PPUG Rates: Fiscal Year (FY) 2023-2024

Note: Provided below is guidance intended for State departmental and program use only. To view more guidance and policy information, please visit the Central Payroll Services page.

Glossary of Terms

CPPS: Central Payroll Processing System
GTN: Gross-to-net
Empl: Employee
HDHP: High Deductible Health Plan
NTD: Non-taxable dependent
AD&D: Accidental Death & Dismemberment
STD: Short-term disability
LTD: Long-term disability
FSA: Flexible Spending Account

FY2024 State Of Colorado Monthly Rates/CPPS GTNs and Option Codes

Cigna HDHP

Contribution Type	GTN After-Tax	GTN Pre-Tax	Empl Only T1/P1	Empl + Spouse T2/P2	Empl + Child(ren) T3/P3	Empl + Spouse + Child(ren) T4/P4
Employee Share	201	202	$26.78	$162.28	$61.44	$258.78
State Contribution	203	No Value	$786.08	$1,417.26	$1,391.54	$1,949.14
Total Rate	No Value	No Value	$812.86	$1,579.54	$1,452.98	$2,207.92

Cigna Copay Plus

Contribution Type	GTN After-Tax	GTN Pre-Tax	Empl Only T1/P1	Empl + Spouse T2/P2	Empl + Child(ren) T3/P3	Empl + Spouse + Child(ren) T4/P4
Employee Share	210	211	$94.82	$301.08	$166.12	$456.56
State Contribution	212	No Value	$742.12	$1,388.86	$1,383.00	$1,932.52
Total Rate	No Value	No Value	$836.94	$1,689.94	$1,549.12	$2,389.08

Cigna Copay Basic

Contribution Type	GTN After-Tax	GTN Pre-Tax	Empl Only T1/P1	Empl + Spouse T2/P2	Empl + Child(ren) T3/P3	Empl + Spouse + Child(ren) T4/P4
Employee Share	213	214	$40.08	$199.96	$74.26	$281.08
State Contribution	215	No Value	$779.14	$1,454.08	$1,441.96	$2,057.18
Total Rate	No Value	No Value	$819.22	$1,654.04	$1,516.22	$2,338.26

Kaiser HDHP

Contribution Type	GTN After-Tax	GTN Pre-Tax	Empl Only T1/P1	Empl + Spouse T2/P2	Empl + Child(ren) T3/P3	Empl + Spouse + Child(ren) T4/P4
Employee Share	216	217	$27.94	$170.24	$55.82	$214.58
State Contribution	218	No Value	$631.88	$1,142.20	$1,138.38	$1,632.20
Total Rate	No Value	No Value	$659.82	$1,312.44	$1,194.20	$1,846.78

Kaiser Copay Plus

Contribution Type	GTN After-Tax	GTN Pre-Tax	Empl Only T1/P1	Empl + Spouse T2/P2	Empl + Child(ren) T3/P3	Empl + Spouse + Child(ren) T4/P4
Employee Share	219	220	$59.40	$267.04	$126.88	$423.12
State Contribution	221	No Value	$669.20	$1,254.08	$1,249.78	$1,747.36
Total Rate	No Value	No Value	$728.60	$1,521.12	$1,376.66	$2,170.48

Kaiser Copay Basic

Contribution Type	GTN After-Tax	GTN Pre-Tax	Empl Only T1/P1	Empl + Spouse T2/P2	Empl + Child(ren) T3/P3	Empl + Spouse + Child(ren) T4/P4
Employee Share	222	223	$38.00	$187.92	$71.60	$310.08
State Contribution	224	No Value	$651.74	$1,251.70	$1,231.32	$1,743.96
Total Rate	No Value	No Value	$689.74	$1,439.62	$1,302.92	$2,054.04

Eyemed Vision - Basic

Contribution Type	GTN After-Tax	GTN Pre-Tax	Empl Only TV1/PV1	Empl + Spouse TV2/PV2	Empl + Child(ren) TV3/PV3	Empl + Spouse + Child(ren) TV4/PV4
Employee Share	228	229	$0.00	$0.00	$0.00	$0.00
State Contribution	230	No Value	$3.18	$6.06	$6.38	$9.38
Total Rate	No Value	No Value	$3.18	$6.06	$6.38	$9.38

Eyemed Vision - Enhanced

Contribution Type	GTN After-Tax	GTN Pre-Tax	Empl Only TE1/PE1	Empl + Spouse TE2/PE2	Empl + Child(ren) TE3/PE3	Empl + Spouse + Child(ren) TE4/PE4
Employee Share	228	229	$4.40	$8.36	$8.80	$12.92
State Contribution	230	No Value	$3.18	$6.06	$6.38	$9.38
Total Rate	No Value	No Value	$7.58	$14.42	$15.18	$22.30

