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About the Form 1095-C

The Office of the Comptroller will mail paper Forms 1095-C (Employer-Provided Health Insurance and Coverage) by the end of February.

Forms 1095-B and 1095-C should be kept with tax records. Do not submit them to the IRS or Massachusetts Department of Revenue.

VIEW FORM 1095-C INSTRUCTIONS

If you have questions about your Form 1095-C (the offer of health insurance coverage) issued by the Commonwealth of Massachusetts (including institutions of higher education), the MBTA, or MSBA, call your human resources department.

If you have any questions about a Form 1095-B (offer of health insurance coverage) from the GIC, please see the Form 1095-B Frequently Asked Questions. You can also visit the IRS website.

View Your Form 1095-C in HR/CMS Self-Service

Go Paperless!

State employees can suppress their paper Form W-2 and Form 1095-C through HR/CMS Self-Service Time and Attendance.

Going paperless helps employees get their forms faster, and is more secure. In addition, this saves the Commonwealth money and is environmentally friendly. View instructions on Mass.gov.

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Form 1095-C Legend

A blank specimen Form 1095-C

Part I

Employee: Employees assessed ACA full-time, including from Commonwealth of Massachusetts, University of Massachusetts, MBTA, or MSBA are listed under the Applicable Large Employer

Employer: Employer information including Tax ID for Commonwealth of Massachusetts, MBTA or MSBA

Part II

Employee Offer of Coverage / Employee’s Age on January 1: Not applicable. The Commonwealth of Massachusetts does not offer plans with Health Reimbursement Arrangement (HRA)

All 12 Months: If the reporting value for you was unchanged throughout the year, then you will have a single value for the year.

Line 14 – Employer’s Offer of Coverage: Codes reporting.

Line 15 – Employee Required Contribution: The lowest cost of Commonwealth Heath Plan available to you, not the cost of coverage you chose, if any.

Line 16 – Section 4980H Safe Harbor and Other Relief: The determination of a “Safe Harbor” of affordability, based on your rate of pay, not your annual pay.

Line 17 – Zip Code: Not applicable. The Commonwealth of Massachusetts does not offer plans with Health Reimbursement Arrangement (HRA).

Part III

Covered Individuals: This part will be blank. This data will be included on the Form 1095-B, available upon request.

Frequently Asked Questions

Why am I receiving a health care tax statement (Form 1095-C)?

If you were determined to be a full-time employee of the Commonwealth of Massachusetts (including institutions of higher
education), the Massachusetts Bay Transit Authority (MBTA), or Massachusetts School Building Authority (MSBA) under the
Affordable Care Act (ACA) rules, you will receive a Form 1095-C.

The Affordable Care Act requires Applicable Large Employers having more than 50 full-time employees working an average
of 30 or more hours per week to be provided this form.

Why am I receiving Form 1095-C now, after I have already filed my taxes?

The IRS requires that Form 1095-C be postmarked by March 2, 2023. The IRS does not require individuals to submit the form with their annual income tax return, but you should retain the Form 1095-C with your other important tax records.

You do not need to wait until you receive the Form 1095-C to file your taxes. IRS guidelines allow for taxes to be filed using
other information provided by the employer.

What other forms may I receive? And how are they different?

There are other IRS tax forms that are similar to Form 1095-C that you may request:

  • IRS Form 1095-B details the months of health insurance coverage that you, your spouse and/or any eligible
    dependents had for each month. Form 1095-B is generally provided by the insurance carrier and gives details about the
    health insurance coverage you elected, including who in your family was covered.
    The IRS no longer requires you to keep Form 1095-B. You do not need it to file your taxes. This form will no longer be
    automatically mailed to you. As a Group Insurance Commission (GIC) beneficiary, you may request one from the GIC
    via https://www.mass.gov/forms/contact-the-gic. Alternatively, you can mail your request to: GIC, PO Box 556,
    Randolph, MA 02368.Note: If you were a full-time employee and changed health plans during the year to or from a non-GIC employer, you
    may receive multiple Forms 1095-B.
  • IRS Form 1095-A provides information as to any Marketplace coverage you had (if applicable), and any Premium Tax
    Credits you received. If applicable, this form would be provided by the Marketplace Exchange.Note: All above forms should be kept with tax records. Do not submit them to the IRS

Why did I receive more than one Form 1095-C?

If you worked at more than one agency, municipality, or company, you may receive a Form 1095-C from each employer. For
example, if you changed jobs during the year and were enrolled in coverage with both employers, you should receive a
1095-C from each employer.

Note: If you work more than one job at the Commonwealth of Massachusetts (including working for one or more agencies
or institutions of higher education), you will receive one Form 1095-C that will be inclusive of all your jobs within the
Commonwealth. If you worked for the MBTA, MSBA, and the Commonwealth, each is considered a separate employer, and
you may receive three forms.

What should I do with Form 1095-C?

Keep this form with the materials you give to your tax preparer. If you prepare your own taxes, you will need to refer to this
information as you prepare your federal return. Do not include it with your filing to the IRS.

What information is included on the Form 1095-C?

There are three parts to the form:

  • Employee and Employer Information (Part I) reports information about you and your employer, the Commonwealth
    of Massachusetts.
  • Employee Offer and Coverage (Part II) reports information about the coverage offered to you by your employer, the
    affordability of the coverage offered, and the reason you were or were not offered coverage by your employer.
  • Covered Individuals (Part III) will be blank. This information will be reported on the Form 1095-B.

Who should I contact if I have questions regarding the Form 1095-C that I received?

If you have questions about your Form 1095-C (the offer of health insurance coverage) issued by the Commonwealth of Massachusetts (including institutions of higher education), the MBTA, or MSBA, call your human resources department.

If you have any questions about the Form 1095-B (offer of health insurance coverage) from the GIC, please see the Form 1095-B FAQs at mass.gov. You can also visit the IRS website.

Related Content

Visit HR/CMS Self-Service

Log into HR/CMS Self-Service to view Forms 1095-C

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Form 1095-B

The Form 1095-B (Offer of Health Insurance Coverage) will no longer be automatically mailed by the Group Insurance Commission (GIC). For more information please visit see the GIC's page.

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Form W-2

View information on the Form W-2 for Commonwealth employees

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