Important Notice to Employees Residing in the State of Nevada Concerning the Availability of
Coverage through the Silver State Health Insurance Exchange, Your Potential Eligibility for Premium
Tax Credits and Reductions in Cost Sharing Through the Exchange, Your Employer’s Contributions to
Your Existing Health Benefits, and Other Federal Tax Matters
Month, Day, 2013
(Legal name of the employer) is notifying its employees residing in the State of Nevada that the State
has established A State Based Exchange to help Nevadans without affordable health insurance coverage
to obtain such coverage.
(Legal name of the employer) does not offer all full time employees health insurance that meets
minimum essential coverage requirements. Employees may purchase health insurance through Nevada
Health Link.
Nevada Health Link can help you to select a qualified health plan, to determine if you and your family
may be eligible for health insurance premium tax credits and reductions in cost sharing, and to calculate
the net amount of any premiums that you may be required to pay for coverage through Nevada Health
Link.
We are providing you with the following information to help you contact Nevada Health Link if you wish
to obtain such assistance from them:
Nevada Health Link
www.nevadahealthlink.com
Address: TBD
Telephone: 855-768-5465 [855-7-NVLINK]
Fax: 855-868-5465 [855-8-NVLINK]
E-mail: contact@exchange.nv.gov
Federal law requires employers to notify their employees that:
1. If your employer does not offer health insurance coverage that meets minimum essential
coverage requirements, you may be eligible (depending on the modified adjusted gross income
of your household for Federal income tax purposes, your legal residency, other coverage that
you may have, and other Federal requirements) for a premium tax credit under section 36B of
the Internal Revenue Code of 1986 and a cost sharing reduction under section 1402 of the
Patient Protection and Affordable Care Act if you purchase a qualified health plan through the
Exchange.
This notice is being provided to you in accordance with the requirements of the Patient Protection and
Affordable Care Act (Public Law 111-148) and Health-Related Portions of the Health Care and Education
Reconciliation Act of 2010 (Public Law 111-152), section 1512.
Please contact (employer HR department contact) if you have any questions concerning this notice or if
you have any questions concerning your existing benefits through (legal name of employer), your
employer’s contributions to your benefits, and any exclusions from your income for Federal income tax
purposes.