38-F2 - 2026 Burleson COBRA-Retiree Guide rev 09 10 25 FINAL.pdf
PDF 4 MB Posted
- Attached to
- Ancillary Insurance Benefits
- Solicitation number
- RFP 2026-018
- Issued by
- Johnson County, Texas
About this file
This document is a 2026 Benefits Guide for Retirees and COBRA Participants of the City of Burleson, Texas, outlining the organization's comprehensive ancillary insurance benefits program. The guide provides detailed information on medical coverage through UnitedHealthcare (UHC) in two plan options: a High-Deductible Plan and a Copay/Retiree Plan, both structured as Exclusive Provider Organization (EPO) plans with varying deductibles, out-of-pocket maximums, and copay structures. Additional coverage includes dental services through UHC with Base and Buy-Up plan options, vision coverage administered by Spectera, and supplementary health care tools and resources such as the Advocate 4 Me program, LabCorp/Quest lab services, orthopedic programs, Airrosti chronic pain management, and fitness memberships through the Burleson Recreation Center and One Pass Select. Retirees must meet TMRS retirement qualification standards and have completed five years of consecutive service with the City of Burleson to be eligible for these benefits, which continue until Medicare eligibility at age 65. COBRA participants are administered through Flores HR.
The guide establishes tiered monthly rates for medical, dental, and vision coverage that differ between COBRA participants and retirees across individual and family coverage categories. Retirees with 20 or more years of service receive rate discounts ranging from 25 to 50 percent on the retiree-only portion of medical and dental benefits for the first five years following retirement, with no discounts available for dependent coverage. For example, the High-Deductible Plan ranges from $739.15 monthly for individual-only retiree coverage to $2,695.80 for individual plus family COBRA coverage, while the Copay Plan ranges from $1,015.29 to $3,702.79 monthly across the same tiers. Pre-Medicare eligible retirees must execute an affidavit confirming they have no access to alternative health or dental coverage. Enrollment is managed through the HR Department at (817) 426-9642 or via Bentek at mybentek.com/cityofburleson, with ongoing support available through the Advocate 4 Me program at no cost to participants.
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Text version
HELPING YOU THRIVE
guide
2026 BENEFITS
FOR RETIREES AND COBRA PARTICIPANTS OF THE CITY OF BURLESON
LOOK INSIDE
FOR IMPORTANT
INFORMATION ON
YOUR 2026 BENEFITS
PROGRAM.
welcome
DENTAL
VISION
RATES
Look Inside
HOW TO ENROLL
Retirees Benefits & Enrollment Support
MEDICAL
HEALTH CARE TOOLS & RESOURCES
Benefits Contact Directory Topic Contact Group
Number Phone Website & Email
General Benefits and/or Enrollment Human Resources N/A (817) 426-9642 Burlesontx.com/ employeeforms
Advocate 4 Me UnitedHealthcare (UHC) 906435 (866) 844-4864 myuhc.com
Medical Coverage and Telemedicine UnitedHealthcare (UHC) 906435 (866) 844-4864 myuhc.com
Dental Coverage UnitedHealthcare (UHC) 1019974 (866) 844-4864 myuhc.com
Vision Coverage UnitedHealthcare (UHC) 1-1GKH-14580 (866) 844-4864 myuhcvision.com
Lab Work Quest LabCorp
N/A N/A
(866) 697-8378
(817) 447-0367, Burleson Office questdiagnostics.com labcorp.com
Orthopedic Programs UnitedHealthcare (UHC) N/A (800) 379-6898 myuhc.com
Chronic Pain Management Airrosti N/A (800) 404-6050 airrosti.com
Retirement Plan Texas Municipal Retirement System
(TMRS)
00202 (800) 924-8677 mytmrs.com
COBRA Flores N/A (800) 532-3327 floresHR.com
Deferred Compensation:
457(b) Plan and Roth
Voya
Plan Number:
664FN2
Verification Number:
664FN299
(800) 584-6001 login.voya.com http://www.Burlesontx.com/employeeforms http://www.Burlesontx.com/employeeforms http://www.myuhc.com http://www.myuhc.com http://www.myuhc.com http://www.myuhcvision.com http://www.questdiagnostics.com http://www.labcorp.com http://www.myuhc.com http://www.airrosti.com http://www.mytmrs.com http://floresHR.com https://login.voya.com/
RETIREES
You must be qualified to retire, under the standards of retirement as established by TMRS, to qualify for any medical, dental, vision or other insurance benefit for retirees at the City of Burleson. You must also have completed five years of consecutive service immediately prior to retirement with the City of Burleson and/or meet whatever vesting requirement is in place with TMRS (whichever is greater) at the time of retirement.
Retirees are eligible to participate in retiree health insurance with the City of Burleson only until you are eligible for Medicare. If you are a pre-Medicare eligible retiree, you must sign an affidavit stating you will not have access to any other health or dental coverage upon retirement through a new employer, or other individually held private health plan.
