EXCHANGE NOTICES
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)
ZÖe Center for Pediatrics and Adolescent Health, LLC
45-4275397
5. Employer address
6. Employer phone number (706) 221-7139
3031 Williams Road
8. State
9.ZIP code
7. City
Columbus
GA
31909
10. Who can we contact about employee health coverage at this job?
Pursia Jackson
11. Phone number (if different from above)
12. Email address
pjackson@zoepeds.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:
X
Full-Time
Some employees. Eligible employees are:
• With respect to dependents:
X
We do offer coverage. Eligible dependents are:
Spouses and dependent children to age 26
We do not offer coverage.
X
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.
26 | Zoe Pediatrics 2024 Benefits Guide
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