30-E2 - 11 November 2025 Symetra A161768 Backup.pdf
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- Attached to
- Ancillary Insurance Benefits
- Solicitation number
- RFP 2026-018
- Issued by
- Johnson County, Texas
About this file
This is a billing statement for ancillary insurance benefits provided by Symetra to the City of Burleson for the billing period of November 1, 2025. The document details premium charges across multiple insurance product categories including Basic AD&D, Long Term Disability (LTD), Basic Life, Supplemental Employee Life/AD&D, Supplemental Spouse Life/AD&D, Basic Spouse & Child Life/AD&D, Supplemental Child(ren) Life/AD&D, and Short Term Disability Employee Paid. The billing is organized by 72 distinct row labels (likely representing individual departments, divisions, or employee groups within the municipality) with varying participant counts ranging from 1 to 17 members per category. The volume of covered lives totals 2,213 across all categories, with premium volumes exceeding $161 million and total premiums charged at $28,029.55 for the billing period.
The pricing structure shows no adjustments applied to any premium charges, with all adjustments listed at $0.00. Individual product premiums vary significantly based on participant volume and coverage type, with Basic Life insurance representing the largest premium component at $6,086.99, followed by Supplemental Employee Life/AD&D at $5,310.66 and Short Term Disability at $6,811.64. The billing reflects granular cost allocation across the municipality's organizational structure, enabling department-level budget tracking and cost attribution for employee benefit expenditures.
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Text version
Billing Period: 11/01/2025
Values Row Labels Count Volume Premium Adjustments Total Premium Basic AD&D 407 $64,756,600.00 $1,942.70 $0.00 $1,942.70
33 17 $2,404,000.00 $72.12 $0.00 $72.12 40 13 $2,552,000.00 $76.56 $0.00 $76.56 32 9 $1,361,000.00 $40.83 $0.00 $40.83 50 8 $1,395,000.00 $41.85 $0.00 $41.85 36 10 $1,513,000.00 $45.39 $0.00 $45.39 31 7 $976,000.00 $29.28 $0.00 $29.28 27 17 $2,095,000.00 $62.85 $0.00 $62.85 24 12 $1,651,000.00 $49.53 $0.00 $49.53 48 8 $1,295,000.00 $38.85 $0.00 $38.85 42 10 $1,866,000.00 $55.98 $0.00 $55.98 46 7 $1,024,000.00 $30.72 $0.00 $30.72 58 3 $588,000.00 $17.64 $0.00 $17.64 51 8 $1,549,000.00 $46.47 $0.00 $46.47 35 10 $1,610,000.00 $48.30 $0.00 $48.30 47 9 $1,746,000.00 $52.38 $0.00 $52.38 55 7 $1,107,000.00 $33.21 $0.00 $33.21 54 7 $1,301,000.00 $39.03 $0.00 $39.03 49 7 $1,096,000.00 $32.88 $0.00 $32.88 26 10 $1,199,000.00 $35.97 $0.00 $35.97 37 12 $2,160,000.00 $64.80 $0.00 $64.80 41 12 $2,162,000.00 $64.86 $0.00 $64.86 64 5 $1,031,000.00 $30.93 $0.00 $30.93 44 7 $1,412,000.00 $42.36 $0.00 $42.36 52 7 $1,627,000.00 $48.81 $0.00 $48.81 23 17 $2,191,000.00 $65.73 $0.00 $65.73 43 6 $1,187,000.00 $35.61 $0.00 $35.61 30 12 $1,829,000.00 $54.87 $0.00 $54.87 57 7 $828,000.00 $24.84 $0.00 $24.84 39 14 $2,389,000.00 $71.67 $0.00 $71.67 34 16 $2,598,000.00 $77.94 $0.00 $77.94 56 2 $277,000.00 $8.31 $0.00 $8.31 60 4 $817,000.00 $24.51 $0.00 $24.51 28 6 $1,025,000.00 $30.75 $0.00 $30.75 61 4 $381,000.00 $11.43 $0.00 $11.43 38 17 $2,920,000.00 $87.60 $0.00 $87.60 25 11 $1,470,000.00 $44.10 $0.00 $44.10 53 7 $1,241,000.00 $37.23 $0.00 $37.23 62 5 $829,000.00 $24.87 $0.00 $24.87 20 6 $687,000.00 $20.61 $0.00 $20.61
Charge Summary - City of Burleson - for Symetra
Row Labels Count Volume Premium Adjustments Total Premium
59 5 $1,080,000.00 $32.40 $0.00 $32.40 45 7 $1,218,000.00 $36.54 $0.00 $36.54 66 1 $94,900.00 $2.85 $0.00 $2.85 63 2 $226,000.00 $6.78 $0.00 $6.78 29 17 $2,526,000.00 $75.78 $0.00 $75.78 22 6 $653,000.00 $19.59 $0.00 $19.59 65 2 $375,700.00 $11.27 $0.00 $11.27 21 7 $757,000.00 $22.71 $0.00 $22.71 19 3 $371,000.00 $11.13 $0.00 $11.13 71 1 $66,000.00 $1.98 $0.00 $1.98
Long Term Disability (LTD) 407 $2,625,430.60 $5,513.45 $0.00 $5,513.45 33 17 $99,926.63 $209.84 $0.00 $209.84 40 13 $101,177.97 $212.46 $0.00 $212.46 32 9 $56,163.80 $117.93 $0.00 $117.93 50 8 $56,338.62 $118.33 $0.00 $118.33 36 10 $62,880.18 $132.03 $0.00 $132.03 31 7 $40,485.24 $85.02 $0.00 $85.02 27 17 $86,917.24 $182.54 $0.00 $182.54 24 12 $68,533.72 $143.93 $0.00 $143.93 48 8 $53,702.59 $112.78 $0.00 $112.78 42 10 $73,816.08 $155.02 $0.00 $155.02 46 7 $42,225.07 $88.68 $0.00 $88.68 58 3 $21,948.38 $46.09 $0.00 $46.09 51 8 $61,597.65 $129.36 $0.00 $129.36 35 10 $66,898.20 $140.48 $0.00 $140.48 47 9 $70,033.89 $147.06 $0.00 $147.06 55 7 $43,406.01 $91.16 $0.00 $91.16 54 7 $49,493.49 $103.94 $0.00 $103.94 49 7 $44,202.36 $92.82 $0.00 $92.82 26 10 $49,771.29 $104.50 $0.00 $104.50 37 12 $87,735.50 $184.24 $0.00 $184.24 41 12 $88,982.02 $186.87 $0.00 $186.87 64 5 $36,688.18 $77.04 $0.00 $77.04 44 7 $55,600.03 $116.77 $0.00 $116.77 52 7 $62,700.33 $131.67 $0.00 $131.67 23 17 $90,865.85 $190.83 $0.00 $190.83 43 6 $44,330.99 $93.10 $0.00 $93.10 30 12 $75,944.43 $159.49 $0.00 $159.49 57 7 $34,368.53 $72.18 $0.00 $72.18 39 14 $96,821.18 $203.32 $0.00 $203.32 34 16 $104,243.84 $218.92 $0.00 $218.92 56 2 $11,483.91 $24.12 $0.00 $24.12 60 4 $31,845.39 $66.88 $0.00 $66.88 28 6 $42,610.10 $89.48 $0.00 $89.48 61 4 $15,777.15 $33.14 $0.00 $33.14