To check your current benefits or complete enrollment, contact the HR Department:
| • | (817) 426-9642 |
| • | HR@burlesontx.com |
| • | Log on to Bentek using your former employee ID and |
your last four numbers of your Social Security number at mybentek.com/cityofburleson
BENEFITS & ENROLLMENT SUPPORT
If you have questions on your benefits, please contact Human Resources or Advocate 4 Me at (866) 844-4864 or myuhc.com.
COBRA PARTICIPANTS:
Flores will contact you with election information.
MEDICARE SUPPLEMENT
Medicare Supplement details are available by contacting Human Resources.
Qualifications to Retire and How to Enroll the City of Burleson offers a comprehensive and competitive benefits program that provides you with options when it comes to choosing what’s right for you and your family. We are also committed to providing you with the tools and resources you need to live well. At the same time, we look to you to use the health care resources at your disposal to make informed decisions.
Please review this guide carefully for highlights of our benefits and discuss your options with your family.
CITY OF BURLESON BENEFITS
mailto:HR%40burlesontx.com?subject= http://mybentek.com/cityofburleson http://www.myuhc.com
Medical Coverage
UNITEDHEALTHCARE (UHC)
We are proud to offer medical coverage that not only provides coverage for illness and injury, but also enables you and your family to focus on staying well. Both plans are exclusive provider organization (EPO) plans, meaning they generally do not provide out-of-network coverage.
The following is a high-level overview of the coverage available to you. For complete coverage details, please refer to the Summary Plan Description (SPD), found on Burlesontx.com/ employeeforms.
Plan Feature High-Deductible Plan Copay/Retiree Plan
In-Network In-Network Network Choice Network Annual Deductible Individual $3,500 $2,500 Family $7,000 $5,000 Annual Out-of-Pocket Maximum (includes deductible) Individual $5,000 $4,000 Family $10,000 $8,000 Services Office Visit You pay 20% after deductible $25 copay Specialist Visit You pay 20% after deductible $50 copay Wellness Visit Covered at 100% Covered at 100% Hospital Stay (Inpatient & Outpatient) You pay 20% after deductible You pay 20% after deductible
Urgent Care You pay 20% after deductible $50 copay Telemedicine (Virtual Visits) $54 copay $0 with designated Virtual
Network Provider Emergency Room You pay 20% after deductible $250 copay Labcorp Preferred Network Lab (Non-Routine)
You pay 20% after deductible You pay 20% after deductible
Prescription Drugs (Generic/Brand/Non-Formulary/Specialty) Retail Pharmacy (30-day supply)
$0/$35/$70/$200 after deductible $0/$35/$70/$200 copay
Mail Order (90-day supply)* $0/$70/$140 after deductible $0/$70/$140 copay
*Biotech medication is not eligible.
health
ANNUAL MEDICAL
PREVENTIVE EXAM
Remember, there is no waiting period between annual exams—you can schedule your annual preventive exam even if it’s been less than 12 months since your last exam.
Note: The Extended Non-Network Reimbursement Program (ENRP) reimburses you for out-of-network claims. You may be responsible for paying the difference between what the out-of-network provider charges and what the plan covers.
This is known as balance billing.
http://www.Burlesontx.com/employeeforms
Health Care Tools & Resources The City not only provides medical coverage to help you stay well, we also offer a variety of programs, tools and resources to help you make informed health care decisions.
UNITEDHEALTHCARE ADVOCATE 4
ME PROGRAM (for retirees with health insurance) The Advocate 4 Me representatives help take the hassle out of health care and helps you find the right solutions so that you can focus on what matters most to you. The Advocate 4 Me representative can help with:
| • | Understanding your health benefits |
| • | Explaining your medical bills and resolving any |
billing errors
| • | Finding highly rated and cost-effective providers |
| • | Coordinating care |
| • | Comparing costs for common procedures and |
treatment
• Finding lower-cost alternatives to prescriptions
Please note: This program is available at no cost to you and your family.
LABCORP/QUEST
Whenever you require lab work, be sure to use a LabCorp/Quest facility, the preferred lab for the City of Burleson. You will most likely pay less when you visit a LabCorp/Quest facility than when you go outside of the network. Search from more than 1,300 laboratory providers by logging into myuhc.com.
ORTHOPEDIC PROGRAMS
If you have back, knee or hip pain and are looking for information about surgery, you can turn to the orthopedic programs for advice, guidance and support. You will get in touch with an orthopedic nurse, who can go over your treatment options, coordinate your care and follow up with you after your surgery. For more information, call (800) 379-6898.
AIRROSTI
If you suffer from chronic or persistent pain, an Airrosti provider can help you find the root cause and work with you to give you relief as quickly as possible— often within three hour-long visits. Using soft tissue treatment, Airrosti helps you avoid costly surgery and reduces the need for prescription pain medication.
BURLESON RECREATION CENTER
As a retiree, you are eligible for a free BRiCk membership and a family-level discount of $12 per month. Enrollment and family-level payment is set up directly with the BRiCk.
