AN OVERVIEW OF THE WIDE ARRAY OF BENEFITS PROVIDED BY THE CITY TO HELP YOU ENJOY INCREASED WELL-BEING AND FINANCIAL SECURITY
CITY OF HALTOM CITY
PREPARED BY HOLMES MURPHY FOR CITY OF HALTOM CITY
Benefits for 2025 - 2026 Introduction
As an employee of the City of Haltom City (City) enjoying your work and making valuable contributions to the workplace are equally important. The health, satisfaction and security of you and your family are important, not only to your well-being, but also for the City to achieve organizational goals.
For the 2025 - 2026 plan year, the City has worked hard to offer a competitive total rewards package that includes valuable and competitive benefit plans. These programs reflect our commitment to keeping our staff healthy and secure. We understand that your situation is unique, and the City is offering an overall benefits package that can be shaped and molded by you to fit your needs.
This benefits booklet provides a summary description of your City benefit plans. If there is a discrepancy between these summaries and the written legal plan documents, the plan documents shall prevail. This booklet and plan summaries do not constitute a contract of employment.
We hope this benefits booklet, along with our additional communication and decision-making tools, will help you make the best health care choices for you and your family.
Changes to Your Benefits
The City of Haltom City is proud to offer you a comprehensive benefits package for the benefits year beginning October 1, 2025.
• Medical rates will see an increase of approximately 8.75% for the upcoming year.
• There will be no change to dental, vision and voluntary life insurance rates.
• Voluntary supplemental coverage can now be purchased through Aetna.
• TaxSaver’s name is changing to Navia Benefits and participants in this plan will be able to sign up for direct deposit of their reimbursements.
Information on each of these plans can be found later in this guide. Important contact information can be found on page 32.
Benefits for 2025 - 2026 Overview Of Benefits Program
The City provides an array of benefits that can help you enjoy increased well-being, deal with an unexpected illness or accident, build and protect your financial security, balance your personal and professional life and meet everyday needs. These benefits are affordable, comprehensive and competitive.
Benefit changes take place October 1, 2025 Please read this information carefully to ensure that the appropriate benefit decisions are made for you and your family. The table below summarizes the benefits available to eligible employees and their dependents. These benefits are described in greater detail in this booklet.
Benefits At-A-Glance
& Critical Illness Plans
Eligibility
You are eligible to enroll in the City’s benefit plans if you are a regular, full-time employee scheduled to work at least 32 hours per week. As a regular full-time employee, you are eligible for medical, dental and vision benefits on day one of employment.
You may also cover your eligible dependents including:
• Your legal spouse.
• Your eligible children up to age 26
• “Children” are defined as your natural children, stepchildren, legally-adopted children and children for whom you are the court-appointed legal guardian.
• Physically or mentally disabled children of any age who are incapable of self-support. Proof of disability may be requested.
If your child becomes ineligible for coverage (i.e., turning 26 under the medical plan), you must notify Human Resources at 817-222-7737.
Paperwork (marriage certificate, certificate of common law marriage, birth certificate or court paperwork showing legal guardian) will need to be provided for all new dependents being added to the City’s plan.
Benefits for 2025 - 2026 Overview Of Benefits Program Changes and Qualifying Events
When Coverage Begins
When you first join the City, you may enroll yourself and your dependents for benefits. Medical, dental, and vision benefits are effective on day one of employment. If you do not enroll when hired, you will have to wait until the next annual Open Enrollment to enroll for benefits and make changes to coverage.
Annual Open Enrollment
Open enrollment occurs annually, and coverage takes effect on October 1. Open Enrollment will run from August 7th – September 4th, 2025 Enrollment forms must be received in the Human Resources Department no later than 3:00 pm on September4th for an employee and dependent(s) to make changes to current benefits or enroll in Navia Benefits (formerly TaxSaver)
Making Changes to Coverage
Once you make your benefit elections, these choices remain in effect until the next annual Open Enrollment unless you have a qualified status change, or you or your eligible dependents become eligible for coverage through special enrollment rules. If you have a qualified status change or another allowable event, you can makecertain changes during the plan year. However, you must submit your enrollment change form to Human Resources within 30 days of the event by completing the appropriate Benefit Change/Enrollment form(s). If your form (and any required documents) is not received by Human Resources within 30 days, you will have to wait until the next Open Enrollment to make new elections. If a change in your status results in a move to a less expensive rate tier, state law requires that you pay premiums through the end of the month and the new rate tier will take effect on the 1st of the month following the reported change.
A qualified status change may include, but are not limited to:
▪ Changes in employment status
▪ Changes in legal marital status
▪ Changes in number of dependents
▪ Taking an unpaid leave of absence
▪ Dependent satisfies or ceases to satisfy eligibility requirement
▪ Family Medical Leave Act (FMLA) leave
▪ A COBRA-qualifying event
▪ Entitlement to Medicare or Medicaid
▪ A change in the place of residence of the employee, resulting in the current carrier not being available
For a more complete list of qualified status changes, refer to the appropriate Summary Plan Description.
Benefits for 2025 - 2026 Overview Of Benefits Program
Special Enrollment Rules
(You must enroll within 60 days of the qualified events shown below)
If you choose not to enroll yourself or your dependents (including your spouse) becauseyou have other coverage, you may be able to enroll yourself and your dependents at a later date if:
▪ You or your dependents lose Medicaid or Children’s Health Insurance Program (“CHIP”) coverage as a result of a loss of eligibility for such coverage, or
▪ If you or your dependents become eligible for a premium assistance subsidy under Medicaid or CHIP. If your dependent also had other health coverage and lost that coverage in the above situations, they may be added to your coverage. However, you will not be able to add yourself or your dependents to this coverage if the other coverage was terminated “for cause” (including failure to pay the required premiums on time). You must be enrolled to cover your dependents. If you have a special enrollment event and want to enroll for health coverage, call Human Resources at 817-222-7737.
Benefits for 2025 - 2026 Premiums & Contributions
Your cost for Medical, Dental and Vision will be paid on a before-tax basis through your payroll deductions the first two paychecks each month. This means that your benefit deductions go further because you save the federal income tax that would otherwise be required on these contributions. Optional Life, AD&D insurance and supplemental Aetna Insurance will be taken from your paycheck on a post-tax basis.