38 17 $116,371.09 $244.38 $0.00 $244.38 25 11 $61,055.56 $128.21 $0.00 $128.21 53 7 $49,068.33 $103.05 $0.00 $103.05 62 5 $34,400.70 $72.24 $0.00 $72.24 20 6 $28,540.09 $59.94 $0.00 $59.94 59 5 $40,765.99 $85.61 $0.00 $85.61 45 7 $47,405.63 $99.55 $0.00 $99.55 66 1 $6,069.90 $12.75 $0.00 $12.75 63 2 $9,362.43 $19.66 $0.00 $19.66 29 17 $103,549.78 $217.45 $0.00 $217.45 22 6 $27,016.41 $56.74 $0.00 $56.74 65 2 $20,000.00 $42.00 $0.00 $42.00 21 7 $31,423.95 $65.99 $0.00 $65.99 19 3 $15,413.20 $32.37 $0.00 $32.37 71 1 $5,471.70 $11.49 $0.00 $11.49
(blank) (blank)
Basic Life 407 $64,756,600.00 $6,086.99 $0.00 $6,086.99 33 17 $2,404,000.00 $225.98 $0.00 $225.98 40 13 $2,552,000.00 $239.87 $0.00 $239.87 32 9 $1,361,000.00 $127.94 $0.00 $127.94 50 8 $1,395,000.00 $131.13 $0.00 $131.13 36 10 $1,513,000.00 $142.21 $0.00 $142.21 31 7 $976,000.00 $91.75 $0.00 $91.75 27 17 $2,095,000.00 $196.93 $0.00 $196.93 24 12 $1,651,000.00 $155.16 $0.00 $155.16 48 8 $1,295,000.00 $121.72 $0.00 $121.72 42 10 $1,866,000.00 $175.40 $0.00 $175.40 46 7 $1,024,000.00 $96.25 $0.00 $96.25 58 3 $588,000.00 $55.27 $0.00 $55.27 51 8 $1,549,000.00 $145.61 $0.00 $145.61 35 10 $1,610,000.00 $151.35 $0.00 $151.35 47 9 $1,746,000.00 $164.12 $0.00 $164.12 55 7 $1,107,000.00 $104.05 $0.00 $104.05 54 7 $1,301,000.00 $122.28 $0.00 $122.28 49 7 $1,096,000.00 $103.03 $0.00 $103.03 26 10 $1,199,000.00 $112.70 $0.00 $112.70 37 12 $2,160,000.00 $203.04 $0.00 $203.04 41 12 $2,162,000.00 $203.24 $0.00 $203.24 64 5 $1,031,000.00 $96.92 $0.00 $96.92 44 7 $1,412,000.00 $132.72 $0.00 $132.72 52 7 $1,627,000.00 $152.94 $0.00 $152.94 23 17 $2,191,000.00 $205.92 $0.00 $205.92 43 6 $1,187,000.00 $111.58 $0.00 $111.58 30 12 $1,829,000.00 $171.94 $0.00 $171.94
57 7 $828,000.00 $77.83 $0.00 $77.83 39 14 $2,389,000.00 $224.57 $0.00 $224.57 34 16 $2,598,000.00 $244.23 $0.00 $244.23 56 2 $277,000.00 $26.03 $0.00 $26.03 60 4 $817,000.00 $76.79 $0.00 $76.79 28 6 $1,025,000.00 $96.34 $0.00 $96.34 61 4 $381,000.00 $35.82 $0.00 $35.82 38 17 $2,920,000.00 $274.46 $0.00 $274.46 25 11 $1,470,000.00 $138.19 $0.00 $138.19 53 7 $1,241,000.00 $116.65 $0.00 $116.65 62 5 $829,000.00 $77.92 $0.00 $77.92 20 6 $687,000.00 $64.58 $0.00 $64.58 59 5 $1,080,000.00 $101.52 $0.00 $101.52 45 7 $1,218,000.00 $114.48 $0.00 $114.48 66 1 $94,900.00 $8.92 $0.00 $8.92 63 2 $226,000.00 $21.24 $0.00 $21.24 29 17 $2,526,000.00 $237.44 $0.00 $237.44 22 6 $653,000.00 $61.38 $0.00 $61.38 65 2 $375,700.00 $35.32 $0.00 $35.32 21 7 $757,000.00 $71.15 $0.00 $71.15 19 3 $371,000.00 $34.88 $0.00 $34.88 71 1 $66,000.00 $6.20 $0.00 $6.20
