Page 35 - 2016 Enrollment
P. 35
PART B: Information About Health Coverage Offered by If checked, this coverage meets the
Your Employer minimum value standard, and the cost
This section contains information about any health coverage offered by your of this coverage to you is intended
employer. If you decide to complete an application for coverage in the Marketplace, to be affordable, based on employee
you will be asked to provide this information. This information is numbered to wages.
correspond to the Marketplace application. Note Even if your employer intends
Employer Name Employer Identiication Number (EIN) your coverage to be affordable,
Intertek USA, INC. 72–0703433 you may still be eligible for a
Employer address Employer phone number premium discount through the
2 Riverway Suite 500 877-694-8543 Marketplace. The Marketplace will
City State ZIP Code use your household income, along
Houston TX 77056 with other factors, to determine
Who can we contact about employee health coverage at this job? whether you may be eligible
Intertek Employee Beneits Center for a premium discount. If, for
Phone Number (if different Email address example, your wages vary from
from above) week to week (perhaps you are an
855.203.0911 usa.beneits@intertek.com hourly employee or you work on a
commission basis), if you are newly
Here is some basic information about health coverage employed mid-year, or if you have
offered by this employer other income losses, you may still
As your employer, we offer a health plan to: qualify for a premium discount.
All employees. Eligible employees are: 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
Some employees. Eligible employees are: tax credit to lower your monthly premiums.
Regular Full time employees, and Regular Part Time employees working 30 or
more hours per week on average over a 12 month period.
With respect to dependents:
We do offer coverage. Eligible dependents are:
Natural, adopted or step children if they are under age 26, children for whom you
have been awarded a court-appointed guardianship, a disabled child of any age
whose disability began prior to age 26 and who has been continuously covers as
your dependent since becoming disabled, legal spouses and same-sex domestic
partners.
We do not offer coverage.
35
PART B: Information About Health Coverage Offered by If checked, this coverage meets the
Your Employer minimum value standard, and the cost
This section contains information about any health coverage offered by your of this coverage to you is intended
employer. If you decide to complete an application for coverage in the Marketplace, to be affordable, based on employee
you will be asked to provide this information. This information is numbered to wages.
correspond to the Marketplace application. Note Even if your employer intends
Employer Name Employer Identiication Number (EIN) your coverage to be affordable,
Intertek USA, INC. 72–0703433 you may still be eligible for a
Employer address Employer phone number premium discount through the
2 Riverway Suite 500 877-694-8543 Marketplace. The Marketplace will
City State ZIP Code use your household income, along
Houston TX 77056 with other factors, to determine
Who can we contact about employee health coverage at this job? whether you may be eligible
Intertek Employee Beneits Center for a premium discount. If, for
Phone Number (if different Email address example, your wages vary from
from above) week to week (perhaps you are an
855.203.0911 usa.beneits@intertek.com hourly employee or you work on a
commission basis), if you are newly
Here is some basic information about health coverage employed mid-year, or if you have
offered by this employer other income losses, you may still
As your employer, we offer a health plan to: qualify for a premium discount.
All employees. Eligible employees are: 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
Some employees. Eligible employees are: tax credit to lower your monthly premiums.
Regular Full time employees, and Regular Part Time employees working 30 or
more hours per week on average over a 12 month period.
With respect to dependents:
We do offer coverage. Eligible dependents are:
Natural, adopted or step children if they are under age 26, children for whom you
have been awarded a court-appointed guardianship, a disabled child of any age
whose disability began prior to age 26 and who has been continuously covers as
your dependent since becoming disabled, legal spouses and same-sex domestic
partners.
We do not offer coverage.
35
