Adams 12 Five Star Schools provides all required Employee Benefit notices electronically in PDF format on both the Employee Benefits Internet site at www.adams12.org and Employee Benefits Intranet site at https://staff.adams12.org, which is accessible on Adams 12 Five Star Schools computers.
- ACA Marketplace Notice
- Children's Health Insurance Program Notice
- Family Medical Leave Act Notice
- Family Outreach Notice
- Initial COBRA Notice
- Kaiser HDHP Summary of Benefits Coverage
- Kaiser DHMO Summary of Benefits Coverage
- Kaiser POS Summary of Benefits Coverage (CLOSED to new participants / current participants only)
- Medicare Creditable Coverage Notice - DHMO & POS Plans
- Medicare Non-Creditable Coverage Notice - HDHP Plan
- Notice of Electronic Disclosure
- Notice of Privacy Practices
- Primary Care Provider Designation, Direct Access to OB-GYN Providers, and Newborns' and Mothers' Protection Act Notices
- Women's Health and Cancer Right Act Notice
Each insurance plan also has an Evidence of Coverage, Certificate of Coverage or Summary Plan Description that contains critical information about the plan. Examples of this critical information include, but are not limited to: coverage limits; covered services and exclusions; applicable cost sharing; rights under the plan; claim appeal procedures; and any material changes made to the plan.
- Delta Dental EPO Certificate of Coverage
- Delta Dental PPO Certificate of Coverage
- Kaiser Permanente HDHP Evidence of Coverage
- Kaiser Permanente DHMO Evidence of Coverage
- Kaiser Permanente POS Evidence of Coverage (CLOSED to new participants / current participants only)
- Mutual of Omaha Life and AD&D Certificate of Coverage for Administrative & Certified Employees
- Mutual of Omaha Life and AD&D Certificate of Coverage for Classified Employees
- The Standard LTD Certificate of Coverage
- The Standard STD Certificate of Coverage
- VSP Vision Plan Certificate of Coverage
- Section 125 Summary Plan Description
Employees have the right to request a paper version of these documents free of charge or withdraw consent to electronic distribution at any time by writing to us at:
Adams 12 Five Star Schools
Attn: Human Resources
1500 East 128th Avenue
Thornton, CO 80241
Thank you! Thank you for investing in the students of Adams 12 Five Star Schools. Ballot Issue 5C passed with 56.30 percent voter approval.
With your support, we are now able to jump-start the priorities outlined in our strategic plan ELEVATE that parents, students, staff and community members worked together to create.
Thank you for passing 5C
This additional funding ...