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DW
Dana Whitfield
Tamarack Benefit Partners
12 active ICHRA groups

Dontay B.

Foxglove Trail Outfitters  ·  Enrolled
DB

Dontay B.

Foxglove Trail Outfitters · employee FOX-100
Date of birth 07/02/1986 Gender Male Tobacco No State CO
Address 444 Aspen Court, Durango, CO Phone (303) 555-2664
3covered
Carrier Denver Health Plan Bronze Elevate 6000 Metal Bronze Coverage start Jan 1, 2026 Covering Family
Monthly premium
$455
Bronze Elevate 6000
Employer pays
$421
Reference plan — 70% of the lowest Silver
They pay
$34
about $16 a paycheck, 26 a year

Household

Who the allowance has to stretch across
EmployeeDontay B.
Spouse coveredYes
Dependants covered1
Reimbursement tierFamily

Paperwork

What this person has signed
ICHRA Notice (90 day)On file
Annual Coverage AttestationOn file
Plan WaiverNot applicable
Form 1095Due 28 Feb 2027
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