Employee Contributions Last deduction of fiscal year will be reduced for rounding.
Medical Plan
Dental (DPPO) Plan
Dental (DHMO) Plan
Vision Plan
Benefits for 2025 - 2026 Medical
Key Terms to Remember Annual Deductible
The amount you have to pay each year before the plan starts paying a portion of medical expenses. All family members’ expenses that count toward a health plan deductible accumulate together in the aggregate; however, each person also has a limit on their own individual accumulated expenses (the amount varies by plan).
Copays and Coinsurance
These expenses are your share of cost paid for covered health care services. Copays are a fixed dollar amount, and are usually due at the time you receive care. Coinsurance is your share of the allowed amount charged for a service, and is generally billed to you after the health insurance company reconciles the bill with the provider.
Out-of-Pocket Maximum
This is the total amount you can pay out of pocket each calendar year before the plan pays 100 percent of covered expenses for the rest of the calendar year. Most expenses that meet provider network requirements count toward the annual out-of-pocket maximum, including expenses paid to the annual deductible*, copays and coinsurance.
*Except for Grandfathered medical plans
Plan Types
EPO/PPO – A network of doctors, hospitals and other health care providers
HMO – A network that requires you to select a Primary Care Physician (PCP) who coordinates your health care
POS – Combines aspects of a PPO and HMO
HDHP – A plan that has higher annual deductibles in exchange for lower premiums.
Benefits for 2025 - 2026 Medical
Benefits for 2025 - 2026 Pharmacy
If you enroll in the City’s medical plan, you will automatically receive prescription drug coverage.
Retail Prescription Program
The retail prescription program uses a network of participating pharmacies. To receive the highest level of benefits, you must use a participating pharmacy. Remember, there are formulary changes every year. You will be notified by Aetna if you are affected by formulary changes and will be provided additional information.
Mail Order Pharmacy – CVS Caremark
Your medicines – your mailbox
With CVS Caremark Mail Service Pharmacy, get your medicines sent to your home – or wherever you choose.
This service is for medications taken regularly to treat conditions like arthritis and high cholesterol.
There’s no extra cost
This service is included with your pharmacy benefits. And it’s a simple way to help you stay on track with your medicines.
Delivery perks
• Fast reorders with no trips to the pharmacy
• Free standard shipping to your home, job or wherever you choose
• Privacy because your medicines will arrive in unmarked, secure packaging.
Your safety comes first. Registered pharmacists check each and every order. And if you have concerns or questions, you can call them anytime.
Wellness and Health Management Preventive Care
Understanding the full value of covered benefits allows you to take responsibility for maintaining good health and incorporating healthy habits into your lifestyle. Some examples include getting regular physical examinations, mammograms and immunizations. Through the plans offered by the City all covered individuals and family members are eligible to receive routine wellness services like these, at no cost; all copays, coinsurance, and deductibles are waived.
Which Preventive Care Services Are Covered?
The US Preventive Services Task Force maintains a regular list of recommended services that all Affordable Care Act (i.e. Health Care Reform) compliant insurance plans should cover at 100% for in-network providers. Below is a list of common services that are included in the plans offered this year:
▪ Routine Physical Exam
▪ Well Baby and Child Care
▪ Well Woman Visits
▪ Immunizations
▪ Routine Bone Density Test
▪ Routine Breast Exam
▪ Routine Gynecological Exam
▪ Screening for Gestational Diabetes
▪ Obesity Screening and Counseling
▪ Routine Digital Rectal Exam
▪ Routine Colonoscopy
▪ Routine Colorectal Cancer Screening
▪ Routine Prostate Test
▪ Routine Lab Procedures
▪ Routine Mammograms
▪ Routine Pap Smear
▪ Smoking Cessation
▪ Health Education/Counseling Services
▪ Health Counseling for STDs and HIV
“An ounce of prevention is worth a pound of cure”
▪ Testing for HPV and HIV
▪ Screening and Counseling for Domestic Violence
Benefits for 2025 - 2026
Aetna Benefits
Check to see if your Medical, Dental or Vision Provider is participating on a plan:
1. Go to: https://www.aetna.com/individuals-families/find-a-doctor.html
2. Select: Find a Doctor
3. As a “Guest” select: Plan from an employer
4. Continue as a guest and enter “Haltom City, Texas” or your zip code and then “Search”
5. Select a plan: Select “Managed Choice® POS (Open Access)” Or “Dental PPO/PDN with PPO II and Extended Network” or “DMO” or “Aetna VisionSM Preferred”, then “Continue”. Scroll down to make a provider selection.
Note: Once you select “Aetna VisionSM Preferred” when looking for a Vision provider, you will be directed to the Aetna Vision website to complete your search.
Benefits for 2025 - 2026
Aetna Benefits
Benefits for 2025 - 2026
Aetna Benefits
Benefits for 2025 - 2026
Aetna Benefits
Benefits for 2025 - 2026
Aetna Benefits
Benefits for 2025 - 2026 Telemedicine
Benefits for 2025 - 2026 Dental Coverage
The City’s Dental Coverage is administered through Aetna and provides you and your family with coverage for typical dental expenses, such as cleanings, X-rays, fillings and orthodontia.
Choosing a Dental Option
Aetna DPPO -
The Aetna DPPO allows you the freedom to visit any dentist, without referrals, for all of your dental care. If you receive care from one of Aetna’s in-network dentists, you’ll pay less for your care. If you choose an out-of-network dentist, your share of the costs will generally be higher, and you may need to file your own claims.
Aetna DHMO –
The Aetna DHMO provides a higher level of benefits and has lower out-of-pocket costs than the Aetna DPPO plan and there are no deductibles, benefit maximums or claim forms. However, you are required to choose an Aetna Primary Care Dentist for all of your dental care. Your Primary Care Dentist will refer you to other Aetna specialists as needed.
If you are enrolled in the Dental PPO plan, you will not receive an ID card from Aetna. Verify PPO coverage by logging in to your Aetna app or you can provide your name and date of birth at an in-network dentist. DHMO participants will receive an ID card.
Dental Plan Highlights
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City of Haltom City
Benefits for 2025 - 2026 Vision Coverage
The City of Haltom City’s Vision Plan administered through Aetna promotes preventive care through regular eye exams and provides coverage for corrective materials, such as glasses and contact lenses.