Supplemental Employee Life/AD&D 192 $23,841,000.00 $5,310.66 $0.00 $5,310.66 33 11 $1,210,000.00 $133.10 $0.00 $133.10 40 6 $880,000.00 $149.60 $0.00 $149.60 32 4 $500,000.00 $55.00 $0.00 $55.00 50 8 $1,000,000.00 $360.00 $0.00 $360.00 36 4 $650,000.00 $84.50 $0.00 $84.50 31 4 $530,000.00 $58.30 $0.00 $58.30 27 4 $550,000.00 $55.00 $0.00 $55.00 24 3 $350,000.00 $35.00 $0.00 $35.00 48 5 $600,000.00 $150.00 $0.00 $150.00 42 5 $770,000.00 $130.90 $0.00 $130.90 46 5 $770,000.00 $192.50 $0.00 $192.50 58 3 $390,000.00 $222.30 $0.00 $222.30 51 4 $340,000.00 $122.40 $0.00 $122.40 47 6 $840,000.00 $210.00 $0.00 $210.00 55 5 $440,000.00 $250.80 $0.00 $250.80 54 6 $730,000.00 $262.80 $0.00 $262.80 49 5 $560,000.00 $140.00 $0.00 $140.00 26 3 $550,000.00 $55.00 $0.00 $55.00 37 9 $1,090,000.00 $141.70 $0.00 $141.70 41 8 $930,000.00 $158.10 $0.00 $158.10 64 2 $190,000.00 $142.50 $0.00 $142.50 44 5 $650,000.00 $110.50 $0.00 $110.50
52 4 $450,000.00 $162.00 $0.00 $162.00 23 5 $680,000.00 $68.00 $0.00 $68.00 43 4 $430,000.00 $73.10 $0.00 $73.10 30 7 $750,000.00 $82.50 $0.00 $82.50 57 2 $40,000.00 $22.80 $0.00 $22.80 39 9 $1,290,000.00 $167.70 $0.00 $167.70 34 6 $870,000.00 $95.70 $0.00 $95.70 56 1 $150,000.00 $85.50 $0.00 $85.50 60 2 $300,000.00 $225.00 $0.00 $225.00 28 1 $150,000.00 $15.00 $0.00 $15.00 61 3 $40,000.00 $30.00 $0.00 $30.00 38 11 $1,800,000.00 $234.00 $0.00 $234.00 53 4 $710,000.00 $255.60 $0.00 $255.60 62 3 $260,000.00 $195.00 $0.00 $195.00 20 2 $250,000.00 $25.00 $0.00 $25.00 59 1 $100,000.00 $57.00 $0.00 $57.00 45 5 $580,000.00 $145.00 $0.00 $145.00 29 4 $370,000.00 $37.00 $0.00 $37.00 22 1 $10,000.00 $1.00 $0.00 $1.00 65 2 $91,000.00 $113.76 $0.00 $113.76
Supplemental Spouse Life/AD&D 96 $4,966,250.00 $1,242.31 $0.00 $1,242.31 33 7 $310,000.00 $34.10 $0.00 $34.10 40 3 $110,000.00 $18.70 $0.00 $18.70 32 2 $100,000.00 $11.00 $0.00 $11.00 50 5 $270,000.00 $97.20 $0.00 $97.20 36 1 $120,000.00 $15.60 $0.00 $15.60 31 1 $50,000.00 $5.50 $0.00 $5.50 27 1 $50,000.00 $5.00 $0.00 $5.00 24 1 $50,000.00 $5.00 $0.00 $5.00 48 4 $140,000.00 $35.00 $0.00 $35.00 42 2 $150,000.00 $25.50 $0.00 $25.50 46 3 $95,000.00 $23.75 $0.00 $23.75 58 1 $50,000.00 $28.50 $0.00 $28.50 47 5 $295,000.00 $73.75 $0.00 $73.75 55 4 $140,000.00 $79.80 $0.00 $79.80 54 4 $205,000.00 $73.80 $0.00 $73.80 49 3 $130,000.00 $32.50 $0.00 $32.50 37 4 $325,000.00 $42.25 $0.00 $42.25 41 3 $220,000.00 $37.40 $0.00 $37.40 64 2 $170,000.00 $127.50 $0.00 $127.50 44 4 $325,000.00 $55.25 $0.00 $55.25 52 3 $95,000.00 $34.20 $0.00 $34.20 43 2 $100,000.00 $17.00 $0.00 $17.00 30 3 $150,000.00 $16.50 $0.00 $16.50 39 7 $320,000.00 $41.60 $0.00 $41.60
