Health Insurance Marketplace Coverage Options

Retail Merchandising Services
8801 Brooklyn Boulevard

Brooklyn Park, MN 55445
RE: Health Insurance Marketplace Coverage Options
Dear RMS Employee;
In 2014, the health care reform law created a new type of online marketplace for purchasing health
insurance coverage. This marketplace is referred to as a Health Insurance Marketplace, or an Exchange.
RMS is providing the enclosed notice to help you understand your health insurance coverage options that
will be available to you.
As you are aware, RMS does not offer health insurance to its employees. Within the merchandising
industry this is a very typical practice.
If you are interested in getting more information regarding the healthcare exchanges you can visit the
federal website at www.Healthcare.gov.
Thank you,
Human Resources
Retail Merchandising Services
New Health Insurance Marketplace Coverage
Form Approved
Options and Your Health Coverage OMB No. 1210-0149
(expires 5-31-2020)
PART A: General Information

When key parts of the health care law take effect in ²014, there will be a new way to buy health
insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and
your family, this notice provides some basic information about the new Marketplace and
employment–based health coverage offered by your employer.
What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits
your budget. The Marketplace offers "one–stop shopping" to find and compare private health
insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly
premium right away. Open enrollment for health insurance coverage through the Marketplace
begins in October ²013 for coverage starting as early as January 1, ²014.
Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does
not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your
premium that you're eligible for depends on your household income.
Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that meets certain standards,
you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your
employer's health plan. However, you may be eligible for a tax credit that lowers your monthly
premium, or a reduction in certain cost–sharing if your employer does not offer coverage to you at
all or does not offer coverage that meets certain standards. If the cost of a plan from your
employer that would cover you (and not any other members of your family) is more than ¤.5% of
your household income for the year, or if the coverage your employer provides does not meet the
"minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.1
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your
employer, then you may lose the employer contribution (if any) to the employer–offered coverage. Also, this employer
contribution –as well as your employee contribution to employer–offered coverage– is often excluded from income for
Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after– tax
basis.
How Can I Get More Information?

For more information about your coverage offered by your employer, please check your
summary plan description or contact
.
The Marketplace can help you evaluate your coverage options, including your eligibility for
coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information,
including an online application for health insurance coverage and contact information for a Health
Insurance Marketplace in your area.
1 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.
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)

Retail Merchandising Services 41-1514566
5. Employer address 6. Employer phone number

8801 Brooklyn Boulevard 800-777-3767
7. City 8. State 9. ZIP code
Brooklyn Park MN 55445
10. Who can we contact about employee health coverage at this job?
Michele Reusse, Director of HR
11. Phone number (if different from above) 12. Email address
[email protected]
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:
With respect to dependents:

□ We do offer coverage. Eligible dependents are:
□ 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. 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.

Health Insurance Marketplace Coverage Options

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Retail Merchandising Services

8801 Brooklyn Boulevard

RE: Health Insurance Marketplace Coverage Options

Dear RMS Employee;

PART A: General Information

What is the Health Insurance Marketplace?

Can I Save Money on my Health Insurance Premiums in the Marketplace?

How Can I Get More Information?

3. Employer name 4. Employer Identification Number (EIN)

5. Employer address 6. Employer phone number

□ Some employees. Eligible employees are:

With respect to dependents:

□ We do not offer coverage.

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