The Vision Plan is designed to cover eye care needs that are visually necessary. Additional cost may apply for certain cosmetic or elective eyewear, so be sure to ask your eye doctor what items are covered by the plan before you purchase materials.
Summary of Coverage
Benefits for 2025 - 2026 Basic Life, AD&D and Disability Insurance
The City offers life insurance coverage through Symetra at no cost to provide financial protection in the event you die while actively employed. The City also offers accidental death and dismemberment (AD&D) insurance at no cost to help with expenses in the event you die or become injured as a result of an accident.
Basic Life Insurance
The Basic Life Insurance is equal to one times your annual base earnings (base salary only as of October or at the time you are hired), up to a maximum benefit of $125,000. This benefit is paid to your beneficiaries in the event of your death.
IRS Rules About Basic Life Coverage
If your Basic Life Insurance coverage is more than $50,000, your income taxes may be affected. IRS regulations require that the volume (amount) of life insurance benefits over $50,000 be reported as “imputed income,” which is non-cash income that you receive from an employer-provided benefit. The value of any coverage that exceeds $50,000 will be reported to the IRS as imputed income on your W-2 form. If applicable, this will show on the first paycheck of the month as “Taxable Life”.
Additionally, these same IRS rules apply to the Supplemental Death Benefits provided by TMRS to active employees. The Supplemental Death Benefit pays a benefit approximately equal to one times the employee’s annual salary.
Basic AD&D Insurance
Your Basic AD&D Insuranceis equal to one times your annual base earnings, up to a maximum benefit of $125,000 for covered accident / injury.
Disability Coverage
The City offers you long-term disability coverage through Symetra in the event you cannot work because of illness or injury.
If you remain totally disabled and unable to work for more than 90 days, you may be eligible for Long-Term Disability (LTD) benefits.TheCity automatically provides you LTD benefits that replaceup to 60% of your base pay, up to a maximum of $10,000 per month. Your monthly LTD benefit will be reduced by Social Security and any other disability income you are eligible to receive (such as Workers’ Compensation). Benefits can be paid up to normal Social Security Retirement Age provided you continue to meet the definition of disability. In order to be considered totally disabled and eligible for LTD benefits,you mustbe approved by the insurance carrier. For further information please refer to your Summary Plan Description of Symetra LTD benefits.
Benefits for 2025 - 2026 Optional Life and AD&D Insurance
In addition to Basic Life and AD&D Insurance provided by the City, you may also purchaseOptional Life and AD&D Insurance for yourself, your spouse and your dependent children. However, you may only elect coverage for your dependents if you enroll in Optional Life coverage for yourself. You pay for the cost of Optional Life and AD&D Insurance on an after-tax basis through payroll deductions taken from your first two paychecks each month.
This plan includes the option to select coverage for your spouse and dependent children. Children include those, up to age 26.
In the event of death, the benefit paid will be equal to the benefit amount after any age reductions less any living care/accelerated death benefits previously paid under this plan.
Within the coverage guidelines defined in the “AD&D Coverage Selection and Premium Calculation” section listed in the Summary of Benefits, you select the amount of AD&D coverage that you want for yourself, your spouse, and your dependent child(ren).
AD&D coverage is available if you or your dependents are injured or die as a result of an accident, and the injury or death is independent of sickness and all other causes. The benefit amount depends on the type of loss incurred and is either all or a portion of the Principal Sum.
Annual Benefit Amount Increase Option
If you enroll for even the minimum amount of coverage during your initial enrollment, you have the ability to enroll for additional coverage at your next enrollment by up to $10,000, provided the total amount of insurance does not exceed your maximum benefit amount. This feature allows you to secure additional life insurance protection in the event your needs change (ex. You get married or have a child). Amounts over the Guarantee Issue will require evidence of insurability (information about your health).
Benefits for 2025 - 2026 Optional Life and AD&D Insurance
Features
Living Care / Accelerated Death Benefit
Waiver of Premium
Additional AD&D Benefits
Portability
Conversion
80% of the amount of the life insurance benefit is available to you if terminally ill, not to exceed $350,000
If it is determined that you are totally disabled, your life insurance benefit will continue without payment of premium, subject to certain conditions.
In addition to basic AD&D benefits, you are protected by the following benefits: Child education, day care, repatriation, seat belt, spouse education, airbag.
Allows you to continue this insurance program for yourself and dependents should you leave your employer for any reason, without having to provide Evidence of Insurability (information about your health). You will be responsible for the premium for the coverage.
If your employment ends, you may apply for an individual life insurance policy from Symetra without having to provide evidence of insurability (information about your health). You will be responsible for the premium for the coverage.
Optional Term Life Coverage Selection and Premium Calculation
To select your benefit amount and calculate your premium, please do the following:
1) Locate the benefit amount you want from the top row of the employee premium table. Your benefit amount must be in an increment of $10,000. Refer to the Coverage Guidelines section for minimums and maximums if needed.
2) Find your age bracket in the far-left column.
3) Your premium amountis foundin the box where the row (your age) and thecolumn(benefit amount) intersect.
4) Enter the benefit and premium amounts into their respective areas in the Voluntary Life section of your enrollment form.
If the benefit amount you want to select is greater than any amount in the table below, select the benefit amount from the top row that when multiplied by another number results in the benefit amount you want. For example, if you want $150,000 in coverage, you obtain your premium by multiplying the rate for $50,000 times 3.
City of Haltom City
Benefits for 2025 - 2026 Optional Life and AD&D Insurance
Optional Term Life Coverage Selection and Premium Calculation
Follow the method described on the previous page to select a benefit amount and calculate premiums for optional dependent spouse and/or child(ren) coverage. Your spouse’s rate is based on your their age, so find your spouse’s age bracketin the far left column of the Spouse Premium Table. Your spouse’s premium amount is found in the box where the row (the age) and the column (benefit amount) intersect. Your spouse’s benefit amount must be in an increment of $5,000. Refer to the Coverage Guidelines section for minimums and maximums, if needed.
Benefits for 2025 - 2026 Optional Life and AD&D Insurance
Voluntary AD&D Coverage Selection and Premium Calculation
You may select the amount of AD&D coverage you feel is appropriate for yourself and eligible dependents. However, there are some guidelines you need to consider when choosing this coverage.
