Return to flip book view
ALABAMA-Medicaid CALIFORNIA-MedicaidWebsite:http://myalhipp.com/ Phone: 1-855-692-5447Health Insurance Premium Payment (HIPP) Program Website: http://dhcs.ca.gov/hippPhone: 916-445-8322 // Fax: 916-440-5676Email:hipp@dhcs.ca.govALASKA-MedicaidCOLORADO-Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/Phone: 1-866-251-4861Email: CustomerService@MyAKHIPP.com Medicaid Eligibility:http://health.alaska.gov/dpa/Pages/default.aspxHealth First Colorado Website:https://www.healthfirstcolorado.com/Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711CHP+:https://hcpf.colorado.gov/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/ State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/HIBI Customer Service: 1-855-692-6442ARKANSAS-Medicaid FLORIDA-MedicaidWebsite:http://myarhipp.com/Phone: 1-855-MyARHIPP (855-692-7447)Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery. com/hipp/index.html Phone: 1-877-357-3268Premium Assistance Under Medicaid and theChildren’s Health Insurance Program (CHIP)If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs, but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW orwww.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of March 17, 2025. Contact your State for more information on eligibility –
GEORGIA edicaid MAINE MedicaidGA HIPP Website: https://medicaid.georgia.gov/health-insurance-premium-payment-program-hippPhone: 678-564-1162, Press 1 GA CHIPRA Website:https://medicaid.georgia.gov/programs/third-party-liability/childrens-health-insurance-program-reauthorization-act-2009-chipra Phone: (678) 564-1162, Press 2Enrollment Website:https://www.mymaineconnection.gov/benefits/s/? language=en_USPhone: 1-800-442-6003. TTY: Maine relay 711 Private Health Insurance Premium Webpage: https://www.maine.gov/dhhs/ofi/applications-forms Phone: 1-800-977-6740. TTY: Maine relay 711INDIANA Medicaid MASSACHUSETTS Medicaid and CHIPHealth Insurance Premium Payment Program All other Medicaid: Website: https://www.in.gov/medicaid/http://www.in.gov/fssa/dfr/Family and Social Services Administration Phone: 1-800-403-0864Member Services Phone: 1-800-457-4584Website: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840TTY: 711Email: masspremassistance@accenture.comIOWA Medicaid and CHIP (Hawki) MINNESOTA MedicaidMedicaid Website:Iowa Medicaid | Health & Human Services Medicaid Phone: 1-800-338-8366Hawki Website:Hawki - Healthy and Well Kids in Iowa | Health & Human ServicesHawki Phone: 1-800-257-8563 HIPP Website:Health Insurance Premium Payment (HIPP) | Health & Human Services (iowa.gov)HIPP Phone: 1-888-346-9562Website:https://mn.gov/dhs/health-care-coverage/Phone: 1-800-657-3672KANSAS Medicaid MISSOURI MedicaidWebsite: https://www.kancare.ks.gov/ Phone: 1-800-792-4884HIPP Phone: 1-800-967-4660Website:http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005KENTUCKY Medicaid MONTANA MedicaidKentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website:https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx Phone: 1-855-459-6328Email: KIHIPP.PROGRAM@ky.govKCHIP Website: https://kynect.ky.gov Phone: 1-877-524-4718Kentucky Medicaid Website: https://chfs.ky.gov/agencies/dmsWebsite:http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084Email: HHSHIPPProgram@mt.govLOUISIANA Medicaid NEBRASKA MedicaidWebsite:www.medicaid.la.gov or www.ldh.la.gov/lahipp Phone: 1-888-342-6207 (Medicaid hotline) or1-855-618- 5488 (LaHIPP)Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633Lincoln: 402-473-7000Omaha: 402-595-1178NEVADA Medicaid SOUTH CAROLINA MedicaidMedicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900Website:https://www.scdhhs.gov Phone: 1-888-549-0820NEW HAMPSHIRE Medicaid SOUTH DAKOTA MedicaidWebsite: https://www.dhhs.nh.gov/programs-services/medicaid/health-insurance-premium-programPhone: 603-271-5218 Toll free number for the HIPP program: 1-800-852-3345, ext. 15218Email: DHHS.ThirdPartyLiabi@dhhs.nh.govWebsite:http://dss.sd.gov Phone: 1-888-828-0059
