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DW
Dana Whitfield
Tamarack Benefit Partners
12 active ICHRA groups

Bodhi W.

Honeycrisp Bakery  ·  Enrolled
BW

Bodhi W.

Honeycrisp Bakery · employee HON-102
Date of birth 07/19/1974 Gender Male Tobacco No State CO
Address 342 Boulder Bend, Fort Collins, CO Phone (303) 555-2442
2covered
Carrier Anthem Plan Gold PPO 1500 Metal Gold Coverage start Jan 1, 2026 Covering Employee and children
Monthly premium
$744
Gold PPO 1500
Employer pays
$350
Lump sum — $350 a month
They pay
$394
about $182 a paycheck, 26 a year

Household

Who the allowance has to stretch across
EmployeeBodhi W.
Spouse coveredNo
Dependants covered1
Reimbursement tierEmployee and children

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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