minimum $8.00; Maximum $188.88 Minimum $8.00; Maximum $188.88 Minimum $16.00; Maximum $416.66* Minimum $8.00; Maximum $170.00

Non State Group Members should contact their employer to confirm whether FSAs are available for their group.

Dependent Care FSA

Allows reimbursement for care of a dependent under age 13 or an adult dependent physically or mentally incapable of self-care. Common expenses include daycare centers, before/after school care, and adult daycare. There is a 75-day grace period to incur expenses, through March 16, 2026, and the deadline to submit 2025 plan-year dependent care claims is April 30, 2026. Funds do not roll over.

Mass Transit FSA

Allows reimbursement for qualified mass transit tickets or passes, or SOK van pools. Unused contributions may carry over to the next calendar year with continued enrollment. Toll fees, including KTAG charges, are not eligible.

Parking FSA

Allows reimbursement for parking costs associated with the daily commute. Unused contributions may carry over with continued enrollment.

Health Care FSA

Allows reimbursement for qualified medical, dental, or vision expenses not covered by insurance, including copays, prescriptions, glasses, dental services, and orthodontics. Up to $680 of unused contributions may carry over to the next calendar year.

Limited Purpose FSA

Allows reimbursement for qualified dental or vision expenses. Available if you participate in an HSA with Plan C or N. Up to $680 of unused contributions may carry over to the next calendar year.

Health Savings Account

An HSA is a personal healthcare bank account that lets you pay qualified out-of-pocket medical expenses with pre-tax dollars. It is available to members enrolled in QHDHP plans, including Plan C and Plan N.

  • You own and administer the HSA.
  • You decide how much to contribute and when to use the funds.
  • HealthQuest rewards may be deposited into your HSA.
  • Unused funds roll over from year to year.
  • The money is always yours, even if you change health plans or jobs.

Eligibility to contribute

  • You must enroll in Plan C or Plan N.
  • You cannot be enrolled in Medicare A or B, Medicaid, or TRICARE.
  • You cannot be claimed as a dependent on another person’s tax return.
  • You may not be enrolled in another health plan that is not a QHDHP.

Employee and employer contributions

  • Plan C requires an employee contribution of $25 per pay period ($50 per month) to receive employer contributions.
  • Plan N does not require an employee contribution to receive employer contributions.
  • Employee contributions are made on a pretax basis.
  • SEHP members age 55 and older may make catch-up contributions of up to $1,000 per year.
  • Once you enroll in Medicare, you can no longer contribute to an HSA.
  • State employees receive employer contributions quarterly; non-state employees receive them monthly.
  • For new employees, employer contributions begin in the calendar quarter following the benefit effective date.

HealthQuest reward dollars count toward annual HSA contribution limits. Employees can earn up to $500 each year in HealthQuest rewards. Changes to employee HSA payroll deductions can be made during the year through MAP and become effective with the next available paycheck.

Employee HSA contributions
Plan and payroll type Full-time employee only Full-time employee / spouse & family Full-time employee / child(ren) Part-time employee only Part-time employee / spouse & family Part-time employee / child(ren)
IRS maximum total $4,400 $8,750 $8,750 $4,400 $8,750 $8,750
Plan C - Employee bi-weekly payroll deductions $25 to $120.83 $25 to $260.41 $25 to $260.41 $25 to $136.45 $25 to $294.27 $25 to $294.27
Plan C - Regent academic year payroll deductions $25 to $161.11 $25 to $347.22 $25 to $347.22 $25 to $181.93 $25 to $392.36 $25 to $392.36
Plan N - Employee bi-weekly payroll deductions $0 to $141.66 $0 to $296.87 $0 to $302.08 $0 to $149.47 $0 to $308.59 $0 to $319.01
Plan N - Regent academic year payroll deductions $0 to $188.88 $0 to $395.83 $0 to $402.77 $0 to $199.30 $0 to $411.45 $0 to $425.34
Employer HSA contributions
Plan Full-time employee only Full-time employee / spouse & family Full-time employee / child(ren) Part-time employee only Part-time employee / spouse & family Part-time employee / child(ren)
IRS maximum total $4,400 $8,750 $8,750 $4,400 $8,750 $8,750
Plan C employer contribution $250 per quarter / $1,000 year $500 per quarter / $2,000 year $500 per quarter / $2,000 year $156.30 per quarter / $625.20 year $296.88 per quarter / $1,187.52 year $296.88 per quarter / $1,187.52 year
Plan N employer contribution $125 per quarter / $500 year $281.25 per quarter / $1,125 year $250 per quarter / $1,000 year $78.15 per quarter / $312.60 year $210.94 per quarter / $843.76 year $148.44 per quarter / $593.76 year

Health Reimbursement Account

An HRA is a tax-advantaged account for employees enrolled in Plans C, J, or N. The State contributes to the account on your behalf, and you can use the funds to pay eligible healthcare expenses. HealthQuest rewards can also be deposited into your HRA.

Key features

  • The HRA does not roll over to the next year.
  • If you terminate employment, your HRA ends.
  • You have 60 days from Dec. 31 to submit claims for eligible expenses incurred during that plan year.
  • If you terminate employment, you have 60 days to file claims for expenses incurred while employed.

Who should elect the HRA?

Employees who cannot contribute to an HSA should elect an HRA instead, including those enrolled in Medicare A or B, TRICARE, claimed as a dependent on another person’s tax return, or simultaneously enrolled in another non-QHDHP health plan.

State employees receive employer HRA contributions quarterly; non-state employees receive them monthly. New employees begin receiving employer contributions in the calendar quarter following the benefit effective date.