Delta Dental - Basic

Contribution Type	GTN After-Tax	GTN Pre-Tax	Empl Only T1A/P1A	Empl + Spouse T2A/P2A	Empl + Child(ren) T3A/P3A	Empl + Spouse + Child(ren) T4/P4A
Employee Share	237	238	$4.54	$16.68	$15.62	$28.68
State Contribution	239	No Value	$34.16	$55.86	$60.48	$81.26
Total Rate	No Value	No Value	$38.70	$72.54	$76.10	$109.94

Delta Dental - Basic Plus

Contribution Type	GTN After-Tax	GTN Pre-Tax	Empl Only T1B/P1B	Empl + Spouse T2B/P2B	Empl + Child(ren) T3B/P3B	Empl + Spouse + Child(ren) T4B/P4B
Employee Share	237	238	$10.46	$28.52	$28.00	$47.00
State Contribution	239	No Value	$35.48	$58.14	$62.96	$84.66
Total Rate	No Value	No Value	$45.94	$86.66	$90.96	$131.66

Other Benefit Information

Basic Life: GTN 244, Rate $8.84
Employee Optional Life: GTN 241
Spouse Optional Life: GTN 242
Dependent Optional Life: GTN 243
STD: GTN 246
- Rate: 0.15% Of eligible gross pay
LTD: GTN 245
Flexible Spending Accounts:
Health: GTN 247 (After-Tax 249), Limit $3050.00
Dependent: GTN 248 (After-Tax GTN 236), Limit $5000.00
LTD Purpose: GTN 251, Limit $3050.00

Imputed Income Rates FY24

Note: N/A SGDP coverage ended 6/30/21, Civil Unions still apply

Cigna HDHP

Contribution Type	GTN & Tax Election	EE + C. Union T2/P2	EE + C. Union's Child(ren) T3/P3	EE + C. Union + EE's Child(ren) T4/P4	EE + C. Union + C. Union's Child(ren) T4/P4
NTD Amount	201: After-Tax	$631.18	$605.46	$631.18	$1,163.06
NTD Amount	202: Pre-Tax	$766.68	$640.12	$766.68	$1,395.06

Contribution Type

GTN & Tax Election

EE + C. Union T2/P2

EE + C. Union's Child(ren) T3/P3

EE + C. Union + EE's Child(ren) T4/P4

EE + C. Union + C. Union's Child(ren) T4/P4

NTD Amount

201: After-Tax

$631.18

$605.46

$631.18

$1,163.06

NTD Amount

202: Pre-Tax

$766.68

$640.12

$766.68

$1,395.06

Cigna Copay Plus

Contribution Type	GTN & Tax Election	EE + C. Union T2/P2	EE + C. Union's Child(ren) T3/P3	EE + C. Union + EE's Child(ren) T4/P4	EE + C. Union + C. Union's Child(ren) T4/P4
NTD Amount	210: After-Tax	$646.74	$640.88	$646.74	$1,190.40
NTD Amount	211: Pre-Tax	$853.00	$712.18	$853.00	$1,552.14

Contribution Type

GTN & Tax Election

EE + C. Union T2/P2

EE + C. Union's Child(ren) T3/P3

EE + C. Union + EE's Child(ren) T4/P4

EE + C. Union + C. Union's Child(ren) T4/P4

NTD Amount

210: After-Tax

$646.74

$640.88

$646.74

$1,190.40

NTD Amount

211: Pre-Tax

$853.00

$712.18

$853.00

$1,552.14

Cigna Copay Basic

Contribution Type	GTN & Tax Election	EE + C. Union T2/P2	EE + C. Union's Child(ren) T3/P3	EE + C. Union + EE's Child(ren) T4/P4	EE + C. Union + C. Union's Child(ren) T4/P4
NTD Amount	213: After-Tax	$674.94	$662.82	$674.94	$1,278.04
NTD Amount	214: Pre-Tax	$834.82	$697.00	$834.82	$1,519.04

Contribution Type

GTN & Tax Election

EE + C. Union T2/P2

EE + C. Union's Child(ren) T3/P3

EE + C. Union + EE's Child(ren) T4/P4

EE + C. Union + C. Union's Child(ren) T4/P4

NTD Amount

213: After-Tax

$674.94

$662.82

$674.94

$1,278.04

NTD Amount

214: Pre-Tax

$834.82

$697.00

$834.82

$1,519.04

Kaiser HDHP

Contribution Type	GTN & Tax Election	EE + C. Union T2/P2	EE + C. Union's Child(ren) T3/P3	EE + C. Union + EE's Child(ren) T4/P4	EE + C. Union + C. Union's Child(ren) T4/P4
NTD Amount	216: After-Tax	$510.32	$506.50	$510.32	$1,000.32
NTD Amount	217: Pre-Tax	$652.62	$534.38	$652.62	$1,186.96

