myCSUSM
1095-B FAQs
- What am I supposed to do with this form?
You will need information provided on this form to indicate on your income tax return that you, your spouse and dependent children (if applicable) had minimum essential coverage.
You should file this form with your income tax records and may need to provide a copy to other covered individuals identified in Part IV of the form.
- What is the purpose of this form?
Under the ACA's Individual Shared Responsibility provision (known as the individual mandate), most individuals are required to maintain minimum essential health coverage. Individuals who do not maintain minimum essential coverage may be subject to a penalty.
The ACA also requires every provider of minimum essential coverage to file annual reports with the IRS with information about individuals covered by minimum essential coverage and furnish a statement, Form 1095-B, by January 31 to individuals who had a minimum essential coverage for at least one day during the preceding calendar year.
The IRS will use information reported on this form to determine if an individual is complying with the ACA's individual mandate.
- Why did I get this form?You received this form because you were enrolled in state-sponsored health or COBRA coverage, which provides minimum essential coverage, for at least one day during the preceding calendar year.
- Who sent this form to me?This form was provided by your health coverage provider because you were enrolled in state-sponsored health or COBRA coverage for at least one day during the preceding calendar year.
- Why didn't I receive this form?You did not receive this form because you were not enrolled in state-sponsored health or COBRA coverage for at least one day during the preceding calendar year.
- Who should I contact if I believe I should have received this form and did not?You should contact your health coverage provider, using the Benefit Provider Contact List, if you were enrolled in state-sponsored health or COBRA coverage for at least one day during the preceding calendar year and did not receive this form.
- Who should I contact if the information reported on the form is incorrect?You should contact your health coverage provider if any information reported on the form is incorrect. Use the Benefit Provider Contact List for health coverage provider contact information.
- Who should I contact if I have additional questions about this form?You should contact your health coverage provider with questions, using the Benefit Provider Contact List, or visit the IRS Affordable Care Act (ACA) Tax Provisions website.
- Health Care Provider Contact Numbers
Provider Numbers Health Coverage Provider Contact Number Anthem Blue Cross (Select or Traditional) (855) 839-4524 Blue Shield Access Plus/Blue Shield Trio (800) 334-5847 Health Net of California/Health Net Salud Y Mas (888) 926-4921 Kaiser Permanente of California (800) 464-4000 Peace Officers Research Association of CA (PORAC) (800) 288-6928 PERS Platinum/PERS Gold (877) 737-7776 Sharp Performance Plus (855) 995-5004 UnitedHealthcare Signature Alliance or Harmony (877) 359-3714