Previous Plan Years

This page includes archived information from previous plan years arranged into the following years:

• FY 2022-23
• FY 2021-22
• FY 2020-21
• FY 2019-20
• FY 2018-19
• FY 2017-18

FY 2022-23

• Employee Benefits Guide (English FY 2022-23 and Spanish)
• Benefit Premium Rates FY 2022-23
• Group Benefits Plan FY 2022-23 (Governing provisions for the State of Colorado Benefits Plan.)

Medical

Cigna

• FY 2022-23 Cigna Copay Basic Plan Benefits Summary
• FY 2022-23 Cigna Copay Basic Plan Summary Plan Description (legal document)
• FY 2022-23 Cigna Copay Plus Plan Benefits Summary
• FY 2022-23 Cigna Copay Plus Plan Summary Plan Description (legal document)
• FY 2022-23 Cigna HDHP Benefits Summary
• FY 2022-23 Cigna HDHP Summary Plan Description (legal document)
• FY 2022-23 Cigna Preventive Drugs List
• FY 2022-23 Cigna Annual Compliance Rider (legal document)
• FY 2022-23 Cigna Extraterritorial Legislation (legal document)
• FY 2022-23 Optum RX Plan Description (legal document)
• FY 2022-23 Optum RX Premium Standard Formulary

Kaiser Permanente

• FY 2022-23 Kaiser Permanente Copay Benefits Summary
• FY 2022-23 Kaiser Permanente Copay Summary Plan Description (legal document)
• FY 2022-23 Kaiser Permanente Copay Plus Benefits Summary
• FY 2022-23 Kaiser Permanente Copay Plus Summary Plan Description (legal document)
• FY 2022-23 Kaiser Permanente HDHP Benefits Summary
• FY 2022-23 Kaiser Permanente HDHP Summary Plan Description (legal document)
• FY 2022-23 Kaiser Permanente Preventive Drugs List

Vision

• FY 2022-23 EyeMed Basic and Enhanced Benefits Summaries
• FY 2022-23 EyeMed Basic Plan Certificate (legal document)
• FY 2022-23 EyeMed Enhanced Plan Certificate (legal document)

Dental

• FY 2022-23 Delta Dental Basic Plan Summary
• FY 2022-23 Delta Dental Basic Plan Description
• FY 2022-23 Delta Dental Basic Plus Plan Summary
• FY 2022-23 Delta Dental Basic Plus Plan Description

Disability

• FY 2022-23 Unum Short-Term Disability (STD) Certificate 
• FY 2022-23 Unum STD Amendment (legal documents)
• FY 2022-23 Unum Long-Term Disability (LTD) Certificate 
• FY 2022-23 Unum LTD Amendment (legal documents)

Life Insurance

• FY 2022-23 Securian Financial Term Life Certificate (legal document)
• FY 2022-23 Securian Financial Life and AD&D Plan Summary

Flexible Spending Accounts

Salary Reduction Plan (legal document)

FY 2021-22

• Employee Benefits Guide - English
• Employee Benefits Guide - Spanish
• COBRA Rates
• Medical, Dental and Vision Rates
• Optional Long-Term Disability Rates

Medical

Cigna

• FY 2021-22 Cigna Copay Plus Plan Description
• FY 2021-22 Cigna Copay Plus Benefits Summary
• FY 2021-22 Cigna Copay Basic Plan Description
• FY 2021-22 Cigna Copay Basic Benefits Summary
• FY 2021-22 Cigna HDHP Plan Description
• FY 2021-22 Cigna HDHP Benefits Summary

Kaiser Permanente

• FY 2021-22 Kaiser Permanente Copay Plus Plan Description
• FY 2021-22 Kaiser Permanente Copay Plus Benefits Summary
• FY 2021-22 Kaiser Permanente Copay Basic Plan Description
• FY 2021-22 Kaiser Permanente Copay Basic Benefits Summary
• FY 2021-22 Kaiser Permanente HDHP Plan Description
• FY 2021-22 Kaiser Permanente HDHP Benefits Summary

Vision

• FY 2021-22 EyeMed Basic Plan Summary
• FY 2021-22 EyeMed Basic Insight Certificate
• FY 2021-22 EyeMed Enhanced Plan Summary
• FY 2021-22 EyeMed Enhanced Insight Certificate

Dental

• FY 2021-22 Delta Dental Rates
• FY 2021-22 Delta Dental Basic Plan Summary
• FY 2021-22 Delta Dental Basic Plan Description
• FY 2021-22 Delta Dental Basic Plus Plan Summary
• FY 2021-22 Delta Dental Basic Plus Plan Description

