Instructions For Schedule Hc - Health Care - 2012 (Page 4 of 10) in pdf

2012 Schedule HC — Line by Line Instructions

the month you became domiciled in (a resident

If you (and your spouse if married filing jointly)

If you answered Yes in line 6 of Schedule HC in-

of) Massachusetts. For example, if you moved

answer Yes on line 8a and No on line 8b, the

dicating that your income was at or below 150%

into Massachusetts on May 14, the mandate ap-

penalty does not apply to you. Skip the remainder

of the Federal Poverty Level, or

plies on August 1. In this example, do not count

of Schedule HC and continue completing your tax

If you had three or fewer blank ovals in a row as

the months of January through July because the

return. Be sure to enclose Schedule HC with your

shown in line 7,

mandate did not apply.

return.

you are not subject to a penalty and should skip

If you moved out of Massachusetts during 2012,

If you (and your spouse if married filing jointly) an-

the remainder of Schedule HC and continue com-

the mandate to obtain and maintain health insur-

swered Yes on both lines 8a and 8b, go to line 9.

pleting your tax return. Be sure to enclose Sched-

ance applies to you up until the last day of the last

If you are filing a joint return and one spouse an-

ule HC with your return.

full month you were a resident. For example, if you

swers No to line 8b but the other spouse answers

You must complete the Schedule HC Worksheets

moved out of Massachusetts on July 10, the man-

Yes to line 8b, the spouse who answered No is not

for Lines 10, 11 and 12 if you were uninsured for

date applies up to June 30. In this example, do not

subject to a penalty and should skip the remain-

all of 2012 or if you had four or more consecutive

count the months of July through December be-

der of Schedule HC. The spouse who answered

months without health insurance (four or more

cause the mandate did not apply.

Yes must go to line 9.

blank ovals in a row in the Months Covered by

Deceased taxpayer. If a taxpayer died during 2012,

Health Insurance That Met Minimum Creditable

Line 9. Certificate of Exemption

the mandate to obtain and maintain health insur-

Coverage section of line 7).

The Commonwealth Health Insurance Connector

ance applies to the deceased taxpayer up until the

To complete these worksheets, you will need to

Authority provided certificates of exemption to

last day of the last full month the taxpayer was

have your completed 2012 U.S. Form 1040, 1040A

qualified taxpayers who applied in 2012.

alive. For example, if a taxpayer died on August 4,

or 1040EZ. You also will need to know how much

the mandate applies up to July 31. In this example,

◗ If you have a “Certificate of Exemption” issued

it would have cost you to enroll in any health in-

do not count the months of August through De-

by the Commonwealth Health Insurance Connec-

surance plan offered by an employer in 2012. An

cember because the mandate did not apply.

tor Authority for the 2012 tax year, a penalty does

employer’s Human Resources Department should

not apply to you. Fill in the Yes oval(s) in line 9 of

Line 8. Religious Exemption

be able to provide this amount to you.

Schedule HC and enter the certificate number in

Line 8a. A religious exemption is available for any-

the space provided. Note: Only enter the numbers

Filing an Appeal

one who has a sincere religious belief that is the

of the Certificate of Exemption. Do not enter let-

If you are subject to a penalty for not obtaining

basis of refusal to obtain and maintain health in-

ters, spaces or dashes. For example, if the certifi-

health insurance in 2012, you have the right to

surance coverage. Fill in the Yes oval(s) if you are

cate number on your Certificate of Exemption is

appeal. The appeal will be heard by the Common-

claiming a religious exemption from the require-

AMLI123456-78, enter in the spaces provided

wealth Health Insurance Connector Authority, an

ment to purchase health insurance based on your

12345678. If married filing jointly and both

independent state body.

sincerely held religious beliefs.

spouses have a certificate, each spouse must enter

In your appeal, you may claim that the penalty

If you (and your spouse if married filing jointly)

their certificate number in the space provided. Skip

should not apply to you. You may claim that you

answer Yes to line 8a, go to line 8b.

the remainder of Schedule HC and continue com-

could not afford insurance in 2012 because you

pleting your tax return. Be sure to enclose Sched-

If you (and your spouse if married filing jointly)

experienced a hardship. To establish a hardship,

ule HC with your return.

answer No to line 8a, go to line 9.

you must be able to show that, during 2012:

◗ If you answered No to line 9, go to line 10.

If you are filing a joint return and one spouse an-

(a) You were homeless, more than 30 days in ar-

◗ If you are filing a joint return and one spouse

swers No to line 8a but the other spouse answers

rears in rent or mortgage payments, or received

Yes, the spouse who answered Yes must go to

answers Yes to line 9 but the other spouse an-

an eviction or foreclosure notice;

line 8b and the spouse who answered No must

swers No to line 9, the spouse who answered Yes

(b) You received a shut-off notice, were shut off,

go to line 9.

must enter the certificate number and skip the re-

or were refused the delivery of essential utilities

mainder of Schedule HC and the spouse who an-

Line 8b. If you are claiming a religious exemption

(gas, electric, oil, water, or telephone);

swered No must go to line 10.

but you received medical health care during tax

year 2012, such as treatment during an emer-

For more information about Certificates of Exemp-

in essential expenses resulting directly from the

gency room visit, you may be subject to a penalty

tion, visit the Commonwealth Health Insurance

consequences of: (i) domestic violence; (ii) the

if it is determined that you could have afforded

Connector Authority’s website at

death of a spouse, family member, or partner with

health insurance.

primary responsibility for child care, where that

Medical health care excludes certain treatments

Lines 10, 11 and 12. Affordability

spouse, family member, or partner shared house-

such as preventative dental care, certain eye exam-

hold expenses with you; (iii) the sudden responsi-

As Determined By State Guidelines

inations and vaccinations. It also excludes a physi-

bility for providing full care for yourself, an aging

Taxpayers who had four or more consecutive

cal examination when required by a third party,

parent or other family member, including a major,

months without health insurance that met Mini-

such as a prospective employer. For additional in-

extended illness of a child that required a working

mum Creditable Coverage in 2012 may be subject

formation, see Department of Revenue regulation

parent to hire a full-time caretaker for the child; or

to a penalty if they had access to affordable health

830 CMR 111M.2.1, Health Insurance Individual

(iv) a fire, flood, natural disaster, or other unex-

insurance that met MCC requirements.

Mandate; Personal Income Tax Return Require-

pected natural or human-caused event causing

ments, available on the department’s website at

substantial household or personal damage for the

individual filing the appeal.

HC-4

Instructions For Schedule Hc - Health Care - 2012 Page 4

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