To see if any other states have added a premium assistance program since March 17, 2025, or for more information on special enrollment rights, contact either:U.S. Department of LaborEmployee Benefits Security Administrationwww.dol.gov/agencies/ebsa1-866-444-EBSA (3272)U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov1-877-267-2323, Menu Option 4, Ext. 61565Paperwork Reduction Act StatementAccording to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.OMB Control Number 1210-0137(expires 1/31/2026)NEW JERSEY Medicaid and CHIP TEXAS MedicaidMedicaid Website:http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/Phone: 1-800-356-1561CHIP Premium Assistance Phone: 609-631-2392CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710 (TTY: 711)Website: Health Insurance Premium Payment (HIPP) Program | Texas Health and Human ServicesPhone: 1-800-440-0493NEW YORK Medicaid UTAH Medicaid and CHIPWebsite: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831Utah’s Premium Partnership for Health Insurance (UPP) Website: https://medicaid.utah.gov/upp/Email: upp@utah.govPhone: 1-888-222-2542Adult Expansion Website: https://medicaid.utah.gov/expansion/Utah Medicaid Buyout Program Website: https://medicaid.utah.gov/buyout-program/CHIP Website: https://chip.utah.gov/NORTH CAROLINA Medicaid VERMONT MedicaidWebsite: https://medicaid.ncdhhs.gov/ Phone: 919-855-4100Website: Health Insurance Premium Payment (HIPP) Program | Department of Vermont Health AccessPhone: 1-800-250-8427NORTH DAKOTA Medicaid VIRGINIA Medicaid and CHIPWebsite:https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825Website: https://coverva.dmas.virginia.gov/learn/premium- assistance/famis-selecthttps://coverva.dmas.virginia.gov/learn/premium-assistance/health-insurance-premium-payment-hipp-programs Medicaid / CHIP Phone 1-800-432-5924OKLAHOMA Medicaid and CHIP WASHINGTON MedicaidWebsite: http://www.insureoklahoma.org Phone: 1-888-365-3742Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022OREGON Medicaid and CHIP WEST VIRGINIA Medicaid and CHIPWebsite: http://healthcare.oregon.gov/Pages/index.aspx Phone: 1-800-699-9075Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/Medicaid Phone: 304-558-1700CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)PENNSYLVANIA Medicaid WISCONSIN Medicaid and CHIPWebsite: https://www.pa.gov/en/services/dhs/apply-for-medicaid-health-insurance-premium-payment-program-hipp.html Phone: 1-800-692-7462CHIP Website: Children’s health insurance program (CHIP) (pa.gov). CHIP Phone: 1-800-986-KIDS (5437)Website:https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002RHODE ISLAND Medicaid and CHIP WYOMING MedicaidWebsite: http://www.eohhs.ri.gov/ Phone:1-855-697-4347, or401-462-0311 (Direct RIte Share Line)Website:https://health.wyo.gov/healthcarefin/medicaid/programs-and-eligibility/Phone: 1-800-251-1269
Notice of Special Enrollment RightsIf you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you may in the future be able to enroll yourself or your dependents in this plan, provided that you request enrollment within 30days after your other coverage ends. In addition, if you have a new dependent as a result of marriage, birth adoption, or placement for adoption, you may be able to enroll yourself and your dependents, provided that you request enrollment within 30 days afterthe marriage, birth, adoption, or placement for adoption.Newborns’ Act DisclosureGroup health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length ofstay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attendingprovider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).Notice of Woman’s Health and Cancer Rights (WHCRA)If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a mannerdetermined in consultation with the attending physician and the patient, for:• All stages of reconstruction of the breast on which the mastectomy was performed;• Surgery and reconstruction of the other breast to produce a symmetrical appearance;• Prostheses; and• Treatment of physical complications of the mastectomy, including lymphedema.These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. See medical section of this booklet for this information.Mental Health Parity and Addition Equity ActThe Mental Health Parity Act of 1996 (MHPA) provided that large group health plans cannot impose annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on medical/surgical benefits. There are two disclosure provisions for group health plans.1. The criteria for medical necessity determinations with respect to mental health or substance use disorder benefits must be made available to any current or potential participant, beneficiary, or contracting provider upon request.2. The reason for any claim denial must be made available, upon request, to the participant or beneficiary. The regulations clarify that, in order for plans subject to ERISA to satisfy this requirement, disclosures must comply with the ERISA claims and appeals procedure regulations.The regulations clarify that this disclosure must be made in the form and manner consistent with the rules for group health plans in the ERISA claims procedure regulations.