Contribution Type

GTN & Tax Election

EE + C. Union T2/P2

EE + C. Union's Child(ren) T3/P3

EE + C. Union + EE's Child(ren) T4/P4

EE + C. Union + C. Union's Child(ren) T4/P4

NTD Amount

216: After-Tax

$510.32

$506.50

$510.32

$1,000.32

NTD Amount

217: Pre-Tax

$652.62

$534.38

$652.62

$1,186.96

Kaiser Copay Plus

Contribution Type	GTN & Tax Election	EE + C. Union T2/P2	EE + C. Union's Child(ren) T3/P3	EE + C. Union + EE's Child(ren) T4/P4	EE + C. Union + C. Union's Child(ren) T4/P4
NTD Amount	219: After-Tax	$584.88	$580.58	$584.88	$1,078.16
NTD Amount	220: Pre-Tax	$792.52	$648.06	$792.52	$1,441.88

Contribution Type

GTN & Tax Election

EE + C. Union T2/P2

EE + C. Union's Child(ren) T3/P3

EE + C. Union + EE's Child(ren) T4/P4

EE + C. Union + C. Union's Child(ren) T4/P4

NTD Amount

219: After-Tax

$584.88

$580.58

$584.88

$1,078.16

NTD Amount

220: Pre-Tax

$792.52

$648.06

$792.52

$1,441.88

Kaiser Copay Basic

Contribution Type	GTN & Tax Election	EE + C. Union T2/P2	EE + C. Union's Child(ren) T3/P3	EE + C. Union + EE's Child(ren) T4/P4	EE + C. Union + C. Union's Child(ren) T4/P4
NTD Amount	222: After-Tax	$599.96	$579.58	$599.96	$1,092.22
NTD Amount	223: Pre-Tax	$749.88	$613.18	$749.88	$1,364.30

Contribution Type

GTN & Tax Election

EE + C. Union T2/P2

EE + C. Union's Child(ren) T3/P3

EE + C. Union + EE's Child(ren) T4/P4

EE + C. Union + C. Union's Child(ren) T4/P4

NTD Amount

222: After-Tax

$599.96

$579.58

$599.96

$1,092.22

NTD Amount

223: Pre-Tax

$749.88

$613.18

$749.88

$1,364.30

Eyemed Vision - Basic

Contribution Type	GTN & Tax Election	EE + C. Union T2A/P2A	EE + C. Union's Child(ren) T3A/P3A	EE + C. Union + EE's Child(ren) T4A/P4A	EE + C. Union + C. Union's Child(ren) T4A/P4A
NTD Amount	237: After-Tax	$2.88	$3.20	$2.88	$6.20
NTD Amount	238: Pre-Tax	$2.88	$3.20	$2.88	$6.20

Contribution Type

GTN & Tax Election

EE + C. Union T2A/P2A

EE + C. Union's Child(ren) T3A/P3A

EE + C. Union + EE's Child(ren) T4A/P4A

EE + C. Union + C. Union's Child(ren) T4A/P4A

NTD Amount

237: After-Tax

$2.88

$3.20

$2.88

$6.20

NTD Amount

238: Pre-Tax

$2.88

$3.20

$2.88

$6.20

Eyemed Vision - Enhanced

Contribution Type	GTN & Tax Election	EE + C. Union T2B/P2B	EE + C. Union's Child(ren) T3B/P3B	EE + C. Union + EE's Child(ren) T4B/P4B	EE + C. Union + C. Union's Child(ren) T4B/T4P
NTD Amount	237: After-Tax	$2.88	$3.20	$2.88	$6.20
NTD Amount	238: Pre-Tax	$6.84	$7.60	$6.84	$14.72

Contribution Type

GTN & Tax Election

EE + C. Union T2B/P2B

EE + C. Union's Child(ren) T3B/P3B

EE + C. Union + EE's Child(ren) T4B/P4B

EE + C. Union + C. Union's Child(ren) T4B/T4P

NTD Amount

237: After-Tax

$2.88

$3.20

$2.88

$6.20

NTD Amount

238: Pre-Tax

$6.84

$7.60

$6.84

$14.72

Delta Dental - Basic

Contribution Type	GTN & Tax Election	EE + C. Union T2A/P2A	EE + C. Union's Child(ren) T3A/P3A	EE + C. Union + EE's Child(ren) T4A/P4A	EE + C. Union + C. Union's Child(ren) T4A/P4A
NTD Amount	237: After-Tax	$12.14	$11.08	$12.14	$24.14
NTD Amount	238: Pre-Tax	$21.70	$26.32	$21.70	$47.10