34 3 $150,000.00 $16.50 $0.00 $16.50 60 1 $30,000.00 $22.50 $0.00 $22.50 28 1 $50,000.00 $5.00 $0.00 $5.00 61 1 $10,000.00 $7.50 $0.00 $7.50 38 5 $285,000.00 $37.05 $0.00 $37.05 53 2 $180,000.00 $64.80 $0.00 $64.80 62 3 $95,000.00 $71.25 $0.00 $71.25 59 1 $50,000.00 $28.50 $0.00 $28.50 45 3 $130,000.00 $32.50 $0.00 $32.50 65 1 $16,250.00 $20.31 $0.00 $20.31
Basic Spouse & Child Life/AD&D 275 $0.00 $825.00 $0.00 $825.00 33 13 $0.00 $39.00 $0.00 $39.00 40 12 $0.00 $36.00 $0.00 $36.00 32 8 $0.00 $24.00 $0.00 $24.00 50 8 $0.00 $24.00 $0.00 $24.00 36 8 $0.00 $24.00 $0.00 $24.00 31 6 $0.00 $18.00 $0.00 $18.00 27 9 $0.00 $27.00 $0.00 $27.00 24 2 $0.00 $6.00 $0.00 $6.00 48 7 $0.00 $21.00 $0.00 $21.00 42 8 $0.00 $24.00 $0.00 $24.00 46 5 $0.00 $15.00 $0.00 $15.00 58 2 $0.00 $6.00 $0.00 $6.00 51 7 $0.00 $21.00 $0.00 $21.00 35 9 $0.00 $27.00 $0.00 $27.00 47 8 $0.00 $24.00 $0.00 $24.00 55 6 $0.00 $18.00 $0.00 $18.00 54 7 $0.00 $21.00 $0.00 $21.00 49 4 $0.00 $12.00 $0.00 $12.00 26 2 $0.00 $6.00 $0.00 $6.00 37 9 $0.00 $27.00 $0.00 $27.00 41 12 $0.00 $36.00 $0.00 $36.00 64 4 $0.00 $12.00 $0.00 $12.00 44 6 $0.00 $18.00 $0.00 $18.00 52 5 $0.00 $15.00 $0.00 $15.00 23 4 $0.00 $12.00 $0.00 $12.00 43 5 $0.00 $15.00 $0.00 $15.00 30 10 $0.00 $30.00 $0.00 $30.00 57 3 $0.00 $9.00 $0.00 $9.00 39 13 $0.00 $39.00 $0.00 $39.00 34 12 $0.00 $36.00 $0.00 $36.00 56 1 $0.00 $3.00 $0.00 $3.00 60 2 $0.00 $6.00 $0.00 $6.00 28 3 $0.00 $9.00 $0.00 $9.00 61 3 $0.00 $9.00 $0.00 $9.00
38 16 $0.00 $48.00 $0.00 $48.00 25 1 $0.00 $3.00 $0.00 $3.00 53 5 $0.00 $15.00 $0.00 $15.00 62 5 $0.00 $15.00 $0.00 $15.00 20 1 $0.00 $3.00 $0.00 $3.00 59 4 $0.00 $12.00 $0.00 $12.00 45 6 $0.00 $18.00 $0.00 $18.00 66 1 $0.00 $3.00 $0.00 $3.00 29 10 $0.00 $30.00 $0.00 $30.00 22 1 $0.00 $3.00 $0.00 $3.00 65 1 $0.00 $3.00 $0.00 $3.00 21 1 $0.00 $3.00 $0.00 $3.00