NOTICE OF PRIVACY PRACTICEDuties of Winstanley Enterprises LLC (the Plan) Regarding Your Protected Health InformationYour Information. Your Rights. Our Responsibilities. This notice describes how medical information about you may be used anddisclosed and how you can get access to this information. Please review it carefully.Your Rights—You have the right to: Get a copy of your health and claims records;• Correct your health and claims records• Request confidential communication• Ask us to limit the information we share• Get a list of those with whom we’ve shared your information• Get a copy of this privacy notice• Choose someone to act for you• File a complaint if you believe your privacy rights have been violatedYour Choices - You have some choices in the way that we use and share information as we:• Answer coverage questions from your family and friends• Provide disaster relief• Market our services and sell your informationOur Uses and DisclosuresWe may use and share your information as we:• Help manage the health care treatment you receive• Run our organization• Pay for your health services• Administer your health plan• Help with public health and safety issues• Do research• Comply with the law• Respond to organ and tissue donation requests and work with a medical examiner or funeral director• Address workers’ compensation, law enforcement, and other government requests• Respond to lawsuits and legal actionsYour Rights - When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.Get a copy of health and claims records• You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this.• We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee.Ask us to correct health and claims records• You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this.• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.• We will consider all reasonable requests and must say “yes” if you tell us, you would be in danger if we do not.Ask us to limit what we use or share• You can ask us not to use or share certain health information for treatment, payment, or our operations.• We are not required to agree to your request, and we may say “no” if it would affect your care.Get a list of those with whom we’ve shared information• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.Get a copy of this privacy noticeYou can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.Choose someone to act for you• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.• We will make sure the person has this authority and can act for you before we take any action.File a complaint if you feel your rights are violated• You can complain if you feel we have violated your rights by contacting us using the information on page 1.• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visitingwww.hhs.gov/ocr/privacy/hipaa/complaints/ • We will not retaliate against you for filing a complaint.Your ChoicesFor certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow yourinstructions.In these cases, you have both the right and choice to tell us to:• Share information with your family, close friends, or others involved in payment for your care• Share information in a disaster relief situationIf you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.In these cases, we never share your information unless you give us written permission:• Marketing purposes• Sale of your information
Our Uses and DisclosuresHow do we typically use or share your health information?We typically use or share your health information in the following ways.▪ Help manage the health care treatment you receiveWe can use your health information and share it with professionals who are treating you. Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services.▪ Run our organizationWe can use and disclose your information to run our organization and contact you when necessary.We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage. This does not apply to long term care plans.Example: We use health information about you to develop better services for you.▪ Pay for your health serviceWe can use and disclose your health information as we pay for your health services. Example: We share information about you with your dental plan to coordinate payment for your dental work.▪ Administer your planWe may disclose your health information to your health plan sponsor for plan administration.Example: Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge.How else can we use or share your health information?We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.▪ Help with public health and safety issuesWe can share health information about you for certain situations such as:Preventing diseaseHelping with product recallsReporting adverse reactions to medicationsReporting suspected abuse, neglect, or domestic violencePreventing or reducing a serious threat to anyone’s health or safety▪ Do research We can use or share your information for health research.▪ Comply with the lawWe will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
▪ Respond to organ and tissue donation requests and work with a medical examiner or funeral directorWe can share health information about you with organ procurement organizations.We can share health information with a coroner, medical examiner, or funeral director when an individual dies.▪ Address workers’ compensation, law enforcement, and other government requestsWe can use or share health information about you:For workers’ compensation claimsFor law enforcement purposes or with a law enforcement officialWith health oversight agencies for activities authorized by lawFor special government functions such as military, national security, and presidential protective services▪ Respond to lawsuits and legal actionsWe can share health information about you in response to a court or administrative order, or in response to a subpoena.Our Responsibilities• We are required by law to maintain the privacy and security of your protected health information.• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.• We must follow the duties and privacy practices described in this notice and give you a copy of it.• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.Changes to the Terms of this Notice We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our web site, and we will mail a copy to you.Effective Date of Notice 6/1/2025If you need more information or if you would like to exercise one of your rights described here, please contact: Demian Cage / CFOWinstanley Enterprises LLC150 Baker Ave, Ext, Suite 303, Concord, MA 01742978-287-5000
