Date issued: January 11, 2016
What is Form 1095-B?
Form 1095-B is an IRS health coverage reporting form prepared by health insurers such as EmblemHealth. This form reports information about your health coverage and the type of coverage in which you were enrolled. EmblemHealth sends this information to you and the IRS.
What is it used for?
The Affordable Care Act requires health insurers filing electronically to submit Form 1095-B to the IRS by March 31 to report an individual’s health coverage during the prior tax year. (For 2015 reporting, the IRS granted an extension to June 30, 2016.) The IRS uses the information to help verify which taxpayers satisfied the Individual Shared Responsibility Mandate. This mandate requires nearly all Americans, including children, to have health coverage unless they qualify for an exemption.
Why am I receiving it?
Health insurers are required to send a copy of Form 1095-B to each subscriber by January 31. (For 2015 reporting, the IRS granted an extension to March 31, 2016.) You are receiving the form because you have been identified as a subscriber enrolled in one of EmblemHealth’s health plans. You will report the information on Form 1095-B on your federal income tax return in order to verify that you and any enrolled dependents had health coverage for some or all months during the tax year.
Should I attach Form 1095-B to my income tax return?
No. Currently the IRS does not require you to submit Form 1095-B with your federal income tax return, but you will need the information on Part IV in order to report months of coverage for you and your family. After your tax return is filed, the IRS may conduct an inventory of filings and ask you to provide proof of coverage. Therefore you should keep the form with your tax records.
What information is on Form 1095-B?
Form 1095-B provides basic information about the health insurer, employer sponsoring the health coverage, and individuals covered by the health policy. Individual information includes:
- Name of policy holder
- Address of policy holder
- Name, taxpayer identification number (usually a social security number), and months of coverage for each person on the policy
How will I receive the form?
Form 1095-B will be provided to you by January 31. If you consented to receive it electronically, you will receive an email notification with the subject line IMPORTANT TAX RETURN DOCUMENT AVAILABLE when it is available for download within your secure online account. Otherwise, a paper copy will be sent by first class mail to the address we have on file.
How do I consent to receive my 1095-B Form electronically?
Sign in to or register for your secure online account and select “Get Your 1095-B Tax Form” under Tools That Help You. Once you review the conditions to receive Form 1095-B electronically, click on the Consent button. Note that you can withdraw your consent at any time. When you withdraw consent, EmblemHealth will mail a paper copy of any future Form 1095-B to the address we have on file.
Will Form 1095-B be sent to my family members who are covered under my policy?
No. Form 1095-B will be sent only to each subscriber, not to each member. The form will list the names of each individual covered under the policy and will include information about each month of coverage. You can share your form with any family members who request a copy.
Why did I receive two different 1095-B forms?
Some members might receive two or more 1095-B forms if they were enrolled in a health plan through different employers at any time during the calendar year. For example, if a member was provided with health coverage while working for one company for the first half of the year, but then got a job with a different company, the health coverage provided through each company would be reported on separate 1095-B forms. Additionally, if an EmblemHealth member switches coverage from HIP to GHI, or vice versa, during the year, the member would receive one 1095-B reflecting coverage under HIP and another reflecting coverage under GHI. Members who receive multiple 1095-B forms should use the information from both forms to accurately report coverage on their annual income tax return.
Will I be able to get another copy if I lose the form?
You can view and print copies of the Form 1095-B by signing into your EmblemHealth Member Account and clicking on the “Get Your 1095-B Tax Form” under Tools That Help You. You may also call EmblemHealth Customer Service at 1-866-517-5804 to request a copy of the form.
Why can't I view/download Form 1095-B from my online EmblemHealth member account?
If EmblemHealth does not have your TIN/SSN information, you will not be able to view your Form 1095-B online. Please sign in to your secure online account and update your TIN/SSN in order to view your Form 1095-B. It may take two or three days for the update to be reflected in the EmblemHealth systems. You may also call EmblemHealth customer service at 1-866-517-5804 to request a copy of the form, but please be aware it may take a few days to receive your Form 1095-B by mail.
What if my Form 1095-B is not correct?
