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Commonwealth of Massachusetts Health Insurance Responsibility Disclosure (THIRD) Form For HR/CMS and MASS Agencies Agency: Please complete the first section of this form and give it to every employee

How to fill out hird form massachusetts

How to fill out hird form Massachusetts:

1. Obtain the HIRD form: The HIRD form can be obtained from the Massachusetts Department of Revenue (DOR) website or through your employer. Make sure to download the latest version of the form.
2. Gather necessary information: Collect the relevant information required to complete the form. This may include your personal details, such as name, address, social security number, and employer identification number (EIN).
3. Provide employer information: Fill in the employer information section, including the employer's name, address, and EIN. This information is essential to identify your employer.
4. Employee health coverage information: Indicate whether you have health coverage provided by your employer or if you are enrolled in MassHealth or other insurance programs. Include the details requested regarding the type of coverage and the employer's contributions.
5. Dependents and spousal coverage: If you have dependents or a spouse also covered by the insurance, fill in their information as required.
6. Submit the form: Once you have completed the form, review it for accuracy and ensure all necessary information is included. Sign and date the form before submitting it to the appropriate authority by the due date specified.

Who needs HIRD form Massachusetts:

1. Employers: Employers in Massachusetts are required to complete and file the HIRD form if they have six or more employees in any calendar month during the previous year. This applies to both for-profit and non-profit employers.
2. Employees with unaffordable coverage: The HIRD form is also relevant for employees who have health coverage offered by their employer but find it unaffordable. They may need to complete the form to determine whether they are eligible for additional assistance programs, such as MassHealth or the Health Connector.
3. Covered individuals: Individuals covered by MassHealth or other insurance programs may also be requested to fill out the HIRD form as part of the reporting requirements.

Overall, the HIRD form Massachusetts is necessary for both employers and individuals to ensure compliance and determine eligibility for various health insurance programs and benefits.

For pdfFiller’s FAQs

What is third form massachusetts?

HIRD stands for Health Insurance Responsibility Disclosure. It is a form that Massachusetts employers with 6 or more employees are required to file.

Who is required to file hird form massachusetts?

Massachusetts employers with 6 or more employees are required to file HIRD form.

How to fill out hird form massachusetts?

HIRD form can be filled out online through the Massachusetts Department of Revenue's website. Employers need to provide information about their health insurance offerings.

What is the purpose of hird form massachusetts?

The purpose of HIRD form is to collect information about employer-sponsored health insurance offerings in Massachusetts.

What information must be reported on hird form massachusetts?

Employers must report the type of coverage offered, the number of employees eligible for coverage, and the employer's contributions to health insurance.

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