Form Ma 1099 Hc PDF Details

In Massachusetts, maintaining health care coverage is not just a matter of personal and public health importance; it is also a legal requirement. The Form MA 1099-HC plays a pivotal role in this framework, serving as a key document that substantiates an individual's compliance with the state's health care coverage mandate for the year 2020. Issued by the Massachusetts Department of Revenue, this form details essential information regarding the health insurance coverage of residents. Specifically, it lists the name and Federal Identification Number (FID) of the insurance company or administrator, alongside the subscriber's information including their name, date of birth, subscriber number, and address. More importantly, it documents whether the subscriber and any dependents have maintained "minimum creditable coverage" throughout the year and, if not, for which months the coverage was held. This determination of coverage adequacy is crucial, as it impacts compliance with state health insurance mandates and involves potential tax implications for the residents involved. For families, the form provides a section to list dependents, documenting their coverage status in a similar fashion. Filled with specific and comprehensive details, the form ensures transparency and accountability in the pursuit of statewide health coverage objectives.

QuestionAnswer
Form NameForm Ma 1099 Hc
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names www.mass.govservice-details1095-b-and-1099-hc1095-B and 1099-HC tax formMass.gov

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Form MA 1099-HC

IndividualMandate

MassachusettsHealthCareCoverage

2020

Massachusetts

Department of

Revenue

1.

Name of insurance company or administrator

 

 

2.

FID number of insurance co. or administrator

 

 

 

 

 

 

 

3.

Name of subscriber

4.

Date of birth

5.

Subscriber number

 

 

 

 

 

 

 

 

6.

Street address

7.

City/Town

8.

State

9.Zip

Full-year minimum creditable coverage?

If No, check months with minimum creditable coverage:

 

 

 

 

 

Corrected:

Yes

No

 

Jan.

Feb.

Mar.

Apr.

May

June

July

Aug.

Sept.

Oct.

Nov.

Dec.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a.Name of dependent

Date of birth

 

Subscriber number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Full-year minimum creditable coverage?

If No, check months with minimum creditable coverage:

 

 

 

 

 

Corrected:

Yes

No

 

Jan.

Feb.

Mar.

Apr.

May

June

July

Aug.

Sept.

Oct.

Nov.

Dec.

 

 

 

 

 

 

 

 

 

 

 

b.Name of dependent

Date of birth

 

Subscriber number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Full-year minimum creditable coverage?

If No, check months with minimum creditable coverage:

 

 

 

 

 

Corrected:

Yes

No

 

Jan.

Feb.

Mar.

Apr.

May

June

July

Aug.

Sept.

Oct.

Nov.

Dec.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c.Name of dependent

Date of birth

 

Subscriber number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Full-year minimum creditable coverage?

If No, check months with minimum creditable coverage:

 

 

 

 

 

Corrected:

Yes

No

 

Jan.

Feb.

Mar.

Apr.

May

June

July

Aug.

Sept.

Oct.

Nov.

Dec.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d.Name of dependent

Date of birth

 

Subscriber number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Full-year minimum creditable coverage?

If No, check months with minimum creditable coverage:

 

 

 

 

 

Corrected:

Yes

No

 

Jan.

Feb.

Mar.

Apr.

May

June

July

Aug.

Sept.

Oct.

Nov.

Dec.