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PART B: Information About Health Coverage Offered by Your <br /> Employer <br /> This section contains information about any health coverage offered by your employer. If you decide to <br /> complete an application for coverage in the Marketplace,you will be asked to provide this information. <br /> This information is numbered to correspond to the Marketplace application. <br /> 3.Employer name 4.Employer Identification Number(EIN) <br /> School District of Indian River County 59-6000884 <br /> 15.Employer address 6.Employer phone number <br /> 6500 57th Street 772-564-3175 <br /> 1 7.City 8.State ZIP code <br /> Vero Beach Florida 32967 <br /> I10.Who can we contact about employee health coverage at this job? <br /> Employee Benefits,Amy Yeitter <br /> 11.Phone number(ifdifferentfromabove) 12.Email address <br /> n/a <br /> sdircbenefits@indianriverschools.org <br /> Here are some basic information abouthealth coverage offered by this employer: <br /> • As your employer,we offera health plan to: <br /> aAII employees.Eligible employees are: <br /> All regular employees working at least 30 hours per week. <br /> ❑Some employees.Eligible employees are: <br /> • With respect to dependents: <br /> O We do offer coverage. Eligible dependents are: <br /> Spouse—Legally'married;Children—up to age 26 under Health Care Reform. Up to age 30,Florida Statute if <br /> child is: 1)Unmarried without dependents of their own AND 2)A Florida resident of a full-time student AND 3) <br /> Not covered under any health plan or policy AND 4) Not entitled to coverage under Medicare <br /> 1 <br /> ❑We do not offer coverage ' <br /> 0 If checked,this coverage meets the minimumvalue standard,and the cost of this coverage to you is intended to be <br /> affordable,based on employee wages. <br /> ** Even if your employer intends your coverage to be affordable, you may still be eligible for a <br /> premium discount through the Marketplace.The Marketplace will use your household income, <br /> along with other factors,to determine whether you may be eligible for a premium discount. If,for <br /> example,your wages vary from week to week(perhaps you are an hourly employee,or you work on a <br /> commission basis),if you are newly employed mid-year,or if you have other income losses,you may <br /> still qualify fora premium discount. <br /> If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. <br /> Here's the employer information you'll enter when you visit HealthCare.gov to find out if you can get a tax credit to <br /> loweryour monthly premiums. <br /> 74 <br /> 39 <br />