Employer HRA contributions
Plan Full-time employee only Full-time employee / spouse & family Full-time employee / child(ren) Part-time employee only Part-time employee / spouse & family Part-time employee / child(ren)
Plan C $250 per quarter / $1,000 year $500 per quarter / $2,000 year $500 per quarter / $2,000 year $156.30 per quarter / $625.20 year $296.88 per quarter / $1,187.52 year $296.88 per quarter / $1,187.52 year
Plan N $125 per quarter / $500 year $281.25 per quarter / $1,125.00 year $250 per quarter / $1,000 year $78.15 per quarter / $312.60 year $210.94 per quarter / $843.76 year $148.44 per quarter / $593.76 year
Plan J HealthQuest rewards earned HealthQuest rewards earned HealthQuest rewards earned HealthQuest rewards earned HealthQuest rewards earned HealthQuest rewards earned

Employees can earn up to $500 each year in HealthQuest rewards. Reward dollars are deposited into the HRA only while you have an active paycheck. No changes were made to employer HRA/HSA contributions for Plans C and N for Plan Year 2026.

HealthQuest Health and Wellness Program

HealthQuest is the State of Kansas health and wellness program for active, benefits-eligible employees and covered spouses.

It offers tools to improve overall health and wellbeing while letting employees earn financial rewards through preventive health activities.

Resources include

  • Health coaching
  • Statewide challenges
  • Weight management program
  • Chronic condition management programs
  • EAP webinars
  • Wellness educational webinars
  • Health education modules
  • Rewards for preventive medical care such as annual physicals, eye exams, dental exams, and flu vaccines

Get started

Covered spouses may participate, but their participation is not required for the employee to earn the premium incentive discount or reward dollars.

Your rewards

HSA/HRA reward dollars are deposited throughout the year as HealthQuest credits are earned and posted. Deposits normally appear in the MetLife HRA or HSA account within 1-2 pay periods.

  • If you earned 40 credits in 2026, you earned the $480 premium incentive discount for plan year 2027.
  • The discount is applied as $20 off each semi-monthly rate, or $40 per month, totaling $480 annually.
  • The SOK payroll deadline for 2026-earned HealthQuest HRA/HSA reward dollars is Nov. 13, 2026.

Plan A HealthQuest rewards

  • Employees employed at least 365 days who earn 20 credits in 2026 receive a partial annual premium incentive discount of $240 in 2027.
  • Employees who earn 40 credits in 2026 receive the full annual premium incentive discount of $480 in 2027.

Plans C, J, and N HealthQuest rewards

  • Employees who earn 40 credits in 2026 receive the annual premium incentive discount of $480 in 2027.
  • Employees also earn $12.50 for each credit, up to 40 credits, for a maximum of $500 in 2026. Funds are deposited into the qualified HRA or HSA account.

Employee Assistance Program (EAP)

The EAP includes eight short-term counseling sessions, legal and financial advice, and referrals from licensed professionals.

  • Available to all active, benefits-eligible SOK employees and NSE groups, their family members living in the same household, and dependent children.
  • Benefits-eligible employees who have been laid off or terminated may use the EAP for six months after layoff.
  • ComPsych phone: 888-270-8897
  • TRS: 711
  • Website: guidanceresources.com
  • App: GuidanceNow
  • Web ID / Company ID: SOKEAP

Rates

Plan Year 2026 semi-monthly rates for State of Kansas active employees
Employee category Plan A Plan C Plan J Plan N Dental Eyewear basic Eyewear enhanced
Full Time - Employee only $40.70 $35.90 $53.61 $23.72 $0.00 $1.94 $3.88
Full Time - Employee + spouse $242.02 $126.16 $156.45 $85.99 $10.30 $3.99 $7.89
Full Time - Employee + children $129.09 $66.32 $93.10 $44.80 $8.24 $3.61 $7.12
Full Time - Employee + family $423.71 $212.50 $268.05 $153.17 $18.57 $5.57 $11.04
All Part Time - Employee only $117.99 $53.67 $66.91 $35.46 $0.00 $1.94 $3.88
All Part Time - Employee + spouse $361.04 $161.36 $183.36 $109.99 $13.00 $3.99 $7.89
All Part Time - Employee + children $204.22 $90.09 $110.98 $60.84 $10.37 $3.61 $7.12
All Part Time - Employee + family $572.90 $256.26 $305.60 $184.70 $23.46 $5.57 $11.04
HealthyKIDS - Employee + children $84.48 $50.36 $81.11 $34.03 $1.83 $3.61 $7.12
HealthyKIDS - Employee + family $316.76 $194.35 $252.47 $140.09 $12.13 $5.57 $11.04

These are base, non-discounted rates. If you qualified for the HealthQuest Rewards Program premium incentive discount, subtract $20 per pay period from the rates above. Non State Group Employees should check with their HR office for premium rates.

Contacts

Eligibility and enrollment

General benefits information

Dental coverage

Flexible spending accounts

Health savings / reimbursement account

HealthQuest

Employee Assistance Program

Medical coverage

  • Aetna - Customer Service / Behavioral Health: www.aetnastateofkansas.com, 866-851-0754
  • Blue Cross Blue Shield of Kansas: www.bcbsks.com/sok, 800-332-0307, Topeka 785-291-4185
  • Lucet - Behavioral Health: 800-952-5906
  • Lucet - Autism: (785) 233-1165 or 877-563-9347 option 2

Prescription coverage and savings

Preferred lab benefit program

Voluntary prescription eyewear insurance

Voluntary benefits