Contribution Type

GTN & Tax Election

EE + C. Union T2A/P2A

EE + C. Union's Child(ren) T3A/P3A

EE + C. Union + EE's Child(ren) T4A/P4A

EE + C. Union + C. Union's Child(ren) T4A/P4A

NTD Amount

237: After-Tax

$12.14

$11.08

$12.14

$24.14

NTD Amount

238: Pre-Tax

$21.70

$26.32

$21.70

$47.10

Delta Dental - Basic Plus

Contribution Type	GTN & Tax Election	EE + C. Union T2B/P2B	EE + C. Union's Child(ren) T3B/P3B	EE + C. Union + EE's Child(ren) T4B/P4B	EE + C. Union + C. Union's Child(ren) T4B/T4P
NTD Amount	237: After-Tax	$18.06	$17.54	$18.06	$36.54
NTD Amount	238: Pre-Tax	$22.66	$27.48	$22.66	$49.18

Contribution Type

GTN & Tax Election

EE + C. Union T2B/P2B

EE + C. Union's Child(ren) T3B/P3B

EE + C. Union + EE's Child(ren) T4B/P4B

EE + C. Union + C. Union's Child(ren) T4B/T4P

NTD Amount

237: After-Tax

$18.06

$17.54

$18.06

$36.54

NTD Amount

238: Pre-Tax

$22.66

$27.48

$22.66

$49.18

Notes

For after-tax elections, the taxable amount is the difference of the state shares.
For pre-tax elections, the taxable amount is the difference of the total rates.
The NTD amount for employees with pre-tax deductions is higher because the employee should not receive a tax benefit for covering a non-tax dependent. The higher NTD amount removes the tax benefit the employee derives from his/her pre-tax payroll deduction.
The NTD amount should only be entered for the plan(s) that the non-tax dependent has coverage for (ex: do not enter NTD for dental if the non-tax dependent only has medical coverage). If the non-tax dependent has coverage for both medical and dental plans, then the amounts should be added together.

Health and Wellness Rates FY 24

Wellness Activity Participation: Employees who participate in wellness activities are eligible to receive a $20/month premium reduction.

Cigna HDHP

Contribution Type	GTN After-Tax	GTN Pre-Tax	Empl Only TW1/PW1	Empl + Spouse TW2/PW2	Empl + Child(ren) TW3/PW3	Empl + Spouse + Child(ren) TW4/PW4
Employee share	201	202	$6.78	$142.28	$41.44	$238.78
State contribution	203	No Value	$786.08	$1,417.26	$1,391.54	$1,949.14

Cigna Copay Plus

Contribution Type	GTN After-Tax	GTN Pre-Tax	Empl Only TW1/PW1	Empl + Spouse TW2/PW2	Empl + Child(ren) TW3/PW3	Empl + Spouse + Child(ren) TW4/PW4
Employee share	210	211	$74.82	$281.08	$146.12	$436.56
State contribution	212	No Value	$742.12	$1,388.86	$1,383.00	$1,932.52

Cigna Copay Basic

Contribution Type	GTN After-Tax	GTN Pre-Tax	Empl Only TW1/PW1	Empl + Spouse TW2/PW2	Empl + Child(ren) TW3/PW3	Empl + Spouse + Child(ren) TW4/PW4
Employee share	213	214	$20.08	$179.96	$54.26	$261.08
State contribution	215	No Value	$779.14	$1,454.08	$1,441.96	$2,057.18

Kaiser HDHP

Contribution Type	GTN After-Tax	GTN Pre-Tax	Empl Only TW1/PW1	Empl + Spouse TW2/PW2	Empl + Child(ren) TW3/PW3	Empl + Spouse + Child(ren) TW4/PW4
Employee share	216	217	$7.94	$150.24	$35.82	$194.58
State contribution	218	No Value	$631.88	$1,142.20	$1,138.38	$1,632.20

Kaiser Copay Plus

Contribution Type	GTN After-Tax	GTN Pre-Tax	Empl Only TW1/PW1	Empl + Spouse TW2/PW2	Empl + Child(ren) TW3/PW3	Empl + Spouse + Child(ren) TW4/PW4
Employee share	219	220	$39.40	$247.04	$106.88	$403.12
State contribution	221	No Value	$669.20	$1,254.08	$1,249.78	$1,747.36

Kaiser Copay Basic

Contribution Type	GTN After-Tax	GTN Pre-Tax	Empl Only TW1/PW1	Empl + Spouse TW2/PW2	Empl + Child(ren) TW3/PW3	Empl + Spouse + Child(ren) TW4/PW4
Employee share	222	223	$18.00	$167.92	$51.60	$290.08
State contribution	224	No Value	$651.74	$1,251.70	$1,231.32	$1,743.96

