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What is IRS Form 1095-C?

To comply with Federal Health Care Reform provisions, the state of New York is required to send IRS tax form 1095-C to all full-time employees, enrollees in The Empire Plan or NYSHIP HMOs, as well as retirees who are not enrolled in Medicare. Form 1095-C presents data to be provided to the IRS by the State as proof of qualifying health insurance coverage for 2018.

Federal law requires that Form 1095-C be sent to all employees who meet the Patient Protection and Affordable Care Act’s definition of a full-time employee. This is generally defined as individuals who work at least 30 hours per week or 130 hours per month. In addition to full-time employees, the State will also send Form 1095-C to any other individuals who were enrolled in The Empire Plan or the Student Employee Health Plan (SEHP) for all or a portion of 2018. If you were enrolled in a Health Maintenance Organization (HMO) for all or a portion of 2018, you may receive a similar form, Form 1095-B, from your HMO as well.

Individuals who are enrolled in Medicare or who provide coverage to any dependents enrolled in Medicare should note that enrollment information for Medicare enrollees will not appear on Form 1095-C. You may receive a separate Form 1095-B from Medicare for these individuals.

The 1095-C forms will be mailed in early March; please review your form for accuracy and retain it with your tax records. You do not need to return the form to the state of New York, and it does not need to be filed with your federal or state income tax return. If any of the information contained on your Form 1095-C is inaccurate, call the telephone number on the upper right corner of the form to correct any errors.

See the complete PEF Health Benefits page here.

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