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 2024-25)
Group Benefits Plan (Governing provisions for the State of Colorado Benefits Plan.)
Cigna Medical
- Cigna Copay Cigna Copay Benefits Summary & Summary of Benefits Coverage, Cigna Copay Summary Plan Description (legal document)
- Cigna Copay Plus Cigna Copay Plus Benefits Summary & Summary of Benefits Coverage, Cigna Copay Plus Summary Plan Description (legal document)
- Cigna HDHP Cigna HDHP Benefits Summary & Summary of Benefits Coverage, Cigna HDHP Summary Plan Description (legal document)
- Cigna Annual Compliance Rider (legal document)
- Cigna Extraterritorial Legislation (legal document)
MedImpact (Pharmacy under Cigna)
- MedImpact Summary Plan Description (legal document)
Kaiser Permanente Medical
- Kaiser Permanente Copay Kaiser Permanente Copay Kaiser Permanente Copay Summary of Benefits Coverage & Kaiser Permanente Copay Summary Plan Description (legal document)
- Kaiser Permanente Copay PlusKaiser Permanente Copay Plus Kaiser Permanente Copay Plus Summary of Benefits Coverage & Kaiser Permanente Copay Plus Summary Plan Description (legal document)
- Kaiser Permanente HDHP Kaiser Permanente HDHP Kaiser Permanente HDHP Summary of Benefits Coverage & Kaiser Permanente HDHP Summary Plan Description (legal document)
- Kaiser Permanente Preventive Drugs List
- Kaiser Permanente Specialty Drug List
Vision
Dental
- Delta Dental Basic Delta Dental Basic Plan Summary and Delta Dental Basic Plan Description
- Delta Dental Basic Plus Delta Dental Basic Plus Plan Summary and Delta Dental Basic Plus Plan Description
Disability
Life Insurance
- Securian Financial Term Life Certificate (legal document) & Amendment
- Securian Financial Life and AD&D Plan Summary
Flexible Spending Accounts
- Salary Reduction Plan (legal document)
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.
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