FY24 Subsidy Group A

Cigna HDHP

Contribution Type	GTN Code After-Tax	GTN Code Pre-Tax	Empl + Child(ren) T3T/P3T	Empl + Spouse + Child(ren) T4T/P4T
Employee share	201	202	No Value	No Value
Subsidy amount	No Value	No Value	$61.44	$258.78
State contribution	203	No Value	$1,391.54	$1,949.14
Total rate	No Value	No Value	$1,452.98	$2,207.92

Cigna Copay Plus

Contribution Type	GTN Code After-Tax	GTN Code Pre-Tax	Empl + Child(ren) T3T/P3T	Empl + Spouse + Child(ren) T4T/P4T
Employee share	210	211	No Value	No Value
Subsidy amount	No Value	No Value	$166.12	$456.56
State contribution	212	No Value	$1,383.00	$1,932.52
Total rate	No Value	No Value	$1,549.12	$2,389.08

Cigna Copay Basic

Contribution Type	GTN Code After-Tax	GTN Code Pre-Tax	Empl + Child(ren) T3T/P3T	Empl + Spouse + Child(ren) T4T/P4T
Employee share	213	214	No Value	No Value
Subsidy amount	No Value	No Value	$74.26	$281.08
State contribution	215	No Value	$1,441.96	$2,057.18
Total rate	No Value	No Value	$1,516.22	$2,338.26

Kaiser HDHP

Contribution Type	GTN Code After-Tax	GTN Code Pre-Tax	Empl + Child(ren) T3T/P3T	Empl + Spouse + Child(ren) T4T/P4T
Employee share	216	217	No Value	No Value
Subsidy amount	No Value	No Value	$55.82	$214.58
State contribution	218	No Value	$1,138.38	$1,632.20
Total rate	No Value	No Value	$1,194.20	$1,846.78

Kaiser Copay Plus

Contribution Type	GTN Code After-Tax	GTN Code Pre-Tax	Empl + Child(ren) T3T/P3T	Empl + Spouse + Child(ren) T4T/P4T
Employee share	219	220	No Value	No Value
Subsidy amount	No Value	No Value	$126.88	$423.12
State contribution	221	No Value	$1,249.78	$1,747.36
Total rate	No Value	No Value	$1,376.66	$2,170.48

Kaiser Copay Basic

Contribution Type	GTN Code After-Tax	GTN Code Pre-Tax	Empl + Child(ren) T3T/P3T	Empl + Spouse + Child(ren) T4T/P4T
Employee share	222	223	No Value	No Value
Subsidy amount	No Value	No Value	$71.60	$310.08
State contribution	224	No Value	$1,231.32	$1,743.96
Total rate	No Value	No Value	$1,302.92	$2,054.04

Delta Dental - Basic

Contribution Type	GTN Code After-Tax	GTN Code Pre-Tax	Empl + Child(ren) T5A/P5A	Empl + Spouse + Child(ren) T6A/P6A
Employee share	237	238	No Value	No Value
Subsidy amount	No Value	No Value	$15.62	$28.68
State contribution	239	No Value	$60.48	$81.26
Total rate	No Value	No Value	$76.10	$109.94

Delta Dental - Basic Plus

Contribution Type	GTN Code After-Tax	GTN Code Pre-Tax	Empl + Child(ren) T5B/P5B	Empl + Spouse + Child(ren) T6B/P6B
Employee share	237	238	No Value	No Value
Subsidy amount	No Value	No Value	$28.00	$47.00
State contribution	239	No Value	$62.96	$84.66
Total rate	No Value	No Value	$90.96	$131.66

COBRA Rates

FY2024 State of Colorado Monthly Rates/CPPS GTNs and Option Codes

Cigna HDHP

Rate Type	Empl Only T1/P1	Empl + Spouse T2/P2	Empl + Child(ren) T3/P3	Empl + Spouse + Child(ren) T4/P4
Administrative Cost	$16.26	$31.59	$29.06	$44.16
Premium	$812.86	$1,579.54	$1,452.98	$2,207.92
Total Rate	$829.12	$1,611.13	$1,482.04	$2,252.08

Cigna Copay Plus

Rate Type	Empl Only T1/P1	Empl + Spouse T2/P2	Empl + Child(ren) T3/P3	Empl + Spouse + Child(ren) T4/P4
Administrative Cost	$16.74	$33.80	$30.98	$47.78
Premium	$836.94	$1,689.94	$1,549.12	$2,389.08
Total Rate	$853.68	$1,723.74	$1,580.10	$2,436.86

