Plan Documents, Legal Notices & COBRA

On this page, you'll find plan documents and legal notices related to your employee benefits package as well as important Health Insurance Portability and Accountability Act (HIPAA) and COBRA information.

Plan Documents (FY 2022-23)

Group Benefits Plan (Governing provisions for the State of Colorado Benefits Plan.) 

Medical

Cigna Copay Basic Plan Benefits Summary & Summary Plan Description (legal document)

Cigna Copay Plus Plan Benefits Summary & Summary Plan Description (legal document)

Cigna HDHP Benefits Summary & Summary Plan Description (legal document)

Cigna Preventive Drugs List

Cigna Annual Compliance Rider (legal document)

Cigna Extraterritorial Legislation (legal document)

Optum RX Plan Description (legal document) and Premium Standard Formulary

 

Kaiser Permanente Copay Benefits Summary & Summary Plan Description (legal document)

Kaiser Permanente Copay Plus Benefits Summary & Summary Plan Description (legal document)

Kaiser Permanente HDHP Benefits Summary & Summary Plan Description (legal document)

Kaiser Permanente Preventive Drugs List

Vision

EyeMed Basic and Enhanced Benefits Summaries

EyeMed Basic Plan Certificate (legal document)

EyeMed Enhanced Plan Certificate (legal document)

Dental

Delta Dental Basic Plan Summary and Plan Description

Delta Dental Basic Plus Plan Summary and Plan Description 

Disability

Unum Short-Term Disability (STD) Certificate & Amendment (legal documents)

Unum Long-Term Disability (LTD) Certificate & Amendment (legal documents)

Life Insurance

Securian Financial Term Life Certificate (legal document)

Securian Financial Life and AD&D Plan Summary

Flexible Spending Accounts

Salary Reduction Plan (legal document)

 

Previous Plan Years

Health Insurance Portability and Accountability Act (HIPAA) - Privacy & Security

HIPAA Notice of Privacy Practices for Personal Health Information

As sponsor of the group health plans and flexible spending accounts offered to state employees, DPA is subject to the privacy and security regulations of the Health Insurance Portability and Accountability Act (HIPAA) (45 CFR Parts 160 and 164). These regulations are better known as the Privacy Rule (45 CFR 164 subpart E) and the Security Rule (45 CFR 164 subpart C). The requirements placed upon DPA by the Privacy and Security Rules include the following.

For more information about HIPAA privacy or security contact steven.halterman@state.co.us.

Annual Required Legal Notices

COBRA

The Consolidated Omnibus Reconciliation Act of 1985 (COBRA) allows employees and their covered dependents to continue group health coverage under certain circumstances. The State uses a COBRA third-party administrator (TPA). The TPA is responsible for sending COBRA notices and for managing COBRA enrollment, billing, payment, and cancellation. Your COBRA coverage will become effective once your first premium is received by the COBRA TPA. Coverage is retroactive once payment is received.

COBRA Rates (FY 2022-23)

Questions?

For questions related to enrollment or payment, contact the COBRA Third-Party Administrator (TPA) at:

  • Phone - 1-877-725-4545
  • Fax - 515-273-1545

Employee Resources