Affordable Care Act | 1095-C

• ACA Benefit Eligibility Designation Guide
• Ensuring ACA Compliance ~ Tips for HRIS
• Eligibility Determination Chart for New Hire and Job Change
• IRS Website - ACA Information Center for Applicable Large Employers (ALEs)

AFFORDABLE CARE ACT GENERAL NOTICE

• The Affordable Care Act (ACA) requires nearly all Americans to have health insurance or pay a penalty. The ACA also requires certain employers, including the State of Arizona, to offer health insurance coverage to full-time employees and their dependents.
• Further, the State of Arizona is required to send an annual statement to all employees eligible for coverage describing the insurance available to them. The Internal Revenue Service (IRS) created Form 1095-C to serve as that statement.
• A 1095-C statement will be generated by the State of Arizona to serve as your documentation to the IRS about the coverage offered to you. The IRS will use the information from your 1095-C to determine whether you have health care coverage.
• Statements are scheduled to be placed in the mail to employees’ home addresses by January 31 each year.  If you believe you should have received a 1095-C but did not, please contact the Benefits Services Division at 602-542-5008.
• To avoid any delays in receiving your 1095-C, Please always ensure that your address is current in hrsystems.az.gov > YES Portal. 
• If you have additional questions about your 1095-C, please contact the Benefit Services Division at 602-542-5008 or [email protected].
• Any tax-related questions should be directed to your personal tax adviser.
• Legal Notice
• IRS Website - ACA Tax Provisions for Individuals and Families

AFFORDABLE CARE ACT FREQUENTLY ASKED QUESTIONS | FAQ

• In February each year, State of Arizona employees will receive a tax form called the IRS 1095-C. This form will contain detailed information about your personal health care coverage. It is important to keep this form for your records as you may need to provide this to the IRS.
• What is Form 1095-C? 
  The 1095-C statements that will be generated by the State of Arizona serve as documentation to the IRS about coverage offered to you under the Affordable Care Act. The form includes information about offers of health insurance along with information about covered dependents. It is important to keep this form for your records as you may need to provide this to the IRS. Think of the form as your “proof of insurance” for the IRS.
• How do I receive additional copies of the 1095-C statement?  
  Please contact the Benefit Services Division at 602-542-5008 or [email protected].
• Who receives Form 1095-C?  
  The State of Arizona is required to send a 1095-C to any full-time employee (who worked an average of 30 or more hours per week) or enrolled in ADOA medical benefits in a given tax year. This will include individuals who are enrolled in the ADOA retiree plan and COBRA participants.
• Why did I get Form 1095-C? 
  If you were full-time (worked an average of 30 or more hours per week) or were enrolled in health insurance through ADOA at any time during a given tax year, you should receive a 1095-C.
• Why did I get more than one Form 1095-C? 
  If you worked at more than one company or employer, you may receive a 1095-C from each company/employer. For example, if you worked at Arizona State University and a State Personnel System Agency for the State of Arizona, you will receive two separate statements.
• Why did I not get Form 1095-C? 
  If you were not full-time (worked less than 30 hours per week) and were not enrolled in health care coverage through your employer at any time during a given tax year, you should not receive a 1095-C. You may also not receive a 1095-C if you were not the primary insured.
• When will I get my Form 1095-C? 
  Statements will be mailed to the employee's home address by January 31 each year. If you believe you should have received a 1095-C but did not, please contact the Benefits Services Division at 602-542-5008 or [email protected]. If you do not receive the document, you may request a reprint after March 2. by filling out this form.
• Where will Form 1095-C be mailed? 
  Statements will be mailed to the last known address in HRIS/YES as of January 15 each year. Ensure your address is updated by this date. To update your address, log in to hrsystems.azdoa.gov > Y.E.S. Portal and click on the following path: Bookmarks > Your Employee Services > Personal Information > Contact Information.
• What should I do with my Form 1095-C? 
  When you receive your 1095-C, keep it for your records as you may need to provide this to the IRS.
• What information is on Form 1095-C?
  • Part I reports information about you and the State of Arizona.
  • Part II reports information about the coverage offered by the State of Arizona, the affordability of the coverage offered, and why you were or were not offered coverage.
  • Part III reports information about the individuals covered under your plan, including dependents.
• Will dependents that are covered on my medical plan also get 1095-C statements? 
  No. The 1095-C statements are only sent to the person who is the primary individual insured by the policyholder. If your dependents are filing their own personal tax returns, you will need to provide them with a copy of the 1095-C statement for their tax records.
• How will Form 1095-C impact my taxes? 
  If you do not have health care coverage and do not qualify for an exemption, you may be subject to a fine when you file your tax return. Or, if there’s a discrepancy in the information you and your employer report to the IRS about the health care coverage offered, your tax return may be delayed.
• How do I determine if I am eligible for Premium Tax Credit? 
  Individuals should consult with a tax adviser to determine eligibility.
• What should I do if there is an error on the 1095-C statement?
  • If you believe there is a mistake in your home address, please verify and correct your address by logging in to hrsystems.azdoa.gov > Y.E.S. Portal and click on the following path: Bookmarks > Your Employee Services > Personal Information > Contact Information. Even if your address is not correct on the form, the form is still valid and can be used to complete your taxes. You will not receive an updated Form 1095-C for an address correction.
  • Explanations for the codes listed in Part II are on the back of the 1095-C statement.
  • If any dependent information is incorrect in Part III, you will have to provide government-issued documentation to support a change in name, social security number, or date of birth. Acceptable documentation includes a driver’s license, original social security card (not a receipt) or certified birth certificate.
  • If you believe data or information on the form is incorrect in Part II (employee offer and coverage) or Part II (covered individuals), please contact the ADOA Benefits Services Division at 602-542-5008 and describe the mistake. A representative will investigate and respond to your inquiry as soon as possible.
• What if I have other questions? 
  If you have additional questions about your 1095-C, please contact the Benefit Services Division at 602-542-5008 or [email protected]. Any tax questions should be directed to your personal tax adviser.

PLEASE NOTE: These frequently asked questions (FAQ’s) and corresponding answers are not intended to be tax advice. If you have any tax questions, you should contact your tax adviser.

• The 1095-C statements are mailed annually in February.  
• Please do not request a new form until March 1 to allow time for the postal service to deliver the form.
  • Requests received before March 1 will not be processed until after March 1.
  • Form 1095-C Reprint Request

• If you have general questions regarding ACA, please contact the Benefit Services Division at 602-542-5008, 800-304-3687 or [email protected]