51 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. 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: Active employees working 30+ hours per week • With respect to dependents: We do offer coverage. Eligible dependents are: Legally married spouses and child(ren) to age 26 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. ** Even if your employer intends your coverage to be affordable, 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 find out if you can get a tax credit to lower your monthly premiums. • An employer - sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs (Section 36 B(c)(2)(C)(ii) of the Internal Revenue Code of 1986) 3. Employer name City of Hutchinson 4. Employer Identification Number (EIN) 48-6015517 5. Employer address 125 E. Avenue B 6. Employer phone number 620-694-2620 7. City Hutchinson 8. State KS 9. ZIP code 67504 10. Who can we contact about employee health coverage at this job? Tom Sanders, Director of Human Resources 11. Phone number (if different from above) 12. Email address [email protected] X X X
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