Did you receive a letter from Fallon asking you to submit your Social Security number? Here’s why:

Each year, commercial Fallon Health members receive a form that needs to be included with their tax returns. In 2016, you received a form called a 1095. This form must include your SSN so that the IRS can validate your coverage (it’s now a federal requirement to have health care coverage). If the IRS cannot validate your coverage by matching the SSN on this form to the SSN on your tax return, you may be forced to pay a penalty. To help our commercial members avoid this situation, we’re reaching out to anyone who doesn’t have an SSN on file with us.

To give Fallon Health your SSN, please call our Customer Service Department at the phone number on the back of your member ID card. See our privacy policy (pdf).

Health insurance tax forms-tax year 2016

Federal and state health care reform legislation requires residents to have health care coverage. Residents whose coverage does not meet the federal or state minimum coverage standards, or who have a lapse in coverage greater than 63 consecutive calendar days (state rule) or 2 months (federal rule), may be subject to a penalty for each month of non-compliant coverage during the year.

Taxpayers will receive new forms to reference for their federal tax filing at the beginning of each year. These new 1095 forms are in addition to the 1099-HC covered individuals will receive for Massachusetts state tax reporting.

Learn more about what you need to know for :

Massachusetts tax filing information

Am I required by the state to have health insurance?

Most Massachusetts residents who are 18 years or older are required to have health insurance that meets minimum creditable coverage standards, and not have a lapse in coverage of more than 3 consecutive months, or they may be subject to a penalty for each month of non-compliance. You can see the penalty amounts for 2016 on the Massachusetts Department of Revenue website.

What is minimum creditable coverage?

Minimum creditable coverage (MCC) is the least amount of coverage that an individual must obtain to be in compliance with the health care reform individual mandate.

What if I have a plan that does not meet minimum creditable coverage requirements?

The requirement to meet MCC guidelines may not apply to all individuals. For information on MCC, affordability or waivers, the Commonwealth Connector Public Information Line is available at 1-877-MA-ENROLL (1-877-623-6765) or visit the Connector via their website at www.mahealthconnector.org.

What if I had coverage for non-consecutive months?

Gaps in health care coverage may exist without a penalty providing they are no more than 63 consecutive days, according to legislation. If you are enrolled in health insurance that meets minimum creditable coverage standards anytime during the year, you will receive a 1099-HC form indicating full year coverage, or, if there are gaps in coverage, showing each month you had health insurance that meets minimum creditable coverage standards for at least 15 days or greater.

How do I prove that I have obtained health insurance?

If you are enrolled in health insurance that meets minimum creditable coverage standards anytime during the year, you will receive a 1099-HC form in the mail in January from your health insurance company. The form is proof of coverage and can be used to help fill out the Schedule HC form, which is a required part of the Massachusetts income tax return.

You can also download a copy of your 1099-HC. Just log into myFallon, go to the “My Benefits” page, and click on the “1099-HC” link at the top right of the screen. 1099-HCs for the 2016 tax year will be available for download in January 2017.

I am an employer that offers health benefits through Fallon Health and pharmacy benefits through a separate pharmacy benefits manager. How will Fallon know if I meet minimum creditable coverage standards?

Fallon Health will mail an attestation form to employers whose Fallon plan does not meet minimum creditable coverage standards. Employers receiving the form are required to complete and mail it back to Fallon attesting to meeting minimum creditable coverage standards. Fallon will then send 1099-HC forms to employees by January 31, 2017.

What if I had coverage from different insurers?

If you have coverage from different health care insurers during 2016, you will receive a 1099-HC from each health insurance provider from which you had coverage.

What if I live outside of Massachusetts but have a dependent that lives in Massachusetts?

Fallon Health subscribers living in or outside of Massachusetts will be sent a 1099-HC form. Subscribers and dependents can use the form to obtain information needed to complete their Massachusetts Schedule HC filing. Subscribers that are not filing Massachusetts state income taxes may disregard the form.

How do I obtain a form if I am a dependent?

Fallon Health will send a 1099-HC form to each subscriber who has health coverage that meets minimum creditable coverage standards in 2016. Dependents can use the subscriber form to obtain information needed to complete their Massachusetts Schedule HC filing.

What if I am on a government-subsidized health plan (Medicare/MassHealth/ConnectorCare)?

