Benefits Enrollment and Forms

New Employee Enrollment
New employees must submit the benefits enrollment form 2014, 2015, along with supporting documentation  if enrolling dependents, to the OHR Benefits Office within 31 days of their hire date. 
This form can be used to enroll in medical**, dental, vision, flex cash and prepaid legal.
 
The dependents listed below are eligible for coverage under our medical, dental, and vision plans:
  • Spouse
  • Spousal Equivalent (same-sex domestic partner)
  • Child (eligible until end of  month of age 26)
  • Step-child (eligible until end of month age 26)

 *For part-time employees: 

 
**Important:  If enrolled in Navigate, you must choose a Primary Care Physician (PCP). In order to see the doctor of your choice, email ccdnavigate@uhc.com with your PCP's 11 digit Provider ID. You can find the Provider ID by going to https://www.myuhc.com/member/prewelcome.do, clicking "Find Physician, Laboratory or Facility" and then selecting the "UnitedHealthcare Navigate/Navigate Balanced" plan and searching for your PCP. 

 

Family Status Changes
If your family status changes, you have the option to update your benefit enrollments (medical*, dental, vision, flex cash). Family status changes include:
  • Birth or adoption of a child
  • Death of a beneficiary
  • Marriage or divorce
  • Change in hours worked
  • Gain or loss of other coverage
To update your benefits, complete the benefits enrollment form** within 31 days of the status change, and submit it to the OHR Benefits Office. Please also include the required supporting documentation if you are enrolling new dependents.
 
**For part-time employees: 
*Important: If newly enrolled in Navigate, you must choose a Primary Care Physician (PCP). In order to see the doctor of your choice, email ccdnavigate@uhc.com with your PCP's 11 digit Provider ID. You can find the Provider ID by going to https://www.myuhc.com/member/prewelcome.do, clicking "Find Physician, Laboratory or Facility" and then selecting the "UnitedHealthcare Navigate/Navigate Balanced" plan and searching for your PCP.


Open Enrollment
 
Open enrollment occurs every October. During open enrollment you will have the opportunity to change your medical, dental, vision, short-term disability, and flex cash elections for the following calendar year.
 
If you do not make elections during this time, you will be assigned the same coverage you had in the previous year, except for flex cash, which requires re-enrollment every year. 

Enrollment Forms

Common-Law / Spousal Equivalent Affidavit
Employees wishing to add an opposite-sex spouse (without a marriage certificate) must complete the Common-Law Affidavit. Employees wishing to add a same-sex spouse must complete the Spousal Equivalent Affidavit.
 

Please Note: If you were previously married and are adding a common-law spouse, you must provide a divorce decree for the prior marriage.



Dental
Review Delta Dental benefit summary guides and copay lists, or print out ID Cards.  



Disability Benefits 

Short-Term Disability
Standard Insurance Company is the carrier for short-term disability. The City has 2 short-term disability plans. One is a voluntary benefit for those employees hired prior to January 1, 2010. This benefit is paid for by the employee through payroll deductions.  The other is an automatic benefit for those employees hired after January 1, 2010. This benefit is paid for by the City.

Long-Term Disability
Standard Insurance is the carrier for the City and County of Denver's Long Term Disability plan. All benefit eligible employees are enrolled and premiums are provided to employees as part of their benefit package.



Flex Cash (24 Hour Flex)



Life Insurance

Basic
The City provides a basic life insurance benefit to all benefit-eligible employees. The policy is 2 times the employee's annual salary to a maximum of $100,000 (reduced if a 1/2 or 3/4-time employee). Employees need only complete the following beneficiary designation form to ensure the benefit is appropriately distributed.

Additional
Standard Insurance Company is the carrier for Supplemental/Additional Life and Accidental Death and Dismemberment coverage. Employees may elect to purchase up to $300,000 of additional life insurance for themselves and their spouses at group rates. Employees may also elect to purchase up to $500,000 of Accidental Death and Dismemberment coverage for themselves or their family.
 

 



Denver Employee Retirement Plan (DERP)

 

Deferred Compensation Enroll/Change
Personal Total Compensation Statement

 


RTD Eco Pass


HIPAA Notices

The privacy rules under the Health Insurance Portability and Accountability Act (HIPAA) require the City and County of Denver (the “City”) to provide participants with Privacy Notices for the following Health Plans: the City’s Flex Cash Plan (administered by Denver Reserve Corporation) and the City’s Self-Insured Dental Plan (administered by Delta Dental Plan of Colorado). Each respective Privacy Notice explains participants’ rights under that Plan and the Plan’s legal duties with respect to protected health information (PHI) and how the Plan may use and disclose PHI.
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