Medical Benefits
Your State of Colorado Medical Plan Options
When choosing a medical plan, it's important to consider what you want to cover and the total cost of that coverage. For the same service, you may pay higher costs with one plan than you will with the other. The ideal medical plan should cover most of your health needs and stay within your budget.
The State offers multiple health plan options through Cigna and Kaiser Permanente. Compare Cigna and Kaiser Permanente coverage costs on our plan costs page.
GLP-1 Coverage Change Effective July 1
Effective July 1 2025, coverage of GLP-1s for weight loss will be removed. Employees actively taking GLP-1s for weight loss as of June 30, 2025, will be grandfathered into coverage. On July 1, 2025, their co-pay will increase from $30 to $120. Access the FAQs below as a PDF version.
Frequently Asked Questions
- Why was this change made?
The sustainability and affordability of the State’s benefits program is, and has always been, a key consideration when making budget decisions. Tough decisions were made to remove GLP-1 drug coverage for obesity conditions starting July 1, 2025, due their high cost. However, employees actively taking GLP-1s for weight loss as of June 30, 2025, will be grandfathered into coverage, and their co-pay will increase from $30 to $120 beginning July 1. Current prescribed members will receive communication from either Cigna or Kaiser with additional information and details around how grandfathering works.
We will continue to support our employees efforts to achieve a healthy weight through our award winning STATE OF HEALTH program in addition to a myriad of programs and covered services offered by Cigna and Kaiser. These evidence based programs have a proven track record of success.
Additional information around this change is forthcoming. For questions, employees can reach out to state_benefits@state.co.us.- Does this change impact prescriptions or coverage for GLP-1s for conditions other than weight loss (e.g. Mounjaro or Ozempic for diabetes)?
Coverage is only being removed for GLP-1s for weight loss. Coverage for GLP-1s for conditions other than weight loss, such as diabetes, will continue.
- The copay increase makes these drugs unaffordable for me. Is there a way I can reduce this copay or pay less for these drugs?
Some manufacturers may offer coupon programs that will bring down the costs of these drugs:
- I am not taking GLP-1s for weight loss currently. Can I begin taking them before July 1, 2025, and continue after July 1, 2025?
Employees actively taking GLP-1s for weight loss as of June 30, 2025, will be grandfathered into coverage.
- What other weight loss solutions does the state offer employees?
For more information on the programs below, contact Cigna, Kaiser, or your agency benefits administrator to learn more.
- If I am grandfathered into coverage and I stop taking these medications, will I lose my grandfathered status?
Once you have a gap between prescription fills of more than 120 days, you will lose grandfathered status and will no longer be eligible for GLP-1 coverage for weight loss. Other resources offered by STATE OF HEALTH, Cigna and Kaiser can help you to maintain your healthy lifestyle.
- Can I choose to continue using GLP-1s drugs for weight loss, even if they are not covered by my insurance?
Yes. In this case, you will be responsible for the full cost of the drug.
- What if my doctor wants to change my dosage or change my prescription from one GLP-1 for weight loss to another?
Each insurer has their own guidelines in this area. Please consult with them prior to any changes to your medications.
- If I am enrolled in the HDHP do I have a copay or must I still satisfy my deductible first?
Under the HDHP plan, all non-preventive medicines are first subject to deductible then applicable copay. Your annual deductible must be satisfied first before the $120 copay applies.
- Can I change my medical insurer during open enrollment without jeopardizing my grandfathered status?
Yes. Grandfathered users of GLP-1s for weight loss can change insurers (Cigna and Kaiser) without jeopardizing their grandfathered status.
- Who should I contact if I have questions or concerns about this change?
Kaiser Co-Pilot (888) 413-0591 can answer questions about how grandfathering works and other coverage questions for Kaiser members.
Medimpact (888) 783-1774 can answer questions about how grandfathering works and other coverage questions for Cigna members.
For general questions and concerns, reach out to your agency benefits administrator.
What You Can Expect From Our Medical Plans
These services are available with all medical plans (Cigna and Kaiser Permanente).
Preventive Care Visits
Preventive care visits are always no-cost; they help keep you healthy by screening for and preventing serious medical issues. Annual check-ups, flu shots, immunizations, and some tests and screenings are all examples of preventive care.
Outpatient Mental Wellness
Outpatient mental health services include treatment that takes place in a clinical setting, office, or hospital, but does not involve an overnight stay. These services are 100% covered by the copay medical plans.
Virtual Visits & Telemedicine
Skip the waiting room and speak with a board-certified physician over the phone or on your computer. Phone consultations and online video visits give you direct access to a licensed medical professional.
Cigna members: To schedule an appointment, visit mycigna.com or download the myCigna mobile app.
Kaiser Permanente members: Visit kp.org or download the Kaiser Permanente mobile app.
Choose the Right Place for Care
Need medical attention but it’s not a true emergency? Save time and money by using virtual visits or urgent care. Emergency room costs are expensive, and visits can take hours. Virtual visits and urgent care centers provide quality care just like the ER, but you could save hundreds of dollars and hours of time for non-life-threatening issues.
Non-Life-Threatening
Virtual Visit
Benefits include lower costs, speaking to a doctor from anywhere, and reducing the time you wait to speak to a medical professional.
Reasons to go:
- Headaches
- Fever & flu symptoms
- Cough, cold & sore throat
- Skin irritations & rashes
Primary Care Provider
Benefits include in-person examinations, low in-network pricing, and the familiarity of a regular personal care provider.
Everside Health offers a high-quality, cost-effective, advanced primary care solution for our Cigna members. Benefits include standard one-hour appointment windows, no-cost preventive care and chronic condition management, and more. Visit our Everside Health page to learn more.
Reasons to go:
- Fever & flu symptoms
- Cough, cold & sore throat
- Earaches and infections
- Preventive care
- Headaches
- Regular treatment for chronic conditions
- Abdominal pain
- Skin irritations & rashes
Urgent Care Center
Benefits include lower costs than an emergency room visit and there are often same-day visits available.
Reasons to go:
- Earaches & infections
- Minor cuts, bumps, sprains & burns
- Fever & flu symptoms
- Allergic reactions
- Animal bites
- Mild asthma
- Headaches
- Urinary tract infections
- Back & joint pain
Life-Threatening
Emergency Room (ER)
ERs are necessary for life-threatening conditions.
Reasons to go:
- Sudden numbness or weakness
- Disorientation or difficulty speaking
- Seizure or loss of consciousness
- Severe cuts or burns
- Overdoses
- Uncontrolled bleeding
- Coughing or vomiting blood
- Heart attack or chest pain
Questions?
Have questions about your State benefits package? Contact your agency's benefits administrator.