MA DoR 1099-HC 2011 free printable template
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Form MA 1099-HC Individual Mandate Massachusetts Health Care Coverage 1. Name of insurance company or administrator Department of Revenue 2. FID number of insurance co. or administrator 3. Name of subscriber 4. Date of birth 6. Street address 5. Subscriber number 7. City/Town 8. State 9. Zip Full-year minimum creditable coverage If No check months with minimum creditable coverage Yes No a* Name of dependent Jan* Feb. FID number of insurance co. or administrator 3. Name of subscriber 4. Date...
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How to fill out form ma 1099 hc
How to fill out form MA 1099 HC:
01
Obtain the form: You can download form MA 1099 HC from the Massachusetts Health Connector website or request a copy by calling the Health Connector customer service.
02
Provide personal information: Start by filling out your personal information, including your full name, address, and Social Security number.
03
Enter your health insurance coverage details: In this section, you will need to provide information about your health insurance coverage. This includes the name of your insurer, the policy number, and the coverage period.
04
Indicate if you had coverage for the entire year: Check the appropriate box to indicate if your coverage was in effect for the full calendar year. If not, provide the start and end dates of your coverage.
05
Employer-sponsored coverage: If you had employer-sponsored coverage, you need to indicate the name, address, and federal employer identification number (FEIN) of your employer.
06
Dependent coverage: If you had dependents covered under your health insurance policy, provide their names and Social Security numbers.
07
Signature: Sign and date the form to certify the accuracy of the information provided.
Who needs form MA 1099 HC?
01
Massachusetts residents: Form MA 1099 HC is specifically for residents of Massachusetts who had minimum essential health insurance coverage during the tax year.
02
Those who received health insurance through the Massachusetts Health Connector: If you obtained health insurance through the Massachusetts Health Connector or received premium assistance, you will need to complete form MA 1099 HC.
03
Individuals subject to state tax penalties: Form MA 1099 HC is used to determine eligibility for an exemption from the Massachusetts state tax penalty for not having health insurance coverage.
Remember, it is always a good idea to consult with a tax professional or refer to the Massachusetts Health Connector website for specific instructions and guidance when filling out form MA 1099 HC.
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People Also Ask about form ma 1099 hc
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