Individuals on Medicare, MassHealth or ConnectorCare plans at any time during 2016 will receive 1099-HC information from the state showing proof of coverage. The form is proof of coverage and can be used to help fill out the Schedule HC form, which is a required part of the Massachusetts income tax return.

Individuals covered on a Medicare plan will not receive a 1099-HC form. These individuals should fill in the oval for Medicare on their Massachusetts Schedule HC. They do not need to include a 1099-HC form with their state tax filing.

What information does the 1099-HC form contain?

The 1099-HC indicates:

  • Name of insurance company or administrator, and its Federal Identification Number (FID) (or, Employer Identification Number)
  • Subscriber’s name, address, member number and date of birth
  • Whether an individual had full-year coverage that meets minimum creditable coverage standards, or, if not full-year coverage, the number of months covered (a month of coverage is any month in which you had 15 or greater days of coverage)
  • Dependents’ names, dates of birth, member numbers and coverage data

What if my address or name is incorrect on my form?

If the 1099-HC has an incorrect address and you received the form, please let Fallon Health know your new or correct address. If you received a 1099-HC form, you will not need another one. If your name changed in 2016 or is incorrect on the 1099-HC form, please let Fallon know right away and we will make the correction for you and send you a corrected form.

How do I obtain a 1099-HC form?

Fallon Health subscribers over the age of 18 that have health insurance that meets minimum creditable coverage standards will be mailed a 1099-HC form from Fallon by January 31. If you, as a subscriber, misplace or don’t receive a form, please call the Customer Service phone number on the back of your member ID card to request a new one. (TTY users, please call TRS 711.)

You can also download a copy of your 1099-HC. Just log into myFallon, go to the “My Benefits” page, and click on the “1099-HC” link at the top right of the screen. 1099-HCs for the 2016 tax year will be available for download in January 2017.

If you are a dependent over the age of 18 and filing separately, you can use the information from the subscriber’s 1099-HC form to complete your state tax filing.

Why did I receive more than one 1099-HC form?

If you have coverage from different health care providers during 2016, you will receive a 1099-HC form from each health insurance provider from which you obtained coverage.

When will subscribers receive a 1099-HC form?

Fallon Health will mail 1099-HC forms to subscribers by January 31, 2017, for the 2016 state tax filing.

You can also download a copy of your 1099-HC. Just log into myFallon, go to the “My Benefits” page, and click on the “1099-HC” link at the top right of the screen. 1099-HCs for the 2016 tax year will be available for download in January 2017.

If I receive health care coverage through my employer, will the employer send me a 1099-HC form?

In most cases, health insurers, not employers, will send out 1099-HC forms. Fallon Health will send 1099-HC forms to our members.

You can also download a copy of your 1099-HC. Just log into myFallon, go to the “My Benefits” page, and click on the “1099-HC” link at the top right of the screen. 1099-HCs for the 2016 tax year will be available for download in January 2017.

If I do not receive the 1099-HC form or if I misplace the one that I did receive, can I obtain another form?

You can download a copy of your 1099-HC. Just log into myFallon, go to the “My Benefits” page, and click on the “1099-HC” link at the top right of the screen. 1099-HCs for the 2016 tax year will be available for download in January 2017.

Additional copies of a subscriber’s 1099-HC form issued by Fallon can also be obtained by calling the Customer Service phone number on the back of your member ID card Monday, Tuesday, Thursday, and Friday from 8 a.m. to 6 p.m. and Wednesday from 10 a.m. to 6 p.m. (TTY users, please call TRS 711.) Customer Service can mail, email or fax a copy of your 1099-HC to you. Due to HIPAA privacy regulations, forms can only be requested by the subscriber. The caller may be asked certain questions to confirm that he or she is the actual subscriber.

Do I need more than one 1099-HC form if I am married but my spouse and I file separate tax returns?

No, you will only need one form. Health insurance companies will issue one 1099-HC per subscriber. If you need more than one form, you may make a copy of the original document.

Do I need to attach the 1099-HC form to my state income tax filing?

