Plan Documents, Legal Notices, HIPAA & 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)

Medical

Cigna Copay Basic Plan Benefits Summary

Cigna Copay Plus Plan Benefits Summary

Cigna HDHP Benefits Summary

Cigna Preventive Drugs List

Optum RX Plan Description

 

Kaiser Permanente Copay Benefits Summary

Kaiser Permanente Copay Plus Benefits Summary

Kaiser Permanente HDHP Benefits Summary

Kaiser Permanente Preventive Drugs List

Vision

EyeMed Basic and Enhanced Benefits Summaries

EyeMed Basic Plan Certificate

EyeMed Enhanced Plan Certificate

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

Unum Long-Term Disability (LTD) Certificate

Life Insurance

Securian Financial Term Life Certificate

Securian Financial Life and AD&D Plan Summary

 

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.

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)

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