Benefits for Administrative, Professional, and Technical Employees


General Insurance Information  2013 - 2014 Benefits  NEW 

2013-2014 Employee Choice Flexible Benefit Plan Booklet

Monthly Premium Rates 2013-2014
Insurance Enrollment / Change Form 2013-2014
Flexible Spending Election / Change Form 2013-2014
 
General Insurance Information  2012 - 2013 Benefits

2012-2013 Employee Choice Flexible Benefit Plan Booklet

Monthly Premium Rates 2012-2013
Insurance Enrollment / Change Form 2012-2013
Flexible Spending Election / Change Form 2012-2013

Health Plan Information  2013 - 2014 Benefits  NEW 
Kaiser
Kaiser, Summary of Benefits & Coverage (SBC)
Kaiser, Colo Supplement to SBC
Member Resource Guide 2013 (English)
Member Resource Guide 2012 (Spanish)
Medical Office Map 2013
Anthem
Anthem, Colo Supplement to HMO SBC
Anthem, Colo Supplement to POS SBC
Anthem, Colo Supplement to PPO SBC

Health Plan Information  2012 - 2013 Benefits
Kaiser
Kaiser Evidence of Coverage
2012 Medical Office Map
2012 Denver- Boulder Member Resource Guide (English)
2012 Denver- Boulder Member Resource Guide (Spanish)
Denver-Boulder Service Area Map and Zip Code Directory
Anthem
Anthem HMO Certificate of Coverage and Health Plan Description
Anthem POS Certificate of Coverage and Health Plan Description
Anthem PPO Certificate of Coverage and Health Plan Description
Amendment to Autism Benefit for Anthem HMO, POS and PPO Plans effective July 2010
Anthem Blue View Vision Certificate of Coverage
Anthem Prescription Home Delivery Form

Dental Benefits / Delta Dental
Delta Dental Fact Sheet
Option I Summary Plan Description
Option I Benefit Information Overview
Option II Summary Plan Description
Option II Benefit Information Overview
Easy Steps to creating a Subscriber Web Account

Vision Service Plan
Evidence of Coverage – effective July 2013
Evidence of Coverage

Basic Life Insurance – Standard Insurance Company
Accelerated Benefit Claim Form
Accidental Death and Dismemberment Claim Form
Beneficiary Designation/Change Form
Certificate of Coverage
Conversion Request Form
Life Claim Form
Med Ex Travel Assistance brochure and card
Medical History Statement
Portability and Conversion at a Glance
Portability Claim Form

Voluntary Life Insurance
PERA Enrollment Form, 2013
PERA Beneficiary Form
PERA Rates / Plan Highlights, 2013

Long Term Disability Insurance – Standard Insurance Company
Certificate of Coverage
Long Term Disability (ASO) Claim Form

Flexible Spending Account 2012-2013 (24HourFlex)
What is an FSA?
Claim Form
Eligible FSA Expenses
Letter of Medical Necessity
Over-the-Counter (OTC) Prescription Template
24HourFlex Debit Card Guide
Direct Deposit Request Form
Check Re-issue Form
Calculate Your Annual FSA Tax Savings
Dependent Care - Fillable Receipt
24HourFlex Learning Center Videos

Business Travel Accident Insurance
Certificate of Coverage

Voluntary Accidental Death and Dismemberment Insurance
Benefits Summary
Premium Rates
Enrollment Form
Certificate of Coverage
Rider to Certificate of Coverage
Individual AD&D Policy Conversion Form

COBRA  2012 - 2013 Benefits
COBRA Monthly Premium Rate Sheet
COBRA Enrollment Form
Employee’s Guide to Understanding COBRA

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