This Form Contains a Few Specific Pieces of Information

Form 1095-B

Thisformprovidesinformationthatyouwillneedtoreportonyourincometaxreturnandservesasproofthatyouandyourfamilyhad minimumessentialcoverage(MEC)duringthe2016taxyear.FailuretohaveMECmayresultintaxpenalties.

This form contains a few specific pieces of information:

•WhetheryouhadMECin2016

•Whichdependentswerecovered,ifapplicable

•Whichmonthsyouandanycovereddependentshadcoverage

OnlyonecopyofForm1095-Bwillbeprovidedforallofyourcoveredfamilymembers.Spousesanddependentswhoreceivedcoverage underyourplanin2016willnotreceivetheirownforms.Ifnecessary,youmayprovidecopiesoftheformtoyourspouseanddependents fortheirownrecords.

Form 1095-C

Thisformprovidesproofofthehealthinsurancecoverageyouremployerofferedtoyouandyourfamilyduringthe2016taxyear.If youpurchasedhealthinsurancecoveragethroughtheHealthInsuranceMarketplaceandwishtoclaimthepremiumtaxcredit,this informationwillassistyouindeterminingwhetheryouareeligible.

This form contains the following information:

•Whethercoveragewasofferedtoyou,yourspouseanddependents

•Thelowestmonthlypremiumforself-onlycoverageofferedtoyouin2016

This form will be provided to you regardless of whether you opted to enroll in health insurance benefits through your employer.

Filing Your 2016 Tax Return

The information provided on these forms can help you complete your tax return. Once your tax return is filed, save the forms for your records.TheIRSwillreceivetheirowncopyofeachoftheformsforcomparisonpurposes.Ifyouobtainedhealthinsurancecoveragefrom morethanoneemployerin2016,youwillreceiveaseparate1095-Band1095-Cformfromeachemployerandhealthinsurancecompany thatofferedorprovidedcoverage.

If you have additional questions about Form 1095-B, contact your health insurance company. For questions about Form 1095-C, contact your Human Resource Department.