Health Insurance Marketplace Coverage Options and Your Health CoveragePart A: General InformationEven if you are offered health coverage through your employment, you may have other coverage options through the Health Insur-ance Marketplace (“Marketplace”). To assist you as you evaluate options for you and your family, this notice provides some basicinformation about the Health Insurance Marketplace and health coverage offered through your employment.What is the Health Insurance Marketplace?The Marketplace is designed to help you find health insurance the meets your needs and fits your budget. The Marketplace offers“one-stop shopping” to find and compare private health insurance options in your geographic area.Can I Save Money on my Health insurance Premiums in the Marketplace?You may qualify to save money and lower your monthly premium and other out-of-pocket costs, but only if your employer does not offer coverage, or offers coverage that is not considered affordable for you and doesn’t meet certain minimum value standards(discussed below). The savings that you’re eligible for depends on your household income. You may also be eligible for a tax credit that lowers your costs.Does Employment-Based Health Coverage Affect Eligibility for Premium Savings through the Marketplace?Yes. If you have an offer of health coverage from your employer that is considered affordable for you and meets certain minimum value standards, you will not be eligible for a tax credit, or advance payment of the tax credit, for your Marketplace coverage and maywish to enroll in your employment-based health plan. However, you may be eligible for a tax credit, and advance payments of thecredit that lowers your monthly premium, or a reduction in certain cost-sharing, if your employer does not offer coverage to you at allor does not offer coverage that is considered affordable for you or meet minimum value standards. If your share of thepremium cost of all plans offered to you through your employment is more than 9.02% of your annual household income, or if thecoverage through your employment does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligiblefor a tax credit, and advance payment of the credit, if you do not enroll in the employment-based health coverage. For familymembers of the employee, coverage is considered affordable if the employee’s cost of premiums for the lowest-cost plan thatwould cover all family members does not exceed 9.02% of the employee’s household income.12Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered through your employment, then you may lose access to whatever the employer contributes to the employment-based coverage. Also, this employer contribution, as well as your employee contribution to the employment-based coverage, is generally excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. In addition, note that if the health coverage offered through your employment does not meet the affordability or minimum value standards, but you accept that coverage anyway, you will not be eligible for a tax credit. You should consider all of these factors in determining whether to purchase a health plan through the Marketplace.1.Indexed annually; see https://www.irs.gov/publications/p9742.An employer-sponsored or other employment-based 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. For purposes of eligibility for the premium tax credit, to meet the “minimum value standard,” the health plan must also provide substantial coverage of both inpatient hospital services and physician services.Form Approved OMB No.
Health Insurance Marketplace Coverage Options and Your Health Coverage - ContinuedWhen Can I Enroll in Health Insurance Coverage through the Marketplace?You can enroll in a Marketplace health insurance plan during the annual Marketplace Open Enrollment Period. Open Enrollmentvaries by state but generally starts November 1 and continues through at least December 15.Outside the annual Open Enrollment Period, you can sign up for health insurance if you qualify for a Special Enrollment Period. In general, you qualify for a Special Enrollment Period if you’ve had certain qualifying life events, such as getting married, hav- ing a baby, adopting a child, or losing eligibility for other health coverage. Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the qualifying life event to enroll in a Marketplace plan.There is also a Marketplace Special Enrollment Period for individuals and their families who lose eligibility for Medicaid or Chil- dren’s Health Insurance Program (CHIP) coverage on or after March 31, 2023, through July 31, 2024. Since the onset of the na- tionwide COVID-19 public health emergency, state Medicaid and CHIP agencies generally have not terminated the enrollment of any Medicaid or CHIP beneficiary who was enrolled on or after March 18, 2020, through March 31, 2023. As state Medicaid and CHIP agencies resume regular eligibility and enrollment practices, many individuals may no longer be eligible for Medicaid or CHIP coverage starting as early as March 31, 2023. The U.S. Department of Health and Human Services is offering a temporary Marketplace Special Enrollment period to allow these individuals to enroll in Marketplace coverage.Marketplace-eligible individuals who live in states served by HealthCare.gov and either- submit a new application or update anexisting application on HealthCare.gov between March 31, 2023, and July 31, 2024, and attest to a termination date of Medicaid or CHIP coverage within the same time period, are eligible for a 60-day Special Enrollment Period. That means that if you lose Medicaid or CHIP coverage between March 31, 2023, and July 31, 2024, you may be able to enroll in Marketplace coverage within 60 days of when you lost Medicaid or CHIP coverage. In addition, if you or your family members are enrolled in Medi- caid or CHIP coverage, it is important to make sure that your contact information is up to date to make sure you get any infor- mation about changes to your eligibility. To learn more, visit HealthCare.gov or call the Marketplace Call Center at 1-800-318- 2596. TTY users can call 1-855-889-4325.What about Alternatives to Marketplace Health Insurance Coverage?If you or your family are eligible for coverage in an employment-based health plan (such as an employer-sponsored health plan), you or your family may also be eligible for a Special Enrollment Period to enroll in that health plan in certain circumstances, including if you or your dependents were enrolled in Medicaid or CHIP coverage and lost that coverage. Generally, you have 60 days after the loss of Medicaid or CHIP coverage to enroll in an employment-based health plan, but if you and your family lost eligibility for Medicaid or CHIP coverage between March 31, 2023, and July 10, 2023, you can request this special enrollment in the employment-based health plan through September 8, 2023. Confirm the deadline with your employer or your employment-based health plan.Alternatively, you can enroll in Medicaid or CHIP coverage at any time by filling out an application through the Marketplace or applying directly through your state Medicaid agency. Visit https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/ for more details.How Can I Get More Information?For more information about your coverage offered through your employment, please check your health plan’s summary plan description or contact your HR Department.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.Form Approved OMB No.