Cigna Copay Basic

Rate Type	Empl Only T1/P1	Empl + Spouse T2/P2	Empl + Child(ren) T3/P3	Empl + Spouse + Child(ren) T4/P4
Administrative Cost	$16.38	$33.08	$30.32	$46.77
Premium	$819.22	$1,654.04	$1,516.22	$2,338.26
Total Rate	$835.60	$1,687.12	$1,546.54	$2,385.03

Kaiser HDHP

Rate Type	Empl Only T1/P1	Empl + Spouse T2/P2	Empl + Child(ren) T3/P3	Empl + Spouse + Child(ren) T4/P4
Administrative Cost	$13.20	$26.25	$23.88	$36.94
Premium	$659.82	$1,312.44	$1,194.20	$1,846.78
Total Rate	$673.02	$1,338.69	$1,218.08	$1,883.72

Kaiser Copay Plus

Rate Type	Empl Only T1/P1	Empl + Spouse T2/P2	Empl + Child(ren) T3/P3	Empl + Spouse + Child(ren) T4/P4
Administrative Cost	$14.57	$30.42	$27.53	$43.41
Premium	$728.60	$1,521.12	$1,376.66	$2,170.48
Total Rate	$743.17	$1,551.54	$1,404.19	$2,213.89

Kaiser DHMO Copay Basic

Rate Type	Empl Only T1/P1	Empl + Spouse T2/P2	Empl + Child(ren) T3/P3	Empl + Spouse + Child(ren) T4/P4
Administrative Cost	$13.79	$28.79	$26.06	$41.08
Premium	$689.74	$1,439.62	$1,302.92	$2,054.04
Total Rate	$703.53	$1,468.41	$1,328.98	$2,095.12

EyeMed Vision Basic

Rate Type	Empl Only TV1/PV1	Empl + Spouse TV2/PV2	Empl + Child(ren) TV3/PV3	Empl + Spouse + Child(ren) TV4/PV4
Administrative Cost	$0.06	$0.12	$0.13	$0.19
Premium	$3.18	$6.06	$6.38	$9.38
Total Rate	$3.24	$6.18	$6.51	$9.57

EyeMed Vision Enhanced

Rate Type	Empl Only TE1/PE1	Empl + Spouse TE2/PE2	Empl + Child(ren) TE3/PE3	Empl + Spouse + Child(ren) TE4/PE4
Administrative Cost	$0.15	$0.29	$0.30	$0.45
Premium	$7.58	$14.42	$15.18	$22.30
Total Rate	$7.73	$14.71	$15.48	$22.75

Delta Dental - Basic

Rate Type	Empl Only T1A/P1A	Empl + Spouse T2A/P2A	Empl + Child(ren) T3A/P3A	Empl + Spouse + Child(ren) T4A/P4A
Administrative Cost	$0.77	$1.45	$1.52	$2.20
Premium	$38.70	$72.54	$76.10	$109.94
Total Rate	$39.47	$73.99	$77.62	$112.14

Delta Dental - Basic Plus

Rate Type	Empl Only T1B/P1B	Empl + Spouse T2B/P2B	Empl + Child(ren) T3B/P3B	Empl + Spouse + Child(ren) T4B/P4B
Administrative Cost	$0.92	$1.73	$1.82	$2.63
Premium	$45.94	$86.66	$90.96	$131.66
Total Rate	$46.86	$88.39	$92.78	$134.29

COBRA Rates with Disability Extension

FY2024 State of Colorado Monthly Rates and CPPS GTNs and Option Codes

Cigna HDHP

Rate Type	Empl Only T1/P1	Empl + Spouse T2/P2	Empl + Child(ren) T3/P3	Empl + Spouse + Child(ren) T4/P4
Administrative Cost	$406.43	$789.77	$726.49	$1,103.96
Premium	$812.86	$1,579.54	$1,452.98	$2,207.92
Total Rate	$1,219.29	$2,369.31	$2,179.47	$3,311.88

Cigna Copay Choice

Rate Type	Empl Only T1/P1	Empl + Spouse T2/P2	Empl + Child(ren) T3/P3	Empl + Spouse + Child(ren) T4/P4
Administrative Cost	$418.47	$844.97	$774.56	$1,194.54
Premium	$836.94	$1,689.94	$1,549.12	$2,389.08
Total Rate	$1,255.41	$2,534.91	$2,323.68	$3,583.62

Cigna Copay Basic

Rate Type	Empl Only T1/P1	Empl + Spouse T2/P2	Empl + Child(ren) T3/P3	Empl + Spouse + Child(ren) T4/P4
Administrative Cost	$409.61	$827.02	$758.11	$1,169.13
Premium	$819.22	$1,654.04	$1,516.22	$2,338.26
Total Rate	$1,228.83	$2,481.06	$2,274.33	$3,507.39