If you are filing your state income tax electronically, you do not need to submit a copy of your 1099-HC form. If you are filing a paper return, please attach a copy of your 1099-HC form to your tax return. If you need more than one form, you may make a copy of the original document. If you have not received a copy of your 1099-HC form by January 31, please call the Customer Service phone number on the back of your member ID card, Monday, Tuesday, Thursday, and Friday from 8 a.m. to 6 p.m. and Wednesday from 10 a.m. to 6 p.m. (TTY users, please call TRS 711.) You may submit your return without the form attached; however, please be advised that this could delay the processing of your tax return. As always, electronic filing is the quickest and most efficient way to file your tax return with the Department of Revenue.

What is the Schedule HC tax form?

The Schedule HC form is a required part of your Massachusetts income tax filing which indicates whether or not you had health insurance that meets minimum creditable coverage standards at any time during 2016.

Where can I get a copy of the Schedule HC tax form?

The Massachusetts Department of Revenue will have the Schedule HC tax form available on their website, www.mass.gov/dor. Forms should also be available anywhere you obtain your state income tax forms or through your tax preparer.

More information can be found on the Massachusetts Department of Revenue (DOR) website at www.mass.gov/dor or by phone at 1-617-887-6367 (toll-free at 1-800-392-6089).

Federal

Am I required by the U.S. government to have health insurance?

Most U.S. residents are required to have health insurance that meets minimum essential coverage standards. For any month during the year that you or any of your dependents don’t have minimum essential coverage and don’t qualify for a coverage exemption, you will need to make an individual shared responsibility payment with your tax return.

In general, the annual payment amount is the greater of a percentage of your household income or a flat dollar amount, but is capped at the national average premium for a bronze level health plan available through the Marketplace. You will owe 1/12th of the annual payment for each month you or your dependent(s) don’t have either coverage or an exemption.

To estimate the amount of individual shared responsibility payment you may owe, see this shared responsibility payment estimator.

What is minimum essential coverage?

Minimum essential coverage is the least amount of coverage that an individual must obtain to be in compliance with the Affordable Care Act’s individual shared responsibility provision.

What if I have a plan that does not meet minimum essential coverage requirements?

If you don’t have a health plan that qualifies as minimum essential coverage, you may have to pay a fee for the months you’re uncovered. For 2016 the fee is the higher of these two amounts:

  • 2.5% of your household income; or
  • $695 per adult ($347.50 per child), up to a maximum of $2,085.

You’ll pay the penalty on your federal income tax return. People with very low incomes and others may be eligible for exemptions.

For more information on 2016 health coverage exemptions visit www.healthcare.gov/health-coverage-exemptions/forms-how-to-apply/.

What if I had coverage for non-consecutive months?

Gaps in health care coverage may exist without a penalty providing they are no greater than two months according to legislation. If you are enrolled in health insurance that meets minimum essential coverage standards anytime during the year, you will receive a 1095-B form indicating full year coverage, or, if there are gaps in coverage, showing each month you had health insurance that meets minimum essential coverage standards for at least one day.

How do I prove that I have obtained health insurance?

If you are enrolled in health insurance that meets minimum essential coverage standards anytime during the year, you will receive a 1095 form from your health insurance company.

  • Non-group subscribers enrolled through the Connector will receive a 1095-A.
  • Most group subscribers will receive a 1095-B from Fallon Health.
  • For subscribers who have coverage from a self-funded employer group, a 1095-C will be provided from the employer.

These forms are proof of coverage and can be used to help fill out your federal income tax return.

What if I had coverage from different insurers?

If you have coverage from different health care insurers during 2016, you will receive a 1095-B from each health insurance provider from which you had coverage.

How do I obtain a form if I am a dependent?

Fallon will send a 1095-B form to each subscriber who has health coverage that meets minimum creditable coverage standards in 2016. Dependents can use the subscriber form to obtain information needed to complete their Federal tax filing.

What if I am on a government-subsidized health plan (Medicare/MassHealth/ConnectorCare)?

Individuals on a Medicare or MassHealth plan at any time during 2016 will receive 1095 information from the state or federal agency that administers the program showing proof of coverage. The form is proof of coverage and can be used to help fill out your federal income tax return.

If you have not received your 1095 or you need to make changes, such as an address or name change, you must contact the Connector or MassHealth for assistance as this form comes from the state.

What information does the 1095-B form contain?

