Insurance tax - Form 1095-B

Under federal law, most people have to report to the federal government that they, along with their tax dependents, had medical insurance coverage during the previous year. Form 1095-B is a tax form (like a W-2 or 1099-R) you will get from your State of Texas-sponsored medical provider as proof that you and your tax dependents had the required medical coverage. The State of Texas, like other employers who offer medical coverage to their employees, is working with its medical insurance providers to send Form 1095-B to all members who had medical coverage through the Texas Employees Group Benefits Program (GBP). Members can use Form 1095-B to verify on their IRS tax filings they (and any covered dependents) had medical insurance.

The Affordable Care Act is a federal law that requires almost everyone in the United States to have medical coverage. People who don’t have at least a minimal level of coverage could have to pay a fine to the Internal Revenue Service (IRS). Your Form 1095-B is proof that you and your covered dependents had medical coverage, so you can report it on your tax filing and avoid paying a fine. You should keep your Form 1095-B with all your tax records as supporting documentation.

Every current or former State of Texas employee and retiree who had medical coverage through the GBP during the Calendar Year (January 1 – December 31) will receive Form 1095–B. Please refer to FAQ #4 for more information about which Medicare members will receive a Form 1095-B from The Centers for Medicare & Medicaid Services (CMS). If you covered a spouse or children under your GBP plan, they will be included on this form; you will not receive a separate Form 1095-B for each of your dependents.

If anyone reported as covered by GBP medical coverage on Form 1095-B files a separate income tax return or is listed as tax dependent on another person’s income tax return, the GBP member is responsible for providing copies of the Form 1095-B to the person filing the tax return for that dependent.

If you do not receive your Form 1095-B by the end of February, or if you lose it, you can call your medical insurance provider toll-free to request another copy. Please see the contact information below:

• Blue Cross and Blue Shield of Texas (800) 252-8039 (TTY: 711) 7 a.m. – 7 p.m., CT Monday – Friday, 7 a.m. – 3 p.m., CT Saturday.
• Community First Health Plans: (877) 698-7032, TDD (210) 358-6080, 8.30 a.m. – 5 p.m. CT, Monday - Friday
• KelseyCare powered by Community Health Choice: (844) 515-4877, 8 a.m. – 7 p.m., Monday – Friday
• Scott & White Health Plan: (800) 321-7947, TTY/TTD (800) 735-2989, 24 hours, seven days a week
• *Centers for Medicare & Medicaid Services (CMS) for medical plans listed below:
  • Humana for HealthSelect Medicare Advantage (800) MEDICARE or (800) 633-4227
  • KelseyCare Advantage (800) MEDICARE or (800) 633-4227

*Refer to FAQ #4 for which Medicare & Medicaid members will receive a Form 1095-B from CMS. CMS will not send a Form 1095-B to all members.

Every current or former State of Texas employee and retiree who had medical coverage through the GBP will receive Form 1095-B from the administrator of the plan (or plans) under which he or she had medical coverage during the calendar year. Depending on which plan(s) you were covered by, you will receive form 1095-B directly from: 

• Blue Cross and Blue Shield for HealthSelectSM of Texas and Consumer Directed HealthSelectSM, 
• Community First Health Plans,
• KelseyCare powered by Community Health Choice and/or
• Scott and White Health Plan  

If you have Medicare Part A, you may get IRS Form 1095-B from Medicare in the early part of the year. If you don't get a Form 1095-B, don't worry. Not everyone will get this form from Medicare, and you don't need to have it to file your taxes.

The Centers for Medicare & Medicaid Services (CMS) will mail Form 1095–B only to participants who meet the following criteria: 

• Are under age of 65 with Medicare Part A
• Enrolled in Medicare Part A for the first time
• Had Medicare Part A for part of the year   

If you were covered by Medicare Part A for all 12 months of the year, just check the box on your Federal income tax return indicating you had qualifying health coverage all year.  CMS is reporting your coverage to the IRS. 

This includes members enrolled in:  

• HealthSelectSM Medicare Advantage Plan, a preferred provider organization (MA PPO) or 
• KelseyCare Advantage Medicare health maintenance organization (MA HMO)

People enrolled in the Medicare Advantage plans will not receive a separate Form 1095-B from those plans. 

If you also had coverage under TRICARE, TRICARE will send a Form 1094-B. 

Medical coverage providers are required to mail Form 1095-B to members by January 31, but some providers may start mailing them in December. You can expect to get the form by the end of February. If you had GBP medical coverage and don’t receive a Form 1095-B by the end of February, please call your medical plan directly. See question 3 for contact information for medical plans.

You will use the Form 1095-B to verify medical coverage for yourself and your covered tax dependents on your federal income tax filing – like you use your W-2 to report wages or your 1099-R to report annuity income. You should keep Form 1095-B with all your tax records as supporting documentation.

If you don’t report information from your Form 1095-B, the IRS may assume you did not have medical coverage and may assess the Individual Mandate Penalty. Please see the Department of Health and Human Services website for detailed information on how the penalty is calculated.

Every medical coverage provider that covered you (and any dependents) for at least one day is required to send you a Form 1095-B. State of Texas medical coverage will be reported for each month of your enrollment in a GBP medical plan. 

If you had medical coverage from another employer and its respective carrier, you will receive a separate Form 1095-B from each one.

If you had coverage from more than one GBP plan – for example, if you were in an HMO January through August, but switched to HealthSelect in September – you will receive Form 1095-B from each plan. If you did not have medical coverage through the GBP at any time during the Calendar Year, you will not receive a Form 1095-B from any of the GBP plans.

Additional benefits such as dental plans, life insurance or short-term and long-term disability (through the Texas Income Protection Plan) do not need to be reported to the federal government and will not be included on Form 1095-B.

The Form 1095-B will be sent to the person who has medical coverage for the dependent, even if that person does not claim the dependent on his or her taxes. Please see question 2 for more information.

Please make sure your name, Social Security number (SSN), names and SSNs of any dependents you cover, and your mailing address are correct on your Form1095-B. If you’re an active employee, contact your benefits coordinator to update any incorrect information. If you’re a former employee or retiree, contact ERS to update incorrect information. Once you update the information, please contact your medical coverage provider to see if you need an updated Form 1095-B. Please see question 3 for contact information for GBP medical coverage providers.

Providing accurate SSNs on all income and healthcare benefit documentation to your agency is the best way to ensure your employer and medical insurance provider report correct information to the IRS. ERS receives the information from your employer and sends it to medical insurance providers so they can issue Form 1095-B in your name. The IRS will send written notice to you with instructions on how to respond to any questions they have about differences in reporting. Your employer or health insurance provider is not responsible for incorrect or missing employee or dependent IRS reporting information. It’s your responsibility to contact your benefits coordinator or ERS for any corrections to your personal information on your Form 1095-B.

Many employers (such as your agency or institution) are required to send Form 1095-C to their employees, to verify that the employer offered medical coverage to eligible employees. If you have questions about Form 1095-C, please contact the benefits coordinator or human resources department at your agency or institution.