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Fritz Cutting and Coring
Fritz Cutting & Coring
Employee Benefit Programs
Documents and Resources April 2023 to March 2024
Providence Health Plan
Standard Bronze Benefit Summary
Standard Bronze Summary of Benefits and Coverage
Enrollment/Change Form
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Notices
ACA Exchange Model Notice
Medicare Creditable Pharmacy Disclosure
Primary Care Provider Model Disclosure
Notice of Rights Under The Women's Health and Cancer Rights Act (WHCRA)
HIPAA Special Enrollment Rights Notice
Premium Assistance under Medicaid and the Children's Health Insurance Program (CHIP)
Notice Regarding Patient Protections Against Surprise Billing
Paid Leave Model Notice-Poster
IRS Forms
Form W-4
Form I-9
Eligibility and Contribution
40 hours per week on a regularly scheduled basis
Coverage begins first of the month following 60 days of working the required amount of hours
Open enrollment is from March 1 through March 31 for an April 1 start date annually
Employer pays 100% for employee only on the Providence Standard Bronze plan
Employees may enroll dependents on the plan with premium contributions
Premium Contribution Summary - Coming Soon
Account Manager and Support Staff Contact Information
Contact Katie Ostgarden - Account Manager
Contact Sarah Selix - Assistant