If any of the information on your Form 1095-B is incorrect or needs to be updated (for example, your name is misspelled or your social security number is missing) please call EmblemHealth Customer Service at 1-866-517-5804 to provide the correct information. A corrected Form 1095-B will be generated with the updated information with copies sent to you and the IRS.
Why does the IRS need my Tax Identification Number/Social Security Number (TIN/SSN)?
Under the Affordable Care Act, health insurers are required to file health coverage information with the IRS to help it determine whether individuals met the requirement to maintain minimum essential coverage and therefore are not liable for the Individual Shared Responsibility payment (tax penalty). The IRS will use the TIN/SSN reported on Form 1095-B to help match the health care information with the information reported on the member’s federal tax return.
Does EmblemHealth have my TIN/SSN?
EmblemHealth obtains TINs/SSNs for most members upon enrollment, but there are some records still missing TINs/SSNs, primarily for spouses and dependents of subscribers. If EmblemHealth is/was missing your TIN/SSN information, you will receive a letter from us requesting this information. To provide us with this information, follow the instructions in the letter. Note that you can also sign in to your online account and enter and/or update TINs/SSNs at any time.
For security reasons, I don’t feel comfortable giving my TIN/SSN to EmblemHealth. What will happen if Form 1095-B is filed without it?
You should know that EmblemHealth adheres to strict privacy rules. For security reasons, all TINs/SSNs recorded in our membership files are masked with only the last four numbers visible (for example, ***-**-7020). Only those Customer Service Advocates with unique security access are able to update a member’s TIN/SSN. If you do not respond to our letters requesting your TIN/SSN, EmblemHealth will instead report your date of birth on Form 1095-B. The IRS may not be able to match the health coverage information reported on your Form 1095-B with your income tax return with just your birthdate and therefore may be unable to verify you had health coverage during the tax year. You may receive a notice from the IRS that you are liable for a shared responsibility payment.
Where do I report my health coverage on my income tax return?
Most taxpayers who had health coverage for each month of the year will simply check a box on line 61 of the 1040 income tax form (line 38 of Form 1040A and line 11 of Form 1040EZ) to indicate they, their spouses and dependents had health care coverage for the entire year. You should use the same line to enter a payment amount if you did not have health coverage and therefore need to make an individual shared responsibility payment.
I had coverage only for part of the year. How do I calculate how much I owe?
If you and/or your spouse and dependents did not have health coverage for the full year and did not qualify for an exemption, calculate the amount you owe using the Shared Responsibility Payment Worksheet included in the instructions for Form 8965. Enter the payment amount on line 61 of Form 1040 (line 38 of Form 1040A or line 11 of Form 1040EZ). The penalty is calculated on a monthly basis – one-twelfth of the annual payment for each month that the individual did not have coverage. No payment is required if you or your family members were uninsured for less than three months of the year.
How much is the annual individual shared responsibility payment?
In 2015, the maximum penalty for not maintaining health coverage for the full year is $325 per person or 2 percent of the individual’s income, whatever is greater. The penalty per child under age 18 is $162.50. In 2016, the penalty will be 2.5 percent of income or $695 per person and $347.50 per child under age 18. After year 2016, the penalty amounts are based on the 2016 amounts, plus an inflation.
How will the payment be collected?
The Shared Responsibility Payment will be paid to the IRS when taxpayers file their federal income tax return. For example, the 2015 penalty payment would be paid when taxes are filed in 2016, and the 2016 penalty payment would be paid in 2017.
What will happen if I owe an Individual Shared Responsibility Payment, but cannot afford to make the payment when filing my tax return?
The IRS will hold back the amount of the fee from any future tax refunds. There are no liens, levies or criminal penalties for failing to pay the fee.
For additional information about the Affordable Care Act individual shared responsibility provisions, please visit the Internal Revenue Service website or contact your tax advisor.
If you have questions about the Form 1095-B you receive from EmblemHealth, call 1-866-517-5804 from 9 am to 5 pm, Monday through Friday (excluding major holidays).
The FAQs above are current as of the date written and are subject to change based on updates and guidance from the Internal Revenue Service and other federal government agencies.