Supplemental Child(ren) Life/AD&D: $20,000106 $0.00 $296.80 $0.00 $296.80 33 5 $0.00 $14.00 $0.00 $14.00 40 4 $0.00 $11.20 $0.00 $11.20 32 3 $0.00 $8.40 $0.00 $8.40 50 7 $0.00 $19.60 $0.00 $19.60 36 3 $0.00 $8.40 $0.00 $8.40 31 2 $0.00 $5.60 $0.00 $5.60 24 1 $0.00 $2.80 $0.00 $2.80 48 5 $0.00 $14.00 $0.00 $14.00 42 2 $0.00 $5.60 $0.00 $5.60 46 5 $0.00 $14.00 $0.00 $14.00 51 4 $0.00 $11.20 $0.00 $11.20 47 5 $0.00 $14.00 $0.00 $14.00 55 2 $0.00 $5.60 $0.00 $5.60 54 2 $0.00 $5.60 $0.00 $5.60 49 2 $0.00 $5.60 $0.00 $5.60 37 5 $0.00 $14.00 $0.00 $14.00 41 4 $0.00 $11.20 $0.00 $11.20 64 1 $0.00 $2.80 $0.00 $2.80 44 5 $0.00 $14.00 $0.00 $14.00 52 2 $0.00 $5.60 $0.00 $5.60 23 2 $0.00 $5.60 $0.00 $5.60 43 2 $0.00 $5.60 $0.00 $5.60 30 3 $0.00 $8.40 $0.00 $8.40 39 9 $0.00 $25.20 $0.00 $25.20 34 5 $0.00 $14.00 $0.00 $14.00 61 2 $0.00 $5.60 $0.00 $5.60 38 6 $0.00 $16.80 $0.00 $16.80 53 2 $0.00 $5.60 $0.00 $5.60 45 3 $0.00 $8.40 $0.00 $8.40 29 3 $0.00 $8.40 $0.00 $8.40
Short Term Disability Employee Paid 323 $281,475.23 $6,811.64 $0.00 $6,811.64 33 15 $11,765.68 $284.75 $0.00 $284.75
40 8 $8,333.92 $201.68 $0.00 $201.68 32 9 $7,834.23 $189.58 $0.00 $189.58 50 8 $7,916.13 $191.57 $0.00 $191.57 36 9 $7,988.07 $193.31 $0.00 $193.31 31 7 $5,605.65 $135.66 $0.00 $135.66 27 16 $11,346.60 $274.57 $0.00 $274.57 24 11 $8,762.37 $212.06 $0.00 $212.06 48 8 $7,435.73 $179.95 $0.00 $179.95 42 6 $6,859.59 $166.00 $0.00 $166.00 46 6 $4,461.94 $107.98 $0.00 $107.98 58 3 $3,154.39 $76.34 $0.00 $76.34 51 6 $5,875.06 $142.17 $0.00 $142.17 35 8 $7,354.02 $177.96 $0.00 $177.96 47 6 $6,534.60 $158.13 $0.00 $158.13 55 6 $5,361.96 $129.75 $0.00 $129.75 54 5 $4,961.42 $120.06 $0.00 $120.06 49 7 $6,298.30 $152.41 $0.00 $152.41 26 10 $6,891.41 $166.77 $0.00 $166.77 37 9 $8,479.75 $205.21 $0.00 $205.21 41 7 $6,776.42 $163.99 $0.00 $163.99 64 3 $2,426.05 $58.71 $0.00 $58.71 44 5 $5,277.18 $127.71 $0.00 $127.71 52 4 $4,725.09 $114.35 $0.00 $114.35 23 13 $10,006.39 $242.15 $0.00 $242.15 43 3 $3,079.11 $74.51 $0.00 $74.51 30 9 $7,673.97 $185.71 $0.00 $185.71 57 7 $4,758.72 $115.17 $0.00 $115.17 39 9 $8,476.16 $205.12 $0.00 $205.12 34 13 $10,931.38 $264.52 $0.00 $264.52 60 3 $3,024.74 $73.20 $0.00 $73.20 28 5 $4,845.82 $117.27 $0.00 $117.27 61 4 $2,184.53 $52.86 $0.00 $52.86 38 11 $10,089.27 $244.16 $0.00 $244.16 25 10 $7,558.66 $182.91 $0.00 $182.91 53 5 $5,140.22 $124.39 $0.00 $124.39 62 5 $4,763.17 $115.27 $0.00 $115.27 20 5 $3,594.27 $86.99 $0.00 $86.99 59 3 $3,681.83 $89.10 $0.00 $89.10 45 4 $4,748.30 $114.91 $0.00 $114.91 66 1 $840.45 $20.34 $0.00 $20.34 63 1 $571.60 $13.83 $0.00 $13.83 29 13 $10,376.14 $251.11 $0.00 $251.11 22 5 $3,219.79 $77.91 $0.00 $77.91 65 2 $3,000.00 $72.60 $0.00 $72.60 21 7 $4,351.01 $105.29 $0.00 $105.29
19 3 $2,134.14 $51.65 $0.00 $51.65 Grand Total 2213 $161,227,355.83 $28,029.55 $0.00 $28,029.55
File details come from the government source that posted it. Updated .