New Health Insurance Marketplace Coverage Options And Your Health Coverage Page 2
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1
2PART 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.
3. Employer name
4. Employer Identification Number (EIN)
CNIC
52-0813349
5. Employer address
6. Employer phone number
5720 Integrity Drive
855-271-4616
7. City
8. State
9. ZIP code
Millington
TN
38055
10. Who can we contact about employee health coverage at this job?
Lynn Hickman
11. Phone number (if different from above)
12. Email address
MILL_CNIC_NAF_HealthBenefits
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:
Active Employees: You are eligible for the Plan if you are a regular full-time or part-time civilian employee,
or an employee that worked an average of 30 or more hours per week over a 12 month period, and meets the
eligibility requirements as outlined in the SPD located at
Retired Employees: You may be eligible to continue participation in the Plan after you retire. To be eligible
• With respect to dependents:
for post-retirement coverage, you must meet the requirements outlined in the SPD located on
We do offer coverage. Eligible dependents are:
Your spouse (including a common-law husband or wife in a state that recognizes common-law marriages) or
your domestic partner, and your children up to the end of the month they turn 26. More detailed information
regarding eligible dependents can be found in the SPD located on
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.
** 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.
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