Coverage Selection Guidelines:
1) You and each of your eligible dependents must be covered by some level of voluntary term life insurance to be eligible for AD&D coverage.
2) AD&D coverage is not required for you or your eligible dependents, even if you have voluntary term life coverage.
3) Dependent AD&D benefit amounts cannot exceed 100% of your AD&D benefit amount.
4) You and your eligible dependents can select any amount of AD&D coverage between the minimum and maximum as indicated in the Coverage Guidelines section.
Coverage Selection and Premium Calculation:
To select your benefit amount and calculate your premium, please do the following:
1) Locate the benefit amount you want to select from the top row of the employee premium table. Your benefit amount must be in an increment of $10,000.
2) Locate the corresponding premium amount in the row below.
3) Enter your benefit and premium amounts into their respective areas in the AD&D section of your enrollment form.
If the benefit amount you want to select is greater than any amount in the table below, select the benefit amount from the top row that when multiplied by another number results in the benefit amount you want. For example, if you want $150,000 in coverage, you obtain your AD&D premium amount by multiplying the rate for $50,000 times 3.
Benefits for 2025 - 2026
Voluntary Products Accident Insurance (24-Hour Coverage)
Benefits for 2025 - 2026
Voluntary Products
Critical Illness Insurance
Aetna’s Critical Illness Insurance provides a lump sum benefit to help with costs that medical insurance may not cover, such out-of-pocket medical expenses as well as everyday living expenses. Coverage includes a cancer category. With improved treatment options, more people are surviving critical events. However, treatments and recovery costs can create a financial burden on families affected by a critical illness.
Policy Face Amounts: $10,000 or $20,000
• If elected, Spouse and Child are covered at 50% of the employee election
• $50 Wellness Screening Benefit
• Children are included in the Employee cost
Benefits for 2025 - 2026
Voluntary Products
Hospital Indemnity
Benefits for 2025 - 2026 Flexible Spending Account (FSA)
You can contribute to one or both flexible spending accounts, which can help you save taxes on certain out-of-pocket health dependent care expenses. Prior to October 1, TaxSaver is changing names to Navia Benefit Solutions.
How the FSAs work:
There is a Health Care FSA and Dependent Care FSA. If you elect to contribute to one or both FSAs, you choose an amount to be taken from your first two paychecks each month (deduction every check for Fire shift employees) and deposited into your account throughout the year. Your contributions are taken before you pay taxes, so you save money. Then, when you have eligible health or dependent care expenses, you can use the account to reimburse yourself, up to the amount you have elected to contribute to your account for the year. With the Dependent Care FSA, the IRS requires you to use all of the money in your account by the end of the plan year or you lose it. This is called the “use it or lose it” rule. The Health Care FSA allows you to rollover up to $660 from the 2025 to the 2026 plan year.
Health Care FSA
You can use the Health Care FSA to pay for eligible out-of-pocket expenses that are not covered by another health plan. Examples include but are not limited to:
• Medical expenses: co-pays, co-insurance, and deductibles
• Dental expenses: exams, cleanings, X-rays, and braces
• Vision expenses: exams, contact lenses and supplies, eyeglasses, and laser eye surgery
• Professional services: physical therapy, chiropractor, and acupuncture
• Prescription drugs and insulin
• Over-the-counter health care items: bandages, pregnancy test kits, blood pressure monitors, etc.
For a complete list of eligible expenses, visit www.taxsaverplan.com. Transitioning to Navia Benefits prior to October 1st .
Annual Contribution Amount
You can contribute $100 to $3,300 per year to the Health Care FSA.
The more you use the FSA, the more you save! Here are some examples of tax savings:
Benefits for 2025 - 2026 Flexible Spending Account (FSA)
Note About Over-the-Counter Medications
You areno longer requiredtohave adoctor’s prescriptionto usetheHealth Care FSA toreimburseyourself for certain over-the-counter medications. Examples include:
• Acid controllers, digestive aids and stomach remedies
• Allergy and sinus medicines, cold, cough and flu drugs
• Anti-itch and insect bite remedies
• Cold sore remedies
• Sleep aids and sedatives
• Pain relief medications
• Respiratory treatments
FSA Debit Card and How it Works
If you enroll in the Health Care FSA, you will receive one debit cards in the mail and you may contact Navia Benefits for additional cards. You can use your debit card at certain places to pay for eligible expenses up-front, such as prescription drugs and office visit co-pays, without having to pay with cash and wait for a reimbursement. If you use your debit card at a health care provider’s office or a vendor that has software to track eligible FSA expenses, you will not be required to submit a receipt. However, for most debit card transactions, you will need to submit your receipts as substantiation of your expense, so it’s important to keep them. If you choose not to use your debit card, you can always pay for your eligible expenses and file a claim for reimbursement. Claim forms are available in Human Resources and can be downloaded from www.taxsaverplan.com
Dependent Care FSA
TheDependent Care FSA helps you afforddaycarefor your children underage 13 orfora disabled dependent. There are some special rules for participating in this account:
• The day care expenses must be necessary so you can work
• You can only be reimbursed for expenses incurred during the plan year
• If you are married, your spouse must be: a) employed, or b) a full-time student at least five months during the plan year, or c) mentally or physically disabled and unable to provide care for himself or herself
Eligible Dependent Care Expenses
Generally, you may use the money in your Dependent Care FSA to care for:
• Your children under age 13 whom you claim as a dependent for tax purposes
• Other dependents of any age who are mentally or physically disabled and whom you claim as a dependent for tax purposes (spouses and dependents age 13 and older must spend at least eight hours a day in your home if you are reimbursing yourself for services provided outside the home)
Some typical expenses that are eligible for reimbursement under the plan are:
• Licensed nursery school and day care centers for children
• Licensed day care centers for disabled dependents
• In-home provider as long as the care provider is not your child under age 19, or someone you claim as a tax dependent
Benefits for 2025 - 2026 Employee Assistance Program
The City realizes the pressures of today’s world and provides an Employee Assistance Program (EAP) through Symetra which allows for up to five free sessions per calendar year, plus an additional five with a covered disability claim. The following topics are covered: marital/family concerns, grief and loss, substance abuse, stress, legal/financial concerns, health and wellness issues and others. Access to the EAP is available to employees and dependents living in the employee’s home.
What happens when you call the EAP?
