Page 15 - FW Specialty Surgical Care Benefit Guide 8-1-24 Rev

Marketplace Coverage Options:

PART B: Information About Health Coverage Offered by Your Employer

This section contains information about any health coverage offered by your employer. If you decide to
complete an application for coverage in the Marketplace, you will be asked to provide this information. This

FW Specialty Surgicare, LLC 85-4261198

2001 Cooper Street 817-339-6991

Fort Worth
Dr. Lena Chu

drlena@eyeworksgroup.com

information is numbered to correspond to the Marketplace application.

15