3. Employer name4. Employer Identification Number (EIN)5. Employer address 6. Employer phone number7. City 8. State9. ZIP code10. Who can we contact about employee health coverage at this job?11. Phone number (if different from above)12. Email addressPART B: Information About Health Coverage Offered by Your EmployerThis 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.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 and Your Health Coverage - Continued
The information below corresponds to the Marketplace Employer Coverage Tool. Completing this section is optional for employers but will help ensure employees understand their coverage choices.13. Is the em pl o ye e currently eligible for co v era ge offered by this e mploy er, or will the e mp l o y e e be eligible in the nex t 3 m o nth s ?Yes (Continue)13a. If the employee is not eligible today, including as a result of a waiting or probationary period, when is the employee eligible for coverage? (mm/dd/yyyy) (Continue)No (ST OP and return this form to employee)14. Does the employer offer a health plan that meets the mini mum value standard*? Yes (Go to question 15) No ( STOP and return form to employee)15. For the lowest-cost plan that meets the minimum value standard* offered only to the e m pl o y ee (don't include family plans): If the employer has wellness programs, provide the prem i um that the employee would pay if he/ she received the maxim u m discount for any tobacco cessation programs, and didn't receive any other discounts based on wellness programs.a. Ho w much would the employee have to pay in premiums for this plan? $b. H ow often? Weekly Every 2 weeks Twice a month Monthly Quarterly YearlyIf the plan year will end soon and you know that the health plans offered will change, go to question 16. If you don't know, STOP and return form to employee.16. W h at change will the employer mak e for the new plan year? Employer won't offer health coverageEmployer will start offering health coverage to employees or change the pr emium for the lowest-cost plan available only to the employee that meets the minimum value standard.* (Premium should reflect the discount for wellness programs. See question 15.)a. Ho w much would the employee have to pay in premiums for this plan? $b. H ow often? Weekly Every 2 weeks Twice a month Monthly Quarterly Yearly• An employer-sponsored health plan meets the "min i mum 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 (Section 36B(c)(2)(C)(ii) of the Internal Revenue Code of 1986)
Please read this notice carefully and keep it where you can find it. This notice has information about your currentprescription drug coverage with Winstanley Enterprises LLC and about your options under Medicare’s prescription drugcoverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offersprescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.2. Winstanley Enterprises LLC has determined that the prescription drug coverage offered by the Winstanley Enterprises LLC with the Benemax Wrap plan, pays more than standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.When Can You Join A Medicare Drug Plan?You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th.However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.Prescription Drugs (Rx)Your Cost – In Network – PPO PlanBCBS approved - Retail supply, up to 30 days$25/$45/$65/$125 Co-payWhat Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?• If you decide to join a Medicare drug plan, your current Winstanley Enterprises LLC coverage will not be affected.• If you do decide to join a Medicare drug plan and drop your current Winstanley Enterprises LLC coverage, be aware that you and your dependents will be able to get this coverage back if you remain employed by Winstanley Enterprises LLC. .Important Notice from Winstanley Enterprises LLC About Your PrescriptionDrug Coverage and Medicare
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?You should also know that if you drop or lose your current coverage with Winstanley Enterprises LLC and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drugcoverage. In addition, you may have to wait until the following October to join.For More Information About This Notice Or Your Current Prescription Drug Coverage...Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Winstanley Enterprises LLC changes. You also may request a copy of this notice at any time.For More Information About Your Options Under Medicare Prescription Drug Coverage…More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.For more information about Medicare prescription drug coverage:• Visit www.medicare.gov• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available.For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).Date:Name of Entity/Sender: Contact--Position/Office: Address:Phone Number:6/1/2025Winstanley Enterprises LLCDemian Cage / CFO150 Baker Ave, Ext, Suite 303,Concord, MA 01742978-287-5000