This page includes archived information from previous plan years arranged into the following years:
FY 2020-21
Medical
FY 2020-21 Employee Benefits Guide
Cigna
FY 2020-21 Copay Plus Plan Benefits Summary
FY 2020-21 Copay Basic Plan Benefits Summary
FY 2020-21 HDHP Benefits Summary
FY 2020-21 Summary Plan Description Copay Plus Plan
FY 2020-21 Summary Plan Description Copay Basic Plan
FY 2020-21 Summary Plan Description HDHP
Kaiser Permanente
FY 2020-21 Copay Plus Plan Benefits Summary
FY 2020-21 Copay Basic Plan Benefits Summary
FY 2020-21 HDHP Benefits Summary
FY 2020-21 Summary Plan Description Copay Plus Plan
FY 2020-21 Summary Plan Description Copay Basic Plan
FY 2020-21 Summary Plan Description HDHP
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 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
High Deductible Health Plan Comparison
UnitedHealthcare
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
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 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
| Deductible | Delta Dental Basic | Delta Dental Basic Plus |
|---|---|---|
| Employee Only | $50 | |
| Family | $150 | |
| Maximum Benefit | Delta Dental Basic | Delta Dental Basic Plus |
|---|---|---|
| Annual Maximum | $1,500 per person per plan year | $3,000 per person, per plan year |
| Orthodontic Services | Not applicable | Per lifetime |
Note: Amounts paid by DDCO for your Diagnostic and Preventative Services do not count towards your Annual Maximum Benefit.
| Reimbursement | Delta Dental Basic | Delta Dental Basic Plus |
|---|---|---|
| Diagnostic & Preventative Services (semi-annual check-ups, x-rays, cleanings, and fluoride treatments) | 100% | |
| Basic Services | 70% | 80% |
| Major Services (bridges, crowns, dentures, and implants) | 50% | 50% |
| Orthodontics | Not applicable | |
| PPO Providers | DDCO pays based on PPO allowable fee | |
| Premier Providers | DDCO pays based on maximum plan allowance | |
| Non-Participating Providers | DDCO pays based on a portion of PPO allowable fee | |
Note: Please refer to official plan documents for detailed information and listing of covered services.
Rates - Employee Monthly Contribution
| Employee Tier | Delta Dental Basic Rates | Delta Dental Basic Plus Rates |
|---|---|---|
| Employee Only | $4.61 | $19.78 |
| Employee + Spouse | $16.97 | $47.27 |
| Employee + Child(ren) | $15.89 | $47.69 |
| Family | $29.21 | $76.18 |
Disability
FY 2019-20 Optional Long-Term Disability (LTD) Premium Rates
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
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
UnitedHealthcare
FY 2018-19 UnitedHealthcare Plan Comparison
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
Kaiser Permanente Plan Comparison Chart
Mountain CO 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 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)
Life Insurance
Minnesota Life 2018-19 Power Point Presentation
FY 2018-19 Optional Life Employee, Spouse & Child Premium Rates
FY 2018-19 Life Insurance Summary of Benefits
FY 2018-19 Life Insurance Certificate of Coverage
FY 2017-18
Medical
FY 2017-18 Employee Benefits Guide
FY 2017–18 Plan Year Cost Comparison
UnitedHealthcare
UnitedHealthcare Plan Comparison
2017 Open Enrollment Video for the State of Colorado
FY 2017-18 Summary Plan Description: UHC Co-pay Choice Plus Plan
FY 2017-18 Summary Plan Description: High Deductible Health Plan (HDHP) with HSA
Kaiser Permanente
Kaiser Permanente Plan Comparison Chart
Mountain CO Open Enrollment Guide
SoCO Open Enrollment Guide Guide
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 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