Massachusetts Health Insurance Responsibility Disclosure Form
This file provides detailed information and instructions for employers in Massachusetts to submit the Health Insurance Responsibility Disclosure (HIRD) form annually. The form collects employer-level information about employer-sponsored insurance offerings. Submission is required by December 15 each year through the MassTaxConnect web portal.
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How do I fill this out?
To fill out the HIRD form, ensure you have all the relevant information about your employer-sponsored health plans. Log in to your MassTaxConnect account and locate the 'File health insurance responsibility disclosure' hyperlink. Follow the on-screen instructions to complete and submit the form.
How to fill out the Massachusetts Health Insurance Responsibility Disclosure Form?
1
Gather information about your employer-sponsored health plans.
2
Log in to your MassTaxConnect withholding account.
3
Click on 'File health insurance responsibility disclosure' under account alerts.
4
Fill in the required details about your health plans.
5
Submit the form by the December 15 deadline.
Who needs the Massachusetts Health Insurance Responsibility Disclosure Form?
1
Employers with six or more employees in Massachusetts need this form to comply with state reporting requirements.
2
Out-of-state employers with employees in Massachusetts need this form to provide information about their health plan offerings.
3
HR departments need this form to ensure compliance with Massachusetts laws.
4
Payroll vendors may need this form to assist employers in completing the submission.
5
Legal and compliance teams need this form to review employer obligations under Massachusetts health insurance laws.
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What are the instructions for submitting this form?
To submit the HIRD form, log in to your MassTaxConnect withholding account and select the 'File health insurance responsibility disclosure' hyperlink under account alerts. Complete the form with accurate information about your employer-sponsored health plans. Submit the form between November 15 and December 15 each year through the MassTaxConnect web portal. Advice: Ensure you gather all necessary details about your health plans before starting the submission process to avoid delays or inaccuracies. Consult the resources provided by the Massachusetts Department of Revenue for additional guidance.
What are the important dates for this form in 2024 and 2025?
For the 2024 and 2025 submission periods, the HIRD form must be submitted by December 15 each year. The form becomes available for completion on the MassTaxConnect web portal approximately one month prior to the deadline.
What is the purpose of this form?
The purpose of the Health Insurance Responsibility Disclosure (HIRD) form in Massachusetts is to collect essential employer-level information about employer-sponsored health insurance offerings. This form helps the state's Medicaid and Children's Health Insurance Program (MassHealth) and the Department of Revenue (DOR) identify MassHealth members who have access to qualifying employer-sponsored insurance (ESI). By gathering data on health plan benefits, coverage levels, and costs, the HIRD form enables MassHealth to determine members' eligibility for the Premium Assistance Program. Employers with six or more employees in Massachusetts are required to complete and submit the HIRD form annually by December 15. The submission process is administered through the MassTaxConnect (MTC) web portal. The form must include details such as the total employer and employee premium costs, in-network deductibles, maximum out-of-pocket expenses, cost-sharing details (coinsurance), eligibility criteria, and whether the plan meets the Massachusetts minimum creditable coverage (MCC) requirements. Timely and accurate submission of the HIRD form is crucial for ensuring compliance with state regulations and avoiding potential penalties. Employers are encouraged to gather all necessary information in advance and utilize available resources, such as the FAQs and instructions provided by the Massachusetts Department of Revenue, to complete the form accurately and efficiently.
Tell me about this form and its components and fields line-by-line.
- 1. Employer Information: Contains details about the employer, including name, address, and contact information.
- 2. Employee Count: Number of employees working in Massachusetts, including part-time and full-time employees.
- 3. Health Plan Details: Information about the employer-sponsored health plans, such as plan types, coverage levels, and eligibility criteria.
- 4. Premium Costs: Total employer and employee premium costs for the health plans.
- 5. Coverage Information: Details about the benefits, in-network deductibles, maximum out-of-pocket expenses, and cost-sharing arrangements (coinsurance).
- 6. MCC Compliance: Indicator of whether the health plan meets the Massachusetts minimum creditable coverage (MCC) requirements.
What happens if I fail to submit this form?
Failing to submit the HIRD form on time can lead to compliance issues and potential penalties.
- Penalties: Employers may face monetary penalties for non-compliance.
- Legal Repercussions: Failure to comply with state regulations may result in legal actions.
- Reputational Damage: Non-compliance can harm the employer's reputation and relationships with employees.
How do I know when to use this form?
- 1. Annual Submission: Submit the form annually by December 15 to comply with state regulations.
- 2. New Health Plans: Update the form when new employer-sponsored health plans are introduced.
- 3. Employee Count Changes: Use the form to report changes in the number of employees working in Massachusetts.
Frequently Asked Questions
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Using the built-in PDF editor on PrintFriendly, you can make changes to any field or section of the HIRD form. Simply open the file, edit the desired sections, and save the changes.
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Is there a specific deadline for submitting the HIRD form?
Yes, the HIRD form must be submitted annually by December 15 through the MassTaxConnect web portal.
What information do I need to fill out the HIRD form?
You need details about your employer-sponsored health plans, including employer and employee premium costs, coverage levels, deductibles, out-of-pocket expenses, and eligibility criteria.
Can I use PrintFriendly to fill out multiple HIRD forms?
Yes, you can fill out and edit multiple HIRD forms on PrintFriendly using the same PDF editor.
How do I know if my health plan meets MCC requirements?
Most health plans offered in Massachusetts meet MCC requirements. If unsure, select 'Unknown' and provide an insurance summary of benefits for the plan.
What happens if I fail to submit the HIRD form on time?
Failure to submit the HIRD form on time may result in penalties or non-compliance issues with state regulations.
Who is responsible for submitting the HIRD form?
Employers are responsible for ensuring timely and accurate submission of the HIRD form, though a payroll vendor may assist in the process.
Can I get assistance with filling out the HIRD form?
Yes, consulting with a tax professional or attorney can provide guidance on the application or implications of laws and regulations for your specific circumstances.
