Form 1099-H - Health Coverage Tax Credit (Hctc) Advance Payments

Instructions for Recipient

would receive the credit twice. If you receive the credit for amounts you

are not entitled to, you will be required to repay the IRS. Only payments

This statement is provided to you because the HCTC Program made

you paid directly to your health plan can be claimed on your federal

monthly payment(s) to your health plan to cover a portion of your health

income tax return. This means any amounts for which you received an

insurance costs in 2013. These payments are referred to on this

advance payment or reimbursement credit cannot be claimed on your

statement as advance payments. These advance payments are shown

tax return (any reimbursement credits will be reflected on this form). For

in Boxes 1 through 14 as follows:

example, if you paid $100 to your health plan and received a $72.50

Box 1. Shows the total amount of HCTC advance payments that were

advance payment or reimbursement credit, you cannot claim the same

made on your behalf for the entire year, as well as the total amount of

$100 on your tax return. Similarly, if you sent $27.50 to the HCTC

any reimbursement credits paid to you for eligible months prior to your

Program to cover your portion of your monthly $100 health plan

HCTC enrollment.

premium, you cannot claim that payment on your tax return because

Box 2. Shows the total number of months HCTC advance payments or

you already received the $72.50 tax credit. See IRS Form 8885 for more

reimbursement credits were made on your behalf.

information on these requirements.

Boxes 3 through 14. Shows the monthly amount of any HCTC advance

Need help? If you have any questions regarding this statement, call the

payments or reimbursement credits you received. The sum of these

HCTC Customer Contact Center toll-free at 1-866-628-HCTC (4282). If

amounts equals the amount shown in Box 1.

you have a hearing impairment, call 1-866-626-4282 (TTY). For general

information about the HCTC, visit IRS.gov (keyword/Search: HCTC).

Note. This statement reflects the tax credit that you and any qualified

family members received in 2013 through the monthly HCTC Program.

Future Developments

It does not reflect payments you made to the HCTC Program (“U.S.

Treasury – HCTC”) which were forwarded to your health plan by the

For the latest information about developments related to Form 1099-H

HCTC Program.

and its instructions, such as legislation enacted after they were

Any HCTC amount listed on this statement cannot be claimed on

published, go to

your federal income tax return. Claiming this amount means you

Form 1099-H - Health Coverage Tax Credit (Hctc) Advance Payments - 2013 Page 6