This page includes archived information from previous plan years arranged into the following years:
FY 2022-23
- Employee Benefits Guide (English and Spanish)
- Benefit Premium Rates
- Group Benefits Plan (Governing provisions for the State of Colorado Benefits Plan.)
Medical
Cigna
- 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
- 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)
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
- Copay Plus Plan Description and Benefits Summary
- Copay Basic Plan Description and Benefits Summary
- HDHP Plan Description and Benefits Summary
Kaiser Permanente
- Copay Plus Plan Description and Benefits Summary
- Copay Basic Plan Description and Benefits Summary
- HDHP Plan Description and Benefits Summary
Vision
- EyeMed Basic Plan Summary and Insight Certificate
- EyeMed Enhanced Plan Summary and Insight Certificate
Dental
- Delta Dental Rates
- 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
- STD and LTD Rates
Life Insurance
- Securian Financial Term Life Certificate
- Securian Financial Life and AD&D Plan Summary
FY 2020-21
Medical
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 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
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 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 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
| 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
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
- 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
- Kaiser Permanente Plan Comparison Chart
- 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
UnitedHealthcare
- UnitedHealthcare Plan Comparison
- 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 Summary Plan Description: High Deductible Health Plan (HDHP) with HSA
Kaiser Permanente
- Kaiser Permanente Plan Comparison Chart
- Kaiser Permanente Brochure
- 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