Kaiser HDHP

Rate Type	Empl Only T1/P1	Empl + Spouse T2/P2	Empl + Child(ren) T3/P3	Empl + Spouse + Child(ren) T4/P4
Administrative Cost	$329.91	$656.22	$597.10	$923.39
Premium	$659.82	$1,312.44	$1,194.20	$1,846.78
Total Rate	$989.73	$1,968.66	$1,791.30	$2,770.17

Kaiser Copay Plus

Rate Type	Empl Only T1/P1	Empl + Spouse T2/P2	Empl + Child(ren) T3/P3	Empl + Spouse + Child(ren) T4/P4
Administrative Cost	$364.30	$760.56	$688.33	$1,085.24
Premium	$728.60	$1,521.12	$1,376.66	$2,170.48
Total Rate	$1,092.90	$2,281.68	$2,064.99	$3,255.72

Kaiser Copay Basic

Rate Type	Empl Only T1/P1	Empl + Spouse T2/P2	Empl + Child(ren) T3/P3	Empl + Spouse + Child(ren) T4/P4
Administrative Cost	$344.87	$719.81	$651.46	$1,027.02
Premium	$689.74	$1,439.62	$1,302.92	$2,054.04
Total Rate	$1,034.61	$2,159.43	$1,954.38	$3,081.06

EyeMed Vision Basic

Rate Type	Empl Only TV1/PV1	Empl + Spouse TV2/PV2	Empl + Child(ren) TV3/PV3	Empl + Spouse + Child(ren) TV4/PV4
Administrative Cost	$1.59	$3.03	$3.19	$4.69
Premium	$3.18	$6.06	$6.38	$9.38
Total Rate	$4.77	$9.09	$9.57	$14.07

EyeMed Vision Enhanced

Rate Type	Empl Only TE1/PE1	Empl + Spouse TE2/PE2	Empl + Child(ren) TE3/PE3	Empl + Spouse + Child(ren) TE4/PE4
Administrative Cost	$3.79	$7.21	$7.59	$11.15
Premium	$7.58	$14.42	$15.18	$22.30
Total Rate	$11.37	$21.63	$22.77	$33.45

Delta Dental - Basic

Rate Type	Empl Only T1A/P1A	Empl + Spouse T2A/P2A	Empl + Child(ren) T3A/P3A	Empl + Spouse + Child(ren) T4A/P4A
Administrative Cost	$19.35	$36.27	$38.05	$54.97
Premium	$38.70	$72.54	$76.10	$109.94
Total Rate	$58.05	$108.81	$114.15	$164.91

Delta Dental - Basic Plus

Rate Type	Empl Only T1B/P1B	Empl + Spouse T2B/P2B	Empl + Child(ren) T3B/P3B	Empl + Spouse + Child(ren) T4B/P4B
Administrative Cost	$22.97	$43.33	$45.48	$65.83
Premium	$45.94	$86.66	$90.96	$131.66
Total Rate	$68.91	$129.99	$136.44	$197.49

Life Rates

FY 2023-2024 Basic Life and AD&D Insurance

Monthly premium rates are per employee per month (100% State-paid)

FY 2023-24 Benefit	Basic Life Rate per Employee per Month	Basic AD&D Rate per Employee per Month	Total Basic Life and AD&D Rate per Employee per Month
No Value	$7.40	$1.44	$8.84

FY 2023-2024 Employee Optional Life and AD&D Insurance

Monthly premium rates are for $1,000 of coverage (100% Employee paid)

Age Bracket	Employee Optional Life Rate per $1,000 per Month	Employee Optional AD&D Rate per $1,000 per Month	Total Employee Optional Life and AD&D Rate per $1,000 per Month
Under age 20	$0.04	$0.02	$0.06
20-24	$0.04	$0.02	$0.06
25-29	$0.04	$0.02	$0.06
30-34	$0.06	$0.02	$0.08
35-39	$0.06	$0.02	$0.08
40-44	$0.06	$0.02	$0.10
45-49	$0.08	$0.02	$0.10
50-54	$0.08	$0.02	$0.12
55-59	$0.24	$0.02	$0.26
60-64	$0.38	$0.02	$0.40
65-69	$0.78	$0.02	$0.80
Age 70 and Over	$1.20	$0.02	$1.22

Reminder: The age used for an employee's premium calculation, from 1/1/2023 to 12/31/2023, will be the employee's age as of 12/31/2022.