The 1095-B indicates:

  • Subscriber’s name, address, social security number or date of birth
  • Name of employer, address and its Employer Identification Number, if your coverage was through an employer-sponsored plan.
  • Name of insurance company or administrator, address and its Employer Identification Number
  • Whether an individual had full-year coverage that meets minimum essential coverage standards, or, if not full-year coverage, the number of months covered (a month of coverage is any month in which you had one day of coverage)
  • Dependents’ names, social security numbers or dates of birth, and coverage data

What if my address or name is incorrect on my form?

If the 1095-B has an incorrect address and you received the form, please let Fallon know your new or correct address. If you received a 1095-B form, you will not need another one. If your name changed in 2016 or is incorrect on the form, please let Fallon know right away and we will make the correction for you and send you a corrected form.

How do I obtain a 1095-B form?

You will be mailed a 1095-B form from Fallon Health by the end of February. If you, as a subscriber, misplace or don’t receive a form, you can call the Customer Service phone number on the back of your member ID card to request a new one. (TTY users, please call TRS 711.)

If you are a dependent over the age of 18 and filing separately, you can use the information from the subscriber’s 1095-B form to complete your tax filing.

Why did I receive more than one 1095-B form?

If you have coverage from different health care providers during 2016, you will receive a 1095-B form from each health insurance provider from which you obtained coverage. You may also receive more than one if you switched employers during 2016.

If I receive health care coverage through my employer, will the employer send me a 1095-B form?

In most cases, health insurers, not employers, will send out 1095-B forms. Fallon will send 1095-B forms to our subscribers. Employers who provide self-funded insurance will send a 1095-C form to their covered individuals.

If I do not receive the 1095-B form or if I misplace the one that I did receive, can I obtain another form

Additional copies of a subscriber’s 1095-B form issued by calling the Customer Service phone number on the back of your member ID card to request a new one. (TTY users, please call TRS 711.) Our office hours are Monday, Tuesday, Thursday and Friday from 8 am. to 6 p.m., and Wednesdays 10 a.m. to 6 p.m. Due to HIPAA privacy regulations, forms can only be requested by the subscriber. The caller may be asked certain questions to confirm that he or she is the actual subscriber. We are not able to provide 1095-B tax information over the phone.

Do I need more than one 1095-B form if I am married but my spouse and I file separate tax returns?

No, you will only need one form. Health insurance companies will issue one 1095-B per subscriber. If you need more than one form, you may make a copy of the original document.

Do I need to attach the 1095-B form to my federal income tax filing?

No. You should use the information on the form to fill out your federal income tax return, but you should not attach the form to your tax return.

Do I need to wait to receive all of my 1095 forms before I file my federal income tax return?

Yes. Just like the 1099, you will want to have all documents in hand before filing your tax returns. If you are expecting to receive a Form 1095-A from an Exchange, such as the Massachusetts Health Connector, the IRS has indicated that you should wait to file your 2016 income tax return until you receive that form.

Will I have to pay both a penalty to the state and the federal government if my coverage does not meet both sets of requirements?

Yes, but you are allowed to offset the amount of your federal penalty towards the amount of your state penalty so you may not need to pay the full amount of both. For more information, see www.mass.gov/dor/individuals/taxpayer-help-and-resources/health-care-reform-information/frequently-asked-questions-individuals.html, question 36.

I see my 1099-HC in the member portal, myFallon, but not my 1095-B. When will it be available online?

At this time, your 1095-B is not available online. If you need an electronic copy of your 1095-B, we are happy to email you a copy. To request a copy, please call Customer Service at 1-800-868-5200 (TRS 711) Monday, Tuesday, Thursday and Friday from 8 am. to 6 p.m., and Wednesdays 10 a.m. to 6 p.m.

Why is my Social Security number “x”ed out except for the last four digits?

For security reasons, some numbers on the 1095-B form have been marked with an “x”. If your form falls into someone else’s hands, this will prevent that person from knowing the full number.

My employer name doesn’t look right. It says [MBA or ACA Group or Individual Consumers].

If you get your insurance through the Connector as an individual or through an intermediary, then the employer listed in our system is listed differently. If you are an individual consumer or your employer went through the Connector to get your insurance coverage, it will show your employer name as “Individual Consumer” or “ACA Group”. If your employer went through the MBA to get coverage, then your employer will say “MBA”.

Updated on November 18, 2016