Attachment_O_Payment_of_Employee_Healthcare_Expenses_Certification.pdf
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- Attached to
- BA-681-240-001
- Solicitation number
- BPM058733
- Issued by
- Maryland
About this file
This is a Payment of Employee Healthcare Expenses Certification form required by the State of Maryland for contractors and subcontractors bidding on state and local contracts, specifically in connection with solicitation BA-681-240-001 for ADA Modifications. The certification applies to all employees who will work on or at the project site and must be completed and signed by an authorized representative of the bidding firm or subcontractor. The form requires the contractor to select one of three compliance options regarding employee healthcare expenses: paying aggregate employee healthcare expenses of at least 5% of aggregate social security wages paid, paying 50% or more of the required premium for a credible health insurance plan, or demonstrating exemption status as a firm with 30 or fewer employees.
The form establishes that "Credible Health Insurance Plan" encompasses group policies, contracts, or programs administered by disability insurers, health care service plans, fraternal benefits societies, self-insured employer plans, or other entities in Maryland or elsewhere that provide medical, hospital, and surgical coverage. Completion of this certification is mandatory under State Finance & Procurement Article Title 17, Subtitle 8, with an effective date of July 2024. The certification acknowledges that providing false information regarding these requirements subjects the responsible person or entity to civil penalties ranging from $2,500 to $25,000 per violation under Maryland Annotated Code Section 17-804.
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Attachment O. Payment of Employee Healthcare Expenses Certification effective date: July 2024
Attachment O. Payment of Employee Healthcare Expenses Certification Under State Finance & Procurement Article Title 17, Subtitle 8
In connection with Solicitation Number _________I, ___________________[Name] hereby certify that ___________________ [Firm Name] is ☐ the bidder/☐ a subcontractor on this project (indicate whether the firm is the bidder or a subcontractor). I further certify that, with respect to employees who will work on or at the site of the project:
[CHOOSE ONLY ONE OPTION BELOW. Note that for purposes of this Certification, “Credible Health Insurance Plan” means any group policy, contract, or program that is written or administered by a disability insurer, health care service plan, fraternal benefits society, self-insured employer plan, or any other entity, in the state of Maryland or elsewhere, that arranges or provides medical, hospital, and surgical coverage not designated to supplement other private or governmental plans.]
1. ☐ The firm pays aggregate employee healthcare expenses of at least 5% of the aggregate social security wages paid.
OR
2. ☐ The firm pays 50% or more of the required premium necessary to obtain employee coverage by a credible health care insurance plan (as defined above).
OR
3. ☐ The firm has 30 or fewer employees and is therefore exempt.
Further, I acknowledge that under §17-804 of the State Finance and Procurement Article, Maryland Annotated Code, a person or entity providing false information regarding this requirement may be subject to a civil penalty of not less than $2,500 and not exceeding $25,000 for each violation.
Signature of Authorized Representative Date
Title of Authorized Representative
Company Street Address
City, State, ZIP Code
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