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Schedule HC-A Health Care Appeals - FY 2007 |
| Schedule HC-A Health Care Appeals. If filing an appeal, you must enclose with Form 1 or Form 1-NR/PY and Schedule HC. Taxpayers who did not have health insurance which was deemed affordable on Schedule HC may maintain their personal exemption only by submitting an appeal claiming a hardship prevented them from purchasing health insurance in tax year 2007.T here is a three step process to appeal. First, fill in the oval(s) below that reflects the hardship that you (and/or your spouse if married filing jointly) experienced in 2007. Second, you will receive a follow-up letter and form after you file your tax return. You must complete that form stating your grounds, and provide significant documentation to substantiate your claim for hardship, within 30 calendar days of receipt of the form. Failure to submit the form and provide documentation in the required time frame will result in a dismissal, and you will be issued a bill based on the loss of your personal exemption. Third, the Commonwealth Health Insurance Connector Authority will review your claim and documentation. You may be required to attend a hearing to review your case. All claims and documentation will be filed under the pains and penalties of perjury. ( ) I authorize DOR to share this schedule and any other information on this return that may be relevant with the Commonwealth Health Insurance Connector Authority, which will be making the determination on my appeal. Note: Failure to fill in this oval to share this return will result in your appeal being denied and the loss of your personal exemption. If you do not fill in this oval, enter “0” in line 2a of Form 1 or line 4a of Form 1-NR/PY and continue completing your tax return. -You were homeless, more than 30 days in arrears in rent or mortgage payments, or received an eviction or foreclosure notice. You will be asked to provide proof, such as a copy of an eviction or foreclosure notice. -You received a shut-off notice, were shut off, or were refused the delivery of essential utilities (gas, electric, oil, water, or telephone). You will be asked to provide a copy of a shut off notice (not a late notice) or other similar correspondence from the utility company. Shut off or delivery refusal must be for essential services only. - You had non-cosmetic medical and/or dental out-of-pocket expenses (exclusive of premium payments), totaling more than 7.5% of your adjusted gross income that were not subject to payment by a third party. You will be asked to provide copies of medical bills for noncosmetic, non-reimbursable medical services received in 2007, which the Commonwealth Health Care Connector Authority will compare to your declared income. - The expense of purchasing health insurance would have caused a serious deprivation of food, shelter, clothing or other necessities. You will be asked to provide proof to show additional expenses above and beyond that which your income would cover. Please note that your documentation and claim must show serious deprivation. - You incurred a fire, flood, natural disaster, or other unexpected natural or human-caused event causing substantial household or personal damage to/for you. You will be asked to provide copies of insurance claims correspondence, police reports or other proof. - You incurred a significant, unexpected increase in essential expenses resulting directly from the consequences of: domestic violence; the death of a spouse, family member, or partner with primary responsibility for child care; the sudden responsibility for providing full care for an aging parent or other family member, including a major, extended illness of a child that requires you to hire a full-time caretaker for the child. You will be asked to provide proof, such as death certificates, medical records or other documentation proving your claim. - Other. You may state other grounds, such as the application of the affordability tables in Schedule HC to you is inequitable (for example, because of family size), you were unable to obtain government-subsidized insurance despite your income, or there are circumstances that made you unable to purchase insurance despite your income. - You will be asked to provide documentation for your claims. If filing a joint return and one spouse has health insurance or answered No to line 6c and the other spouse is filing an appeal, the joint filers should enter their full personal exemption amount of $8,250. By filling in an oval above, you will maintain your personal tax exemption pending the review of your appeal. This does not mean the appeal has been allowed. Your appeal may be denied, and you will be billed accordingly. NOTE: Do not include any hardship documentation with your original return. You will be required to submit substantiating hardship documentation at a later date during the appeal process. Since you are making financial claims that will impact your tax return, you are swearing under oath that the information you have provided or the claims you have made are true. If we conduct an audit and your claims turned out to be false, we may revoke your certificate of exemption and you will be liable for the penalty, plus interest and fines, as well as be subject to other legal action. |
| Text from http://www.mass.gov/Ador/docs/dor/health%20care/HC.pdf - Check out the entire form. |
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Please read this very
carefully - this is dead serious and is planned for the entire country.