Disability

• FY 2021-22 Unum Short-Term Disability (STD) Certificate
• FY 2021-22 Unum Long-Term Disability (LTD) Certificate
• FY 2021-22 STD and LTD Rates

Life Insurance

• FY 2021-22 Securian Financial Term Life Certificate
• FY 2021-22 Securian Financial Life and AD&D Plan Summary

FY 2020-21

Medical

• FY 2020-21 Employee Benefits Guide
• FY 2020-21 HVD Rates
• FY 2020-21 COBRA Rates

Cigna

• FY 2020-21 Cigna Copay Plus Plan Benefits Summary
• FY 2020-21 Cigna Copay Basic Plan Benefits Summary
• FY 2020-21 Cigna HDHP Benefits Summary
• FY 2020-21 Cigna Summary Plan Description Copay Plus Plan
• FY 2020-21 Cigna Summary Plan Description Copay Basic Plan
• FY 2020-21 Summary Plan Description HDHP

Kaiser Permanente

• FY 2020-21 Kaiser Permanente Copay Plus Plan Benefits Summary
• FY 2020-21 Kaiser Permanente Copay Basic Plan Benefits Summary
• FY 2020-21 Kaiser Permanente HDHP Benefits Summary
• FY 2020-21 Kaiser Permanente Copay Plus Plan Summary Plan Description
• FY 2020-21 Kaiser Permanente Copay Basic Plan Summary Plan Description
• FY 2020-21 Kaiser Permanente HDHP Summary Plan Description

Vision

• FY 2020-21 EyeMed Basic Insight Plan Summary
• FY 2020-21 EyeMed Enhanced Insight Plan Summary
• FY 2020-21 EyeMed Basic Insight Certificate
• FY 2020-21 EyeMed Enhanced Insight Certificate

Dental

• FY 2020-21 Delta Dental Rates
• FY 2020-21 Employee Benefits Guide
• FY 2020-21 Basic Plan - Summary
• FY 2020-21 Basic Plus Plan - Summary
• FY 2020-21 Basic Plan - Summary Plan Description
• FY 2020-21 Basic Plus Plan - Summary Plan Description

Disability

• FY 2020-21 Unum Short-Term Disability Certificate
• FY 2020-21 Unum Long-Term Disability Certificate

Life Insurance

• FY 2020-21 Securian Financial Term Life Certificate
• FY 2020-21 Securian Financial Life and AD&D Plan Summary

FY 2019-20

Medical

• FY 2019-20 Employee Benefits Guide
• FY 2019-20 Medical Plan Rates
• FY 2019-20 COBRA Rates
• High Deductible Health Plan Comparison
• Copay Plan Comparison

UnitedHealthcare

• UHC Plan Comparison
• 2019 Open Enrollment Video
• 2019 UnitedHealthcare Open Enrollment Brochure
• FY 2019-20 Summary of Benefits Copay Choice Plus Plan
• FY 2019-20 Summary of Benefits HDHP with HSA
• FY 2019-20 Summary Plan Description Copay Choice Plus Plan
• FY 2019-20 Summary Plan Description HDHP with HSA

Kaiser Permanente

• Kaiser Plan Comparison
• 2019 Kaiser Permanente Open Enrollment Brochure
• 2019 Enrollment Guide
• FY 2019-20 Summary of Benefits DHMO Copay Plan
• FY 2019-20 Summary of Benefits HDHP HSA Qualified
• FY 2019-20 DHMO Co-Pay Summary Plan Description (Colorado Springs)
• FY 2019-20 DHMO Co-Pay Summary Plan Description (Denver/Boulder)
• FY 2019-20 HDHP with HSA Summary Plan Description (Colorado Springs)
• FY 2019-20 HDHP with HSA Summary Plan Description (Denver/Boulder)

Dental

• FY 2019-20 Delta Dental Rates
• FY 2019-20 Employee Benefits Guide
• FY 2019-20 Delta Dental Presentation
• FY 2019-20 Basic Plan - Summary Plan Description
• FY 2019-20 Basic Plus Plan - Summary Plan Description

Disability

• FY 2019-20 Optional Long-Term Disability (LTD) Premium Rates
• FY 2019-20 Unum Presentation

STD Claim Forms

• State Short-Term Disability (STD) Claim Form (Unum Insurance Company)
• PERA Short-Term Disability (STD) Claim Form

