iSleep 2023-2024 Benefits Guide

HEALTH INSURANCE MARKETPLACE

COVERAGE

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.

3. Employer name

4. Employer Identification Number (EIN)

________

ISLEEP

5. Employer address

6. Employer phone number

4690 Longley

_ _(833) 475-3372

______

7. City

8. State

9. ZIP code

Vallejo

94592

_______

10. Who can we contact about employee health coverage at this job?

John Hickok

_______

11. Phone number (if different from above)

12. Email address

_____

jhickok@isleephst.com _______________________

Here is some basic information about health coverage offered by this employer:

• As your employer, we offer a health plan to:

All employees.

Some employees. Eligible employees are: Full-time employees working at least 30 hours a week

• With respect to dependents:

We do offer coverage. Eligible dependents are: spouse/domestic partner and children

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.