When you contact the EAP, one of the counselors will conduct a telephone assessment with you to determine the best services to assist you. If a referral to a network provider is recommended, the assessment will include gathering your specific provider criteria such as location, day and time availability, and specialty. The network provider will conduct a face-to-face assessment at your first session. All information disclosed will remain confidential.
Financial Consultation:
Personal concerns and daily living issues often have a corresponding financial component. Symetra EAP can connect employees with a financial consultant who can provide information and guidance on a wide range of issues.
How Does this Work?
This telephonic consultation is provided at no additional charge to the employee. When appropriate, the consultant can provide a local community referral or suggest other financial resources for a specific concern. The financial consultation offers employees proactive information and guidance for financial-related questions as well as strategic action plans when dealing with more reactive financial problems. The financial consultant will review your history, assess the current situation and work with the individual to develop a financial plan or resolution strategy.
Legal Consultation
Often when legal concerns arise, individuals do not know where to begin to get assistance. Often, they do not have a family lawyer and are unsure of how to select a lawyer to assist them with a particular need.
How Does this Work?
A guidance consultant will refer you to a qualified attorney in your area for a free 30-minute consultation. Any customary legal fees after that are reduced by 25%. You may talk to an attorney about Divorce and Family Law, Debt and Bankruptcy, Landlord/tenant issues, real estate transactions, civil and criminal actions and contracts.
City of Haltom City
Benefits for 2025 - 2026
Identity Theft
The City of Haltom City is excited to offer you Identity Theft benefits for this upcoming plan year. No one intends to be unsafe online. Help protect your identity and devices with Norton LifeLock Benefit Plans.
Even through the city covers the cost of this benefit for employees, you’ll need to elect this coverage on your open enrollment form to enroll.
Pricing Information
For You
The City covers the cost for all full- and part-time employees For Your Family You can purchase coverage for your family for $8.62 / month
Benefits for 2025 - 2026
Value of Pre-Tax Benefits
Section 125 Plan
The City operates a Premium Only Section 125 Plan, which allows you to reduce your total taxable income by your portion of group insurance premiums. In effect, this is just like getting a raise - your withholding taxes are reduced, and your take-home pay increases!
a
Why Pet Insurance?
financial safety net in case of accidents, injuries, illnesses and chronic conditions. Spot pet insurance plans reimburse up to 90% of eligible vet bills.
Why SpotPet Insurance?
TopRatedPetInsurance
3 Spot plans can offer thousands in coverage plan options starting at less than a cup of coffee per day. As a pet parent, you know how expensive vet visits can be.
Ranked #1 Best Pet Insurance Company of 2023 by US News
Spot plans help you protect your pet in case of accidents, illnesses, and emergencies. With pet insurance plans from Spot, you can get coverage for eligible conditions including surgery, cancer treatment, prescription medications, microchip implantation, X-rays, behavioral issues, dental disease, and more!
Upto90% CashBack
Customize the plan that is best for your pet and get cash back on eligible vet bills. Spot plans offer reimbursement rates up to 90% and a range of annual limits to help fit your budget.
20%
MemberDiscount
As a valued employee, you are eligible for a multi-pet discount! (a 10% employee discount on all pets, plus receive an additional 10% with pets 2, 3, 4, etc.)!
24/7Vet
AccessTM Helpline
Included in your Spot Pet Insurance plan is immediate access to a 24/7 telehealth helpline to ask veterinary professionals questions about pet health, behavior, and wellness. Get answers and reduce unnecessary vet visits during uncertain times.
or
Benefits for 2025 - 2026 Contact Information
Benefits for 2025 - 2026 Legal Notices
For Your Files
This brochure contains legal notices that are required to be distributed to participants in group health plans sponsored by the City of Haltom City. The notices included in this brochure are:
• Health Insurance Marketplace Coverage Options and Your Health Coverage that describes the Health Insurance Marketplace and eligibility and tax credit information.
• Notice of Privacy Practices that explains how the health care plan(s) protect your personal medical information.
• Medicare Part D Notice that provides information about how your current prescription drug coverage under the health care plan(s) is affected and your options for coverage when you become eligible for Medicare.
• COBRA Rights Notice that explains when you and your family may be able to temporarily continue coverage under the health care plan(s) if coverage would otherwise end for you.
• Newborn & Mothers Health Protection Notice that describes federal laws that govern benefits for hospital stays for mothers following the birth of a child.
• Women’s Health and Cancer Rights Act that summarizes the benefits available under your medical plan if you have had or are going to have a mastectomy.
• Patient Protection Disclosure that explains who you and your family can designate as a primary care provider under the health care plans and rules around access to obstetrical/gynecological care.
• Expanded Coverage for Women’s Preventive Care that explains how the health care plan(s) cover(s) women’s preventive care, including contraceptives, under the Affordable Care Act.
• Notice of Special Enrollment Rights that explains when you can enroll in the health care plan(s) due to special circumstances.
• 60-Day Special Enrollment Period that describes a special 60-day timeframe to elect or discontinue coverage.
Benefits for 2025 - 2026
City of Haltom City
Benefits for 2025 - 2026 Legal Notices
CITY OF HALTOM CITY NOTICE
This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.
OUR COMPANY’S PLEDGE TO YOU
This Notice Describes How Medical Information About You May Be Used And Disclosed And How You Can Get Access To This Information.
The Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. This Act gives you significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information.
As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.
We may use and disclose your medical records only for each of the following purposes: treatment, payment and health care operations.
Treatment means providing, coordinating, or managing health care-related services by one or more health care providers. An example of this would include case management.
Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review. An example of this would be adjudicating a claim and reimbursing a provider for an office visit.
Health Care Operations mean such business-related activities such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, and customer service. An example would be an internal quality assessment review.
We may also create and distribute de-identified health information by removing all references to individually identifiable information.
We may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing, and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.
You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the Privacy Officer:
• The right to request restrictions on certain uses and other disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are not, however, required to agree to a request restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
• The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations.
• The right to inspect and copy your protected health information.
• The right to amend your protected health information.
• The right to receive an accounting of non-routine disclosures of protected health information.
We have the obligation to provide, and you have the right to obtain a paper copy of this notice from us at least every three years.
subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.
City of Haltom City
Benefits for 2025 - 2026 Legal Notices
We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information. This notice is effective as of April 14, 2004, and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will post and you may request a written copy of a revised Notice of Privacy Practices from the Office for Civil Rights.
