Page 28 - 2016 Enrollment TSS

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 information is numbered to correspond to the
Marketplace application.
Employer Name Employer Identiication Number (EIN)
Intertek USA, INC. 72–0703433
Employer address Employer phone number
2 Riverway Suite 500 877-694-8543
City State ZIP Code
Houston TX 77056
Who can we contact about employee health coverage at this job?
Intertek Employee Beneits Center
Phone Number (if different from above) Email address
855.203.0911 usa.beneits@intertek.com

Here is some basic information about health coverage offered by this employer
As your employer, we offer a health plan to:

 All employees. Eligible employees are:

 Some employees. Eligible employees are:

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.


If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be
affordable, based on employee wages.

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New Hire Enrollment