FY 2023-2024 Spouse Optional Life and AD&D Insurance

Monthly premium rates are for $1,000 of coverage (100% Employee paid)

Age Bracket	Spouse Optional Life Rate per $1,000 per Month	Spouse Optional AD&D Rate per $1,000 per Month	Total Spouse Optional Life and AD&D Rate per $1,000 per Month
Under age 20	$0.06	$0.02	$0.08
20-24	$0.06	$0.02	$0.08
25-29	$0.06	$0.02	$0.08
30-34	$0.08	$0.02	$0.10
35-39	$0.10	$0.02	$0.12
40-44	$0.10	$0.02	$0.12
45-49	$0.16	$0.02	$0.18
50-54	$0.24	$0.02	$0.26
55-59	$0.44	$0.02	$0.46
60-64	$0.66	$0.02	$0.68
65-69	$1.32	$0.02	$1.34
Age 70 and Over	$2.10	$0.02	$2.12

Reminder: The age used for a spouse's premium calculation, from 1/1/2023 to 12/31/2023, will be the spouse's age as of 12/31/2022.

FY 2023-2024 Child Optional Life and AD&D Insurance

Monthly premium rates are per family unit (100% Employee paid)

Benefit	Child Optional Life Rate per Family Unit per Month	Child Optional AD&D Rate per Family Unit per Month	Total Child Optional Life and AD&D Rate per Family Unit per Month
$5,000	$0.40	$0.10	$0.50
$10,000	$0.80	$0.20	$1.00

STD-LTD Rates

FY 2023-2024 Short-Term Disability (STD) Insurance

Monthly premium rate is a percentage of an employee's monthly covered compensation (100% State paid).

STD Premium Rate: .15% (0.0015) of monthly covered compensation effective 7/1/2023.

FY 2023-2024 Optional Long-Term Disability (LTD) Insurance

The monthly LTD premiums are 100% Employee paid.

The monthly LTD premium rates are a percentage of an employee's monthly covered compensation.

Age	PERA DB Vested Option Rate (Percentage of Monthly Covered Compensation)	PERA DB Non-Vested or DC Option Rate (Percentage of Monthly Covered Compensation)
Under age 30	0.0008	0.0025
30-34	0.0008	0.0025
35-39	0.001	0.003
40-44	0.0013	0.0037
45-49	0.0017	0.0052
50-54	0.0026	0.0079
55-59	0.004	0.0118
60-64	0.0055	0.0174
65-69	0.0059	0.0178
Age 70 and Over	0.0072	0.0216

Reminder: The age used for an employee's premium calculation, from 1/1/2023 to 12/31/2023, will be the employee's age as of 12/31/2022.

PPUG Rates: Fiscal Year (FY) 2023-2024

Glossary of Terms

FY2024 State Of Colorado Monthly Rates/CPPS GTNs and Option Codes

Cigna HDHP

Cigna Copay Plus

Cigna Copay Basic

Kaiser HDHP

Kaiser Copay Plus

Kaiser Copay Basic

Eyemed Vision - Basic

Eyemed Vision - Enhanced

Delta Dental - Basic

Delta Dental - Basic Plus

Other Benefit Information

Imputed Income Rates FY24

Cigna HDHP

Cigna Copay Plus

Cigna Copay Basic

Kaiser HDHP

Kaiser Copay Plus

Kaiser Copay Basic

Eyemed Vision - Basic

Eyemed Vision - Enhanced

Delta Dental - Basic

Delta Dental - Basic Plus

Notes

Health and Wellness Rates FY 24

Cigna HDHP

Cigna Copay Plus

Cigna Copay Basic

Kaiser HDHP

Kaiser Copay Plus

FY24 Subsidy Group A

Cigna HDHP

Cigna Copay Plus

Cigna Copay Basic

Kaiser HDHP

Kaiser Copay Plus

Kaiser Copay Basic

Delta Dental - Basic

Delta Dental - Basic Plus

COBRA Rates

Cigna HDHP

Cigna Copay Plus

Cigna Copay Basic

Kaiser HDHP

Kaiser Copay Plus

Kaiser DHMO Copay Basic

EyeMed Vision Basic

EyeMed Vision Enhanced

Delta Dental - Basic

Delta Dental - Basic Plus

COBRA Rates with Disability Extension

Cigna HDHP

Cigna Copay Choice

Kaiser HDHP

Kaiser Copay Plus

Kaiser Copay Basic

EyeMed Vision Basic

EyeMed Vision Enhanced

Delta Dental - Basic

Delta Dental - Basic Plus

Life Rates

FY 2023-2024 Basic Life and AD&D Insurance

FY 2023-2024 Employee Optional Life and AD&D Insurance

FY 2023-2024 Spouse Optional Life and AD&D Insurance

FY 2023-2024 Child Optional Life and AD&D Insurance

STD-LTD Rates

FY 2023-2024 Short-Term Disability (STD) Insurance

FY 2023-2024 Optional Long-Term Disability (LTD) Insurance

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