Page 35 - Great Circle 2021 Benefits Guide
P. 35
2021
Legal Notices
PART B: Information About Health Coverage Offered by Your Employer
This section contains information about any health coverage ofered by your employer. If you decide to complete an application
for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the
Marketplace application.
3 . Employer name Great Circle Here is some basic information about health coverage ofered
4 . Employer Identiication 43-0681471 by this employer:
Number (EIN) As your employer, we ofer a health plan to:
5 . Employer address P.O. Box 189
6 . Employer phone number 573.228.8812 Some employees.
7 . City St. James
8 . State Missouri Regular full-time employee who is actively working an
9 . ZIP code 65559 average of 30 hours or more weekly.
10 . Who can we contact With respect to dependents:
about employee health Rita Bowie
coverage at this job? We do ofer coverage. Eligible dependents are: your legally
11 . Phone number (if (Same) married spouse and children. Children may include natural,
diferent from above) adopted, step-children, or children obtained through court-
Rita.Bowie@ appointed legal guardianship. Children are covered until
12 . Email address GreatCircle.org age 26 for medical insurance.
If checked, this coverage meets the minimum value
standard, and the cost of this coverage to you is intended
to be afordable, based on employee wages.
** Even if your employer intends your coverage to be
afordable, you may still be eligible for a premium discount
through the Marketplace. The Marketplace will use your
household income, along with other factors, to determine
whether you may be eligible for a premium discount. If,
for example, your wages vary from week to week (perhaps
you are an hourly employee or you work on a commission
basis), if you are newly employed mid-year, or if you have
other income losses, you may still qualify for a premium
discount.
If you decide to shop for coverage in the Marketplace,
HealthCare.gov will guide you through the process. Here’s the
employer information you’ll enter when you visit HealthCare.
gov to ind out if you can get a tax credit to lower your monthly
premiums.
35
Legal Notices
PART B: Information About Health Coverage Offered by Your Employer
This section contains information about any health coverage ofered by your employer. If you decide to complete an application
for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the
Marketplace application.
3 . Employer name Great Circle Here is some basic information about health coverage ofered
4 . Employer Identiication 43-0681471 by this employer:
Number (EIN) As your employer, we ofer a health plan to:
5 . Employer address P.O. Box 189
6 . Employer phone number 573.228.8812 Some employees.
7 . City St. James
8 . State Missouri Regular full-time employee who is actively working an
9 . ZIP code 65559 average of 30 hours or more weekly.
10 . Who can we contact With respect to dependents:
about employee health Rita Bowie
coverage at this job? We do ofer coverage. Eligible dependents are: your legally
11 . Phone number (if (Same) married spouse and children. Children may include natural,
diferent from above) adopted, step-children, or children obtained through court-
Rita.Bowie@ appointed legal guardianship. Children are covered until
12 . Email address GreatCircle.org age 26 for medical insurance.
If checked, this coverage meets the minimum value
standard, and the cost of this coverage to you is intended
to be afordable, based on employee wages.
** Even if your employer intends your coverage to be
afordable, you may still be eligible for a premium discount
through the Marketplace. The Marketplace will use your
household income, along with other factors, to determine
whether you may be eligible for a premium discount. If,
for example, your wages vary from week to week (perhaps
you are an hourly employee or you work on a commission
basis), if you are newly employed mid-year, or if you have
other income losses, you may still qualify for a premium
discount.
If you decide to shop for coverage in the Marketplace,
HealthCare.gov will guide you through the process. Here’s the
employer information you’ll enter when you visit HealthCare.
gov to ind out if you can get a tax credit to lower your monthly
premiums.
35
