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DW
Dana Whitfield
Tamarack Benefit Partners
12 active ICHRA groups

Nilsa Z.

Ridgeway Precision Machining  ·  Enrolled
NZ

Nilsa Z.

Ridgeway Precision Machining · employee RID-112
Date of birth 06/02/1979 Gender Female Tobacco No State CO
Address 321 Pinon Street, Loveland, CO Phone (719) 555-0481
1covered
Carrier Rocky Mountain Plan Bronze Summit 6900 Metal Bronze Coverage start Jan 1, 2026 Covering Employee only
Monthly premium
$449
Bronze Summit 6900
Employer pays
$420
Reference plan — 70% of the lowest Silver
They pay
$29
about $13 a paycheck, 26 a year

Household

Who the allowance has to stretch across
EmployeeNilsa Z.
Spouse coveredNo
Dependants covered0
Reimbursement tierEmployee only

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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