Instructions For Schedule Hc - Health Care - 2012 (Page 3 of 10) in pdf

2012 Schedule HC — Line by Line Instructions

Line 4a. If you (and/or your spouse if married fil-

Lines 4f and 4g. Complete only if you filled in

surance (examples of which include MassHealth,

ing jointly) were enrolled in private health insur-

oval(s) in line(s) 4a or 4e. Enter information in

Commonwealth Care or Commonwealth Care

lines 4f and 4g on up to two insurance carriers

ance, fill in the oval(s) in line 4a and complete line

Bridge), fill in the oval(s) for the months you were

4f (for you) and/or 4g (your spouse) using Form(s)

each, if you (and/or your spouse if married filing

covered in 2012, using the information from

MA 1099-HC. This form will be issued to you by

jointly) were covered by multiple insurers in

Form(s) MA 1099-HC.

your health insurance carrier or administrator, no

2012. Note: If you filled in the oval(s) in line 4e,

If you did not receive a Form MA 1099-HC from

later than January 31, 2013. Note: If you received

only enter the name of the program. After com-

your insurer, fill in the oval(s) for each month in

Form(s) MA 1099-HC, be sure to attach to Sched-

pleting lines 4f and 4g, go to line 5.

which you had coverage that met MCC require-

ule HC. If you did not receive Form(s) MA 1099-

If you (and/or your spouse if married filing jointly)

ments for 15 days or more. If you had coverage in

HC, fill in the oval(s) in lines 4f (for you) and/or 4g

had health insurance from more than two insur-

any month for 14 days or less, you must leave the

(your spouse), and enter the name of your insur-

ance carriers, fill out Schedule HC-CS, Health Care

oval(s) blank.

ance carrier or administrator and your subscriber

Continuation Sheet. If you file Schedule HC-CS,

Note for MassHealth, Commonwealth Care or

number in line 4f and/or 4g and go to line 5. This

report your two most recent insurance carriers first

Commonwealth Care Bridge enrollees: If you

information should be on your insurance card. If

on Schedule HC and use Schedule HC-CS to re-

did not receive a Form MA 1099-HC and you an-

you do not know this information, contact your

port the additional insurance carriers for yourself

swered No to line 6, please call MassHealth at

insurer or your Human Resources Department if

(and/or your spouse if married filing filing jointly).

1-866-682-6745 or Commonwealth Care or Com-

your insurance is through your employer.

Schedule HC-CS is available on DOR’s website at

monwealth Care Bridge at 1-877-623-6765 for a

Note: Generally, employees or retirees of the fed-

copy. If you answered Yes to line 6, you do not

eral, state or local governments have private health

need to complete this section and you do not need

Line 5. Instructions After

insurance and should fill in the oval(s) in line 4a

a Form MA 1099-HC. If you answered Yes to line

Completing Lines 3 and 4

and complete line 4f (for you) and/or line 4g (your

6, you are not subject to a penalty. Skip the re-

spouse) and then go to line 5.

If your health insurance met the Minimum Cred-

mainder of Schedule HC and continue completing

itable Coverage requirements for all of 2012, you

If you and your spouse were enrolled in the same

your return.

are not subject to a penalty. Skip the remainder of

health insurance, you must complete both line 4f

If you have four or more consecutive months ei-

this schedule and continue completing your tax re-

(for you) and 4g (your spouse).

ther with no insurance or insurance that did not

turn. If you were enrolled in Medicare, U.S. Military

Line 4b. If you (and/or your spouse if married fil-

meet MCC requirements (four or more blank ovals

(including Veterans Administration and Tri-Care),

ing jointly) were enrolled in MassHealth, Common-

in a row), go to line 8a. Otherwise, you are not

or other government insurance, not including

wealth Care or Commonwealth Care Bridge, fill in

subject to a penalty. Skip the remainder of Sched-

MassHealth, Commonwealth Care or Common-

the Yes oval(s) in line 4b and go to line 5.

ule HC and continue completing your return. Be

wealth Care Bridge, at any point during 2012, you

sure to enclose Schedule HC with your return.

Line 4c. If you (and/or your spouse if married filing

are not subject to a penalty. Skip the remainder of

jointly) were enrolled in Medicare (including a re-

this schedule and continue completing your tax re-

If you are filing a joint return and one spouse has

placement or supplemental plan), fill in the oval(s)

turn. If you had health insurance that met the MCC

three or fewer blank ovals in a row, and the other

in line 4c and then go to line 5.

requirements for only part of the year in 2012 or

spouse has four or more blank ovals in a row, the

if you had no insurance in 2012, go to line 6.

spouse with three or fewer blank ovals in a row is

Note: Fill in the Medicare oval(s) even if you have

not subject to a penalty and should skip the re-

a supplemental or replacement plan that you may

Line 6. Federal Poverty Level

mainder of Schedule HC. The spouse with four or

have purchased on your own.

Individuals with income at or below 150% of the

more blank ovals in a row must go to line 8a.

Line 4d. If you (and/or your spouse if married fil-

Federal Poverty Level (FPL) are not subject to a

Special Circumstances During 2012

ing jointly) were enrolled in a U.S. Military, plan

penalty for failure to purchase health insurance.

(including Veterans Administration and Tri-Care)

Complete the Line 6, Federal Poverty Worksheet to

Note: Schedule HC must be completed and filed

fill in the oval(s) in line 4d and then go to line 5.

determine if your income in 2012 was at or below

even if you fall into a “Special Circumstances”

150% of the Federal Poverty Level.

category. Also, do not count the months that the

Line 4e. If you (and/or your spouse if married fil-

mandate did not apply when determining if you

ing jointly) were enrolled in Other government

Line 7. Months Covered by

have four or more consecutive months without

health coverage fill in the oval(s) in line 4e and

Minimum Creditable Coverage

health insurance.

complete line 4f (for you) and/or 4g (your spouse)

Health Insurance

by entering the program name(s) only.

Turning 18. If you turned 18 during 2012, the

Complete this section only if you (and/or your

mandate to maintain and obtain health insurance

“Other government health coverage” includes

spouse if married filing jointly) were enrolled in a

applies to you beginning on the first day of the

comprehensive government-subsidized plans such

health insurance plan(s) that met Minimum Cred-

third month following the month of your birthday.

as care provided at a correctional facility. Taxpayers

itable Coverage requirements for part, but not all,

For example, if your birthday is June 15, the man-

who receive MassHealth, Commonwealth Care or

of 2012. You are considered to have coverage for

date applies on September 1. In this example, do

Commonwealth Care Bridge should fill in the oval

part of 2012 if you had coverage for at least 1 but

not count the months of January through August

on line 4b. Taxpayers who receive health care

less than 12 months.

because the mandate did not apply.

through the Health Safety Net (formerly known as

the Uncompensated Care Pool) should not fill in

If you were enrolled in a private health insurance

Part-year residents. If you moved into Mass-

any oval in line 4 because the Health Safety Net is

plan that met MCC requirements (such as cover-

achusetts during 2012, the mandate to obtain and

not health insurance, and thus it does not meet

age provided by your employer or purchased on

maintain health insurance applies to you begin-

Minimum Creditable Coverage requirements.

your own) or government-sponsored health in-

ning on the first day of the third month following

HC-3

Instructions For Schedule Hc - Health Care - 2012 Page 3

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