You have recourse if you feel that your privacy protections have been violated. You have the right to file a formal, written complaint with us at the address below, or with the Department of Health & Human Services, Office for Civil Rights, about violations of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint. Haltom City Human Resources, 5024 Broadway Avenue, Haltom City, TX 76117
For more information about HIPAA or to file a complaint, contact: The U.S. Department of Health & Human Services, Office for Civil Rights 200 Independence Avenue, S.W. Washington, D.C. 20201 (202) 619-0257 Toll-Free: 1-877-696-6775
City of Haltom City
Benefits for 2025 - 2026 Legal Notices
IMPORTANT NOTICE FROM CITY OF HALTOM CITY ABOUT YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with the City of Haltom City and about your options under Medicare's prescription drug coverage This information can help you decide whether or not you want to join a Medicare drug plan. If you are consideringjoining,youshould compare yourcurrent coverage, including which drugs arecovered atwhatcost, with the coverage andcosts of the plans offering Medicare prescription drugcoverage inyourarea. Information about whereyou cangethelp to makedecisionsabout yourprescription drug coverage isattheend ofthisnotice.
There aretwo important things youneedtoknow about your current coverage andMedicare's prescription drug coverage:
1. Medicare prescription drug coverage became availablein 2006 toeveryone with Medicare. You can get this coverageifyoujoinaMedicarePrescriptionDrugPlanorjoinaMedicareAdvantagePlan(likeanHMOor PPO) that offers prescription drug coverage. AllMedicare drugplansprovideatleasta standard levelof coverage setby Medicare. Some plansmayalsooffermorecoverageforahigher monthlypremium.
2. TheCityhas determined thattheprescriptiondrugcoverage offeredbythe Cityplanis,onaverageforallplan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep thiscoverage andnotpaya higherpremium(apenalty)if youlaterdecidetojoina Medicare drugplan.
When CanYouJoin A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th.
However,ifyouloseyourcurrentcreditableprescriptiondrugcoverage,throughnofault ofyourown,youwillalsobeeligible fora two(2)month SpecialEnrollment Period(SEP) to joinaMedicaredrugplan
What Happens To YourCurrent Coverage If YouDecide to Join A MedicareDrugPlan?
If youdecide tojoin aMedicaredrugplan, yourcurrent coverage willbe affected.If you do decideto joinaMedicare drug planand drop your currentCitycoverage,beawarethat youandyourdependents maynotbe ableto getthis coverage back.
When Will You Pay A Higher Premium (Penalty) ToJoin A Medicare Drug Plan?
Youshouldalso knowthatif youdroporloseyourcurrent coveragewiththeCityanddon'tjoinaMedicaredrugplan within 63continuous days after yourcurrent coverageends, youmay pay a higherpremium (a penalty) tojoinaMedicare drug planlater.
If yougo63continuous daysor longer without creditableprescription drugcoverage,your monthly premium may goup byat least1%of theMedicarebase beneficiarypremium permonth for everymonth that youdidnothavethatcoverage. For example, if yougonineteen months without creditable coverage,your premium may consistently be at least19% higher thantheMedicarebasebeneficiarypremium.Youmay haveto pay thishigherpremium(a penalty)as longasyou haveMedicare prescriptiondrug coverage.Inaddition,youmayhaveto wait until the following Octobertojoin
City of Haltom City
Benefits for 2025 - 2026 Legal Notices
For MoreInformationAboutYourOptionsUnder Medicare Prescription DrugCoverage... More detailed information about Medicare plans that offer prescription drug coverage is in the "Medicare & You" handbook. You'll getacopy of the handbookin themaileveryyear fromMedicare. Youmay alsobecontacted directly by Medicare drug plans
Formoreinformation about Medicare Prescriptiondrugcoverage:
• Visit www.medicare.gov.
• CallyourStateHealthInsuranceAssistance Program (seetheinsidebackcover ofyourcopy of"Medicare& You" handbook fortheir telephone number) for personalized help
• Call 1-800-MEDICARE(1-800-633-4227) TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about thisextra help,visit Social Securityon thewebatwww.socialsecurity.gov,or call them at1-800-7721213 (TTY1-800-325-0778).
Remember: Keep thiscreditable coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copyof this noticewhen youjointo show whether ornotyouhave maintained creditable coverage and,therefore, whether or notyouarerequired to paya higherpremium(apenalty)
8/1/2025
Cityof HaltomCity
ToniC.Beckett,DirectorofHumanResources andRiskMgt. 5024 Broadway Ave.,HaltomCity, TX76117 817-222- 7737
Benefits for 2025 - 2026 Legal Notices
GENERAL NOTICE OF COBRACONTINUATION COVERAGE RIGHTS
This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains Public Sector COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage.
The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator.
You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.
What is COBRA continuation coverage?
COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is alsocalled a“qualifyingevent.”Specific qualifying eventsare listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.
If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of one of the following qualifying events:
• Your hours of employment are reduced, or
• Your employment ends for any reason other than your gross misconduct.
If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of one of the following qualifying events:
• Your spouse dies;
• Your spouse’s hours of employment are reduced;
• Your spouse’s employment ends for any reason other than his or her gross misconduct;
• Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or
• You become divorced or legally separated from your spouse. Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events:
• The parent-employee dies;
• The parent-employee’s hours of employment are reduced;
• The parent-employee’s employment ends for any reason other than his or her gross misconduct;
• The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
• The parents become divorced or legally separated; or
• The child stops being eligible for coverage under the Plan as a “dependent child.”
Benefits for 2025 - 2026 Legal Notices
When is COBRA continuation coverage available?
The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events:
• The end of employment or reduction of hours of employment;
• Death of the employee; or
• The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to:
City of Haltom City
Toni C. Beckett, Director of Human Resources and Risk Mgt. 5024 Broadway Ave., Haltom City, TX 76117 817-222- 7737
How is COBRA continuation coverage provided?
Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.
There are also ways in which this 18-month period of COBRA continuation coverage can be extended:
Disability extension of 18-month period of COBRA continuation coverage
If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage.
Second qualifying event extension of 18-month period of continuation coverage
If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.
Benefits for 2025 - 2026 Legal Notices
Are there other coverage options besides COBRA Continuation Coverage?
Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov
Can I enroll in Medicare instead of COBRA continuation coverage after my group health plan coverage ends?
In general, if you don’t enroll in Medicare Part A or B when you are first eligible because you are still employed, after the Medicare initial enrollment period, you have an 8-month special enrollment period to sign up for Medicare Part A or B, beginning on the earlier of
• The month after your employment ends; or
• The month after group health plan coverage based on current employment ends.
If you don’t enroll in Medicare and elect COBRA continuation coverage instead, you may have to pay a Part B late enrollment penalty and you may have a gap in coverage if you decide you want Part B later. If you elect COBRA continuation coverage and later enroll in Medicare Part A or B before the COBRA continuation coverage ends, the Plan may terminate your continuation coverage. However, if Medicare Part A or B is effective on or before the date of the COBRA election, COBRA coverage may not be discontinued on account of Medicare entitlement, even if you enroll in the other part of Medicare after the date of the election of COBRA coverage.
If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA continuation coverage will pay second. Certain plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare.
For more information visit https://www.medicare.gov/medicare-and-you
If you have questions
Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. More information about your Public Sector COBRA rights through the Centers for Consumer Information and Oversight (CCIIO), available at www.cms.gov/cciio/
Keep your Plan informed of address changes
To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.
For more information about the Marketplace, visit www.healthcare.gov
Plan contact information
Date: 10/2025
Name of Entity/Sender: City of Haltom City
Contact/Office: Toni C. Beckett, Director of Human Resources and Risk Mgt.
Address: 5024 Broadway Ave., Haltom City, TX 76117
Phone Number: 817-222-7737
Benefits for 2025 - 2026 Legal Notices
EXPANDED COVERAGE FOR WOMEN’S PREVENTIVE CARE
Under the Affordable Care Act, The City provides female plan participants with expanded access to recommended in-network preventive services, including contraceptives, without cost sharing.
Additional women’s preventive services that will be covered without cost-sharing requirements include:
• Well-woman visits
• Gestational diabetes screening
• HPV DNA testing
• STI counseling, and HIV screening and counseling
• Contraception and contraceptive counseling
• Breastfeeding support, supplies, and counseling
• Domestic violence screening
For a description of what these items include, visit https://www.healthcare.gov/preventive-care-women/.
PATIENT PROTECTION DISCLOSURE
City of Haltom City generally requires the designation of a primary care provider. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact
City of Haltom City
Toni C. Beckett, Director of Human Resources and Risk Mgt. 5024 Broadway Ave., Haltom City, TX 76117 817-222-7737
For children, you may designate a pediatrician as the primary care provider.
You do not need prior authorization from the City or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating healthcare professionals who specialize in obstetrics or gynecology, contact https://www.aetna.com/individuals-families/find-a-doctor.html.
60-DAY SPECIAL ENROLLMENT PERIOD
In addition to the qualifying events listed in this document, you and your dependents will have a special 60-day period to elect or discontinue coverage if:
• You or your dependent’s Medicaid or Children’s Health Insurance Program (CHIP) coverage is terminated as a result of loss of eligibility; or
• You or your dependent becomes eligible for a premium assistance subsidy under Medicaid or CHIP.
Benefits for 2025 - 2026 Legal Notices
NOTICE OF SPECIAL ENROLLMENT RIGHTS
If you decline enrollment in medical coverage for yourself or your dependents (including your spouse) because of other health insurance coverage, you may be able to enroll yourself or your dependents in City of Haltom City medical coverage if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment no more than 30 days after your or your dependent’s other coverage ends (or after the employer stops contributing to the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you can enroll yourself and your dependents in The City medical coverage as long as you request enrollment by contacting the benefits manager no more than 30 days after the marriage, birth, adoption or placement for adoption.
If you oryour dependents lose eligibility for coverage under Medicaid or theChildren’s Health Insurance Program (CHIP) or become eligible for a premium assistance subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents. You must request enrollment within 60 days of the loss of Medicaid or CHIP coverage or the determination of eligibility for a premium assistance subsidy. To request special enrollment or to obtain more information about the plan's special enrollment provisions, contact the City of Haltom City’s Human Resources Department at 817-222-7737.
NEWBORN &MOTHERS HEALTH PROTECTION NOTICE
For maternity hospital stays, in accordance with federal law, the Plan does not restrict benefits, for any hospital length of stay in connection with childbirth for the mother or newborn child, to less than 48 hours following a vaginal delivery or less than 96 hours following a Cesarean delivery.
However, federal law generally does not prevent the mother’s or newborn’s attending care provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours, as applicable). The plan cannot require a provider to prescribe a length of stay any shorter than 48 hours (or 96 hours following a Cesarean delivery).
WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultations with the attending physician and the patient, for:
• All states of reconstruction of the breast on which the mastectomy was performed
• Surgery and reconstruction of the other breast to produce a symmetrical appearance
• Prostheses
• Treatment of physical complications of the mastectomy, including lymphedema These benefits will be provided subject to the same deductibles, copays and coinsurance applicable to other medical and surgical benefits provided under your medical plan. For more information on WHCRA benefits, contact the benefits plan. If you would like more information on WHCRA benefits, contact The City of Haltom City Human Resources Department or your medical plan administrator.
Benefits for 2025 - 2026 Legal Notices
CHIP NOTICE
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN’S HEALTH
INSURANCE PROGRAM (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from City of Haltom City, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs, but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed on the following page, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office, dial 1-877-KIDS NOW, or visit www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272)
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of March 17, 2025. Contact your State for more information on eligibility.