Optional LTD Evidence of Insurability (EOI) Form

• Unum LTD EOI Form - only for Late Enrollees

Life Insurance

• Minnesota Life 2019-20 Power Point Presentation
• FY 2019-20 Optional Life Employee, Spouse & Child Premium Rates
• FY 2019-20 Life Insurance Certificate of Coverage

FY 2018-19

Medical

• 2018 Employee Benefits Guide
• 2018 Medical and Dental Rates
• 2018 COBRA Rates

UnitedHealthcare

• FY 2018-19 UnitedHealthcare Plan Comparison
• 2018 Open Enrollment Brochure
• FY 2018-19 Summary of Benefits: UHC Co-pay Choice Plus Plan
• FY 2018-19 Summary Plan Description: Co-pay Choice Plus Plan
• FY 2018-19 Summary of Benefits: High Deductible Health Plan (HDHP) with HSA
• FY 2018-19 Summary Plan Description: HDHP with HSA

Kaiser Permanente

• 2018 Open Enrollment Presentation
• FY 2018-19 Kaiser Permanente Plan Comparison Chart
• FY 2018-19 Kaiser Permanente Brochure
• FY 2018-19 Medical Premiums
• DB Open Enrollment Guide
• Mountain CO Open Enrollment Guide
• NoCO Open Enrollment Guide
• SoCO Open Enrollment Guide
• FY 2018-19 Summary of Benefits and Coverage: DHMO Co-Pay
• FY 2018 Copay Summary Plan Description
• FY 2018-19 Summary of Benefits and Coverage: High Deductible Health Plan (HDHP) with HSA
• FY 2018 HDHP with HSA Summary Plan Description

Dental

• FY 2018-19 Delta Dental Rates
• FY 2018-19 Basic Plan - Summary Plan Description
• FY 2018-19 Basic Plus Plan - Summary Plan Description

Disability

• FY 2018-19 Optional Long-Term Disability (LTD) Premium Rates
• FY 2018-19 and 2019-20 Short-Term Disability (STD) Certificate of Coverage (Unum Insurance Company)
• FY 2018-19 and 2019-20 Optional Long-Term Disability (LTD) Certificate of Coverage (Unum Insurance Company)

Life Insurance

• Minnesota Life 2018-19 Power Point Presentation
• FY 2018-19 Optional Life Employee, Spouse & Child Premium Rates
• FY 2018-19 Life Insurance Certificate of Coverage

FY 2017-18

Medical 

• FY 2017-18 Employee Benefits Guide
• FY 2017–18 Plan Year Rates
• FY 2017–18 Plan Year Cost Comparison

UnitedHealthcare

• FY 2017-18 UnitedHealthcare Plan Comparison
• FY 2017-18 UnitedHealthcare Brochure
• 2017 Open Enrollment Video for the State of Colorado
• FY 2017-18 Summary Plan Description: UHC Co-pay Choice Plus Plan
• FY 2017-18 UHC Summary Plan Description: High Deductible Health Plan (HDHP) with HSA

Kaiser Permanente

• FY 2017-18 Kaiser Permanente Plan Comparison Chart
• FY 2017-18 Kaiser Permanente Brochure
• FY 2017-18 How to Enroll
• 2017-18 New KP Claims System
• DHMO Summary Benefits Coverage 2017
• DHMO Summary of Benefits Coverage 2017 - Spanish
• FY 2017-18 Summary Plan Description: DHMO Co-Pay
• HDHP Summary of Benefits Coverage 2017
• HDHP Summary Benefits Coverage 2017 - Spanish
• FY 2017-18 Summary Plan Description: High Deductible Health Plan (HDHP) with HSA

Dental

• FY 2017-18 Basic Plan - Summary Plan Description
• FY 2017-18 Basic Plus Plan - Summary Plan Description

Disability

• FY 2017-18 and 2018-19 Short-Term Disability (STD) Certificate of Coverage (Unum Insurance Company)
• FY 2017-18 and 2018-19 Optional Long-Term Disability (LTD) Certificate of Coverage (Unum Insurance Company)
• FY 2017-18 Optional Long-Term Disability (LTD) Premium Rates

Life Insurance

• Minnesota Life 2017-18 Power Point Presentation
• FY 2017-18 Optional Life Employee, Spouse & Child Premium Rates
• FY 2017-18 Life Insurance Summary of Benefits
• FY 2017-18 Life Insurance Certificate of Coverage

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