ONE PASS SELECT
One Pass Select® is on a mission to make fitness fun and engaging for everyone. One Pass can help you reach your fitness goals on your time, while finding new passions along the way. One Pass gives you access to thousands of gym locations, on demand fitness classes at home and nutritious meal deliveries.
You and your eligible family members (18+) can enroll in One Pass Select on January 01, 2026 at OnePassSelect.com.
CITY OF BURLESON BENEFITS
http://OnePassSelect.com
Dental Coverage
UNITEDHEALTHCARE (UHC)
Regular dental checkups can do more than keep your smile attractive—they can also tell dentists a lot about your overall health, including whether or not you may be at risk for chronic diseases. The following is a high-level overview of your dental coverage. For complete coverage details, please refer to the Summary Plan Description (SPD), found on Burlesontx.com/employeeforms.
Plan Feature Base Plan Buy-Up Plan Deductible Individual/Family $50/$150 $50/$150 Annual Benefit Maximum
Per Individual $2,000/$500 for treatment of TMJ $3,000
Covered Services Preventive Services (exams, X-rays, cleanings) Covered at 100% Covered at 100%
Basic Services (fillings, extractions, root canals) Plan pays 80% after deductible
Plan pays 80% after deductible
Major Services (crowns, bridgework, dentures*) Plan pays 50% after deductible
Plan pays 50% after deductible
Orthodontia (children only up to age 19) Plan pays 50% Plan pays 50% Orthodontia Lifetime Maximum $1,500 $2,500
*There is a six-month waiting period for partial or complete dentures.
FINDING
IN-NETWORK
PROVIDERS
You will typically pay less when you stay inside your plan’s network.
To find in-network medical, dental and vision providers in your area, visit myuhc.com.
health
Vision Coverage
UNITEDHEALTHCARE (UHC)
Not only can yearly eye exams protect your eyes, they can help detect signs of serious health conditions like diabetes, brain tumors, high blood pressure and high cholesterol. The following is a high-level overview of your vision coverage. For complete coverage details, please refer to the Summary Plan Description (SPD), found on Burlesontx.com/employeeforms.
Plan Feature Frequency In-Network Out-of-Network Eyeglasses Exam Once every 12 months $10 copay Up to $40 reimbursement Contact Lenses Exam Once every 12 months $25 copay Up to $40 reimbursement Astigmatism Contact Lenses Exam Once every 12 months $129 copay Up to $40 reimbursement Lenses Single Once every 12 months $25 copay Up to $40 reimbursement Bifocal Once every 12 months $25 copay Up to $60 reimbursement Trifocal Once every 12 months $25 copay Up to $80 reimbursement Frames Once every 12 months $150 allowance Up to $45 reimbursement Contact Lenses (in lieu of glasses) Medically Necessary Once every 12 months Covered at 100% $210 allowance Elective Once every 12 months $150 allowance Up to $105 reimbursement
Note: Our vision plan is provided by UHC and administered by Spectera. We encourage you to verify whether your provider accepts Spectera insurance.
http://www.Burlesontx.com/employeeforms rates Medical (Monthly) High-Deductible Plan COBRA Retirees
Individual Only $739.15 $869.60
Individual + Spouse $1,626.17 $1,913.14
Individual + Child(ren) $1,256.58 $1,478.33
Individual + Family $2,291.43 $2,695.80
Copay Plan COBRA Retirees
Individual Only $1,015.29 $1,194.46
Individual + Spouse $2,233.62 $2,627.78
Individual + Child(ren) $1,725.98 $2,030.57
Individual + Family $3,147.37 $3,702.79
Dental (Monthly) Base Plan COBRA Retirees
Individual Only $38.41 $37.66
All Other Tiers $105.73 $103.66
Buy-Up Plan COBRA Retirees
Individual Only $41.68 $40.86
All Other Tiers $114.71 $112.46
Vision (Monthly) Coverage Tier COBRA Retirees
Individual Only $7.71 $7.56
All Other Tiers $16.56 $16.24
Years of Service Rate Discount This discount applies for the first five years immediately following retirement (on or after 1/1/2012) for the RETIREE ONLY portion of coverage for medical and dental benefits; dependent coverage is not eligible for a discount.
Years of Service Discount (You Pay) 0-19 None 20-24 50% 25-29 40% 30+ 25%
Medicare Eligible For Retirees: Participants on the City of Burleson’s retiree medical insurance program lose continued eligibility upon turning age 65.
For COBRA: COBRA participants may decide to discontinue COBRA under the City of Burleson’s health plan, upon turning age 65, if they want to elect Medicare.
CITY OF BURLESON BENEFITS
CITY OF BURLESON, TEXAS
2026 Benefits Guide
Human Resources: (817) 426-9642 Advocate 4 Me: (866) 844-4864 or myuhc.com
File details come from the government source that posted it. Updated .