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DW
Dana Whitfield
Tamarack Benefit Partners
12 active ICHRA groups

Gavin R.

Honeycrisp Bakery  ·  Enrolled
GR

Gavin R.

Honeycrisp Bakery · employee HON-100
Date of birth 05/09/1994 Gender Male Tobacco No State CO
Address 308 Granite Avenue, Fort Collins, CO Phone (719) 555-2368
2covered
Carrier Kaiser Plan Silver HMO 2500 Metal Silver Coverage start Jan 1, 2026 Covering Employee and spouse
Monthly premium
$588
Silver HMO 2500
Employer pays
$350
Lump sum — $350 a month
They pay
$238
about $110 a paycheck, 26 a year

Household

Who the allowance has to stretch across
EmployeeGavin R.
Spouse coveredYes
Dependants covered0
Reimbursement tierEmployee and spouse

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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