To see if any other states have added a premium assistance program since March 17, 2025, or for more information on special enrollment rights, contact either:
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, ext. 61565
State Website/E-mail Phone
Alabama (Medicaid) http://www.myalhipp.com/
Alaska (Medicaid) Premium Payment Program: http://myakhipp.com/ Medicaid Eligibility: https://health.alaska.gov/dpa/Pages/default.aspx E-mail: CustomerService@MyAKHIPP.com
1-866-251-4861
Arkansas (Medicaid) http://myarhipp.com/ 1-855-692-7447
California (Medicaid) http://dhcs.ca.gov/hipp Email: hipp@dhcs.ca.gov
Colorado (Medicaid and CHIP) Medicaid: https://www.healthfirstcolorado.com/ CHIP: https://hcpf.colorado.gov/child-health-plan-plus HIBI: https://www.mycohibi.com/
916-445-8322 916-440-5676 (fax)
1-800-221-3943
1-800-359-1991 1-855-692-6442
Florida (Medicaid) https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/hipp/index.html 1-877-357-3268
Georgia (Medicaid)
Indiana (Medicaid)
Iowa (Medicaid and CHIP)
HIPP: https://medicaid.georgia.gov/health-insurance-premium-payment-program-hipp
CHIPRA: https://medicaid.georgia.gov/programs/third-party-liability/childrens-health-insuranceprogram-reauthorization-act-2009-chipra
Healthy Indiana Plan for low-income adults 19-64: http://www.in.gov/fssa/dfr/
All other Medicaid: https://www.in.gov/medicaid
Medicaid: https://hhs.iowa.gov/programs/welcome-iowa-medicaid
CHIP: http://dhs.iowa.gov/Hawki
HIPP: https://hhs.iowa.gov/programs/welcome-iowa-medicaid/fee-service/hipp
Kansas (Medicaid) https://www.kancare.ks.gov/
Kentucky (Medicaid and CHIP)
Medicaid: https://chfs.ky.gov/agencies/dms
KI-HIPP: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.apsx KI-HIPP E-mail: KIHIPP.PROGRAM@ky.gov
KCHIP: https://kynect.ky.gov
Louisiana (Medicaid) www.medicaid.la.gov www.ldh.la.gov/lahipp
678-564-1162, press 1
678-564-1162, press 2
1-800-403-0864
1-800-457-4584
1-800-338-8366
1-800-257-8563
1-888-346-9562
1-888-342-6207
1-855-618-5488
Maine (Medicaid) https://www.mymaineconnection.gov/benefits/s/?language=e n_US https://www.maine.gov/dhhs/ofi/applications-forms Enroll: 1-800-442-6003 Private HIP: 1-800-9776740
Massachusetts (Medicaid and CHIP) https://www.mass.gov/masshealth/pa Email: masspremassistance@accenture.com
TTY: Maine relay 711
1-800-862-4840 TTY: 711
Minnesota (Medicaid) https://mn.gov/dhs/health-care-coverage/ 1-800-657-3672
Missouri (Medicaid) http://www.dss.mo.gov/mhd/participants/pages/hipp.htm 573-751-2005
Montana (Medicaid) http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP HHSHIPPProgram@mt.gov
Nebraska (Medicaid) http://www.ACCESSNebraska.ne.gov 1-855-632-7633 Lincoln: 402-473-7000 Omaha: 402-595-1178
Nevada (Medicaid) http://dhcfp.nv.gov/ 1-800-992-0900
New Hampshire (Medicaid) https://www.dhhs.nh.gov/programs-services/medicaid/health-insurance-premium-program Email:DHHS.ThirdPartyLiabi@dhhs.nh.gov
New Jersey (Medicaid and CHIP) Medicaid: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/ CHIP: http://www.njfamilycare.org/index.html
New York (Medicaid) https://www.health.ny.gov/health_care/medicaid/
603-271-5218 or 1-800-852-3345, ext. 15218
Medicaid: 609-631-2392 CHIP: 1-800-701-0710 (TTY: 711)
1-800-541-2831
North Carolina (Medicaid) https://medicaid.ncdhhs.gov/ 919-855-4100
North Dakota (Medicaid) https://www.hhs.nd.gov/healthcare
1-844-854-4825
Oklahoma (Medicaid and CHIP) http://www.insureoklahoma.org 1-888-365-3742
Oregon (Medicaid) http://healthcare.oregon.gov/Pages/index.aspx
Pennsylvania (Medicaid and CHIP)
Medicaid: https://www.pa.gov/en/services/dhs/apply-for-medicaid-health-insurancepremium-payment-program-hipp.html
CHIP: https://www.pa.gov/en/agencies/dhs/resources/chip.html
Rhode Island (Medicaid and CHIP) http://www.eohhs.ri.gov/
South Carolina (Medicaid) https://www.scdhhs.gov
South Dakota (Medicaid) http://dss.sd.gov
Texas (Medicaid) https://www.hhs.texas.gov/services/financial/health-insurance-premium-payment-hipp-program
Utah (Medicaid and CHIP)
Medicaid: https://medicaid.utah.gov/ CHIP: https://chip.utah.gov/
Adult Expansion Website: https://medicaid.utah.gov/expansion/ Utah Medicaid Buyout Program Website: https://medicaid.utah.gov/buyout-program/
Vermont (Medicaid) https://dvha.vermont.gov/members/medicaid/hipp-program
Virginia (Medicaid and CHIP) https://coverva.dmas.virginia.gov/learn/premiumassistance/famis-select https://coverva.dmas.virginia.gov/learn/premiumassistance/health-insurance-premium-payment-hippprograms
Washington (Medicaid) https://www.hca.wa.gov/
West Virginia (Medicaid) https://dhhr.wv.gov/bms/ http://mywvhipp.com/
Wisconsin (Medicaid and CHIP) https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm
1-800-699-9075
Medicaid: 1-800-692-7462 CHIP: 1-800-986-KIDS (5437)
1-855-697-4347 or 401-462-0311 (Direct RIte)
1-888-549-0820
1-888-828-0059
1-800-440-0493
1-888-222-2542
1-800-250-8427
1-800-432-5924
1-800-562-3022
Medicaid: 304-558-1700 CHIP: 1-855-699-8447
1-800-362-3002
Wyoming (Medicaid) https://health.wyo.gov/healthcarefin/medicaid/programs-and-eligibility/ 1-800-251-1269
NOTE: This summary highlights the main features of many of the benefit plans sponsored by the City of Haltom City. Full details of these benefits are contained in the legal documents governing the plans. If there is any discrepancy or conflict between the plan documents and the information presented here, the plan documents will govern. In all cases, the plan documents are the exclusive source for determining rights and benefits under the plans. The City of Haltom City reserves the right to change or discontinue the plans at any time. Participation in the plans does not constitute an employment contract. Nothing in this summary guarantees that any new plan provisions will continue in effect for any time period. This guide serves as a summary of material modifications as required by the Employee Retirement Income Security Act of 1974, as amended.
City of Haltom City