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Missouri online Form 1095-A: What You Should Know

For example, if you receive benefits in any of the years between January 1, 2017, and December 31, 2017, you must submit this form. When you submit this form to the UM System, be sure to include all the required information. If you are not sure if you are submitting a report, contact UM System Human Resources. FORM 1095-C REPORT FORM : Form 1095-C is a single page report that reports coverage offered under the Federal Marketplace. If you were eligible for coverage for all or some months of the tax year, contact UM System Financial Aid or HR. If you were not eligible for coverage for all or a portion of the tax year, contact the nearest UM System office to complete the form by filling out the Online Affordability Analysis Form. Form 1095-C requires that you provide each of the following items: Monthly income and expenses: How much you made for each month during the tax year, including wages, salaries, and self-employment tax. Out-of-pocket expenses: How much you spent for all health care service items for each month during the tax year (including out-of-pocket expenses such as deductibles, co-payments, coinsurance, or deductible amounts). Coverage: What health coverage was provided and the coverage is for the month you received benefits during the tax year. If it was a group health plan coverage, please include information about the health coverage members selected, including the name, address, and phone number for each person, if any. Total health insurance value (TIV): The total amount of covered health care services for each month during the tax year. TIV includes medical, dental, vision, prescription, and non-prescription medical and vision benefits. Medicaid enrollment: Indicate (or write for each month) your name, date of birth, home address, and social security number. The enrollment information is included with every coverage document we provide to you so you can determine if you are enrolled under Medicaid. If you did not receive any benefits during the tax year, then the form you submitted during the tax year should indicate that you did not receive any coverage because you are eligible to receive coverage through the Affordable Care Act (commonly known as “Obamacare”) on October 1, 2014.

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