Questions & Answers

What if my insurer didn't send a Form MA 1099-HC?

You can call your insurer or your employer's human resources department or benefits administrator for help, if you get health coverage through your job. If your insurer or your employer is unable to assist you, please refer to the Benefits Required Under MCC section below to see if your policy meets these requirements. If your plan meets all of the requirements, you may certify that you were enrolled in a plan that met the MCC requirements during that time period.

Benefits Required Under MCC: For most plans*, the 2019 Minimum Creditable Coverage standards include:

  • Coverage for a comprehensive set of services (e.g. doctors visits, hospital admissions, day surgery, emergency services, mental health and substance abuse, and prescription drug coverage).
  • Doctor visits for preventive care, without a deductible.
  • A cap on annual deductibles of $2,000 for an individual and $4,000 for a family.
  • For plans with up-front deductibles or co-insurance on core services, an annual maximum on out-of-pocket spending of no more than $7,350 for an individual and $14,700 for a family.
  • No caps on total benefits for a particular illness or for a single year.
  • No policy that covers only a fixed dollar amount per day or stay in the hospital, with the patient responsible for all other charges.
  • For policies that have a separate prescription drug deductible, it cannot exceed $250 for an individual or $500 for a family.
  • All services must be provided to all of those covered (for example, a plan that covers dependents must extend maternity services to them).
  • No cap on prescription drug benefits.

*Other ways of Meeting MCC

You meet MCC if you are enrolled in:
  • Medicare Part A or B;
  • Any Qualified Health Plan purchased through the Massachusetts Health Connector or directly through a carrier, including ConnectorCare plans and catastrophic plans;
  • MassHealth;
  • A Student Health Insurance Plan (SHIP) offered in Massachusetts or another state;
  • A tribal or Indian Health Service plan;
  • TRICARE;
  • The U.S. Veterans Administration Health System;
  • A health insurance plan offered by the federal government to federal employees or retirees;
  • Peace Corps, VISTA or AmeriCorps or National Civilian Community Corps coverage;
  • A Pre-Existing Condition Insurance Plan (PCIP);
  • A federally-qualified high deductible health plan (HDHP) offered with a Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA) may meet MCC if it complies with most of the benefits described above.

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