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About the Form 1095-C

The Office of the Comptroller will mail paper 形式 1095-C (Affordable Care Act) by the end of February.

形式 1095-B and 1095-C should be kept with tax records. Do not submit them to the IRS or 质量achusetts Department of Revenue.

View Your Form 1095-C in HR/CMS Self-Service

Go Paperless!

State employees can suppress their paper Form W-2 and Form 1095-C through HR/CMS Self-Service Time and Attendance.

Going paperless helps employees get their forms faster, and is more secure. In addition, this saves the Commonwealth money and is environmentally friendly. View instructions on 质量.政府.


Form 1095-C Legend

Part I – Employee: Employees assessed ACA full-time, including from Commonwealth of 质量achusetts, University of 质量achusetts, 优先, or MSBA are listed under the Applicable Large Employer.

Part I – Employer: Employer information including Tax ID for Commonwealth of 质量achusetts, 优先 or MSBA

Part II Employee Offer of Coverage:

Employee’s Age on January 1: Not applicable. The Commonwealth of 质量achusetts does not offer plans with Health Reimbursement Arrangement (HRA)

All 12 Months: If the reporting value for you was unchanged throughout the year, then you will have a single value for the year.

Line 14 -Employer’s Offer of Coverage: codes reporting.

Line 15 – Employee Required Contribution: The lowest cost of Commonwealth Heath Plan available to you, not the cost of coverage you chose, if any.

Line 16 – Section 4980H Safe Harbor and Other Relief: The determination of a “Safe Harbor” of affordability, based on your rate of pay, not your annual pay.

Line 17 – Zip Code: Not applicable. The Commonwealth of 质量achusetts does not offer plans with Health Reimbursement Arrangement (HRA).

Part III – Covered Individuals: This part will be blank. This data will be included on the Form 1095-B, available upon request.

Frequently Asked Questions

Why am I receiving a health care tax statement (Form 1095-C)?

If you were determined to be a full-time employee of the Commonwealth of 质量achusetts, the 质量achusetts Bay Transit Authority (优先), or 质量achusetts School Building Authority (MSBA) under the Affordable Care Act (ACA) rules, you will receive a Form 1095-C.

The Affordable Care Act requires Applicable Large Employers having more than 50 full-time employees working an average of 30 or more hours per week to be provided this form.

What other forms may I receive? And how are they different?

There are other IRS tax forms that are similar to Form 1095-C that you may request:

  • IRS Form 1095-B details the months of health insurance coverage that you, your spouse and/or any eligible dependents had for each month. Form 1095-B is generally provided by the insurance carrier and provides details about the health insurance coverage you elected, including who in your family was covered. The IRS no longer requires you to keep the Form 1095-B. You do not need it to file your taxes. This form will no longer be automatically mailed to you. As a Group Insurance Commission beneficiary, you may request one from the GIC at this link.  Alternatively, you can mail your request to: GIC, PO Box 556, Randolph, MA 02368
    If you were a full-time employee and changed health plans during the year to or from a non-GIC employer, you may receive multiple 形式 1095-B.
  • IRS Form 1095-A provides information as to any Marketplace coverage you had (if applicable), and any Premium Tax Credits you received. If applicable, this form would be provided by the Marketplace Exchange.     

Please 注意: All above forms should be kept with tax records. Do not submit them to the IRS.

Why did I get more than one Form 1095-C?

If you worked at more than one agency, municipality, or company, you may receive a Form 1095-C from each employer. For example, if you changed jobs during the year and were enrolled in coverage with both employers, you should receive a 1095-C from each employer.

Please note: If you work for more than one job at the Commonwealth of 质量achusetts (including working for one or more agency or institution of higher education), you will receive one Form 1095-C that will be inclusive of all your jobs with the Commonwealth. If you worked for the 优先, MSBA, and the Commonwealth, each considered a separate employer, you may receive three forms.

What should I do with the Form 1095-C?

Keep this form with the materials you give to your tax preparer. If you prepare your own taxes, you will need to refer to this information as you prepare your federal return. Do not include it with your filing to the IRS.

What information is included on the Form 1095-C?

There are three parts to the form:

  • Employee and Employer Information (Part 1) reports information about you and your employer, the Commonwealth of 质量achusetts.
  • Employee Offer and Coverage (Part 2) reports information about the coverage offered to you by your employer, the affordability of the coverage offered, and the reason you were or were not offered coverage by your employer.
  • Covered Individuals (Part 3) will be blank. This information will be reported on the Form 1095-B.

Who should I contact if I have questions regarding the Form 1095-C that I received?

If you have questions about your Form 1095-C (the offer of health insurance coverage) issued by the Commonwealth of 质量achusetts (including institutions of higher education), the 优先, or MSBA, call your human resources department.

If you have any questions about the Form 1095-B (offer of health insurance coverage) from the GIC, please see the Form 1095-B FAQs at You can also visit the IRS website.

Related Content

Visit HR/CMS Self-Service

Log into HR/CMS Self-Service to view 形式 1095-C


Form 1095-B

The Form 1095-B (Offer of Health Insurance Coverage) will no longer be automatically mailed by the Group Insurance Commission (GIC). For more information please visit see the GIC's page.


Form W-2

View information on the Form W-2 for Commonwealth employees