The 1095-C statements that will be generated by the State of Arizona serve as documentation to the IRS about coverage offered to you under the Affordable Care Act. The form includes information about offers of health insurance along with information about covered dependents. It is important to keep this form for your records as you may need to provide this to the IRS. Think of the form as your “proof of insurance” for the IRS.
Please contact the Benefit Services Division at 602-542-5008 or [email protected] .
The State of Arizona is required to send a 1095-C to any full-time employee (who worked an average of 30 or more hours per week) or enrolled in ADOA medical benefits in a given tax year. This will include individuals who are enrolled in the ADOA retiree plan and COBRA participants.
If you were full-time (worked an average of 30 or more hours per week) or were enrolled in health insurance through ADOA at any time during a given tax year, you should receive a 1095-C.
If you worked at more than one company or employer, you may receive a 1095-C from each company/employer. For example, if you worked at Arizona State University and a State Personnel System Agency for the State of Arizona, you will receive two separate statements.
If you were not full-time (worked less than 30 hours per week) and were not enrolled in health care coverage through your employer at any time during a given tax year, you should not receive a 1095-C. You may also not receive a 1095-C if you were not the primary insured.
Statements will be mailed to the employee's home address by January 31 each year. If you believe you should have received a 1095-C but did not, please contact the Benefits Services Division at 602-542-5008 or [email protected] . If you do not receive the document, you may request a reprint after March 2. by filling out this form.
Statements will be mailed to the last known address in HRIS/YES as of January 15 each year. Ensure your address is updated by this date. To update your address, log in to hrsystems.azdoa.gov > Y.E.S. Portal and click on the following path: Bookmarks > Your Employee Services > Personal Information > Contact Information.
When you receive your 1095-C, keep it for your records as you may need to provide this to the IRS.
- Part I reports information about you and the State of Arizona.
- Part II reports information about the coverage offered by the State of Arizona, the affordability of the coverage offered, and why you were or were not offered coverage.
- Part III reports information about the individuals covered under your plan, including dependents.
- If you believe there is a mistake in your home address, please verify and correct your address by logging in to hrsystems.azdoa.gov > Y.E.S. Portal and click on the following path: Bookmarks > Your Employee Services > Personal Information > Contact Information. Even if your address is not correct on the form, the form is still valid and can be used to complete your taxes. You will not receive an updated Form 1095-C for an address correction.
- Explanations for the codes listed in Part II are on the back of the 1095-C statement.
- If any dependent information is incorrect in Part III, you will have to provide government-issued documentation to support a change in name, social security number, or date of birth. Acceptable documentation includes a driver’s license, original social security card (not a receipt) or certified birth certificate.
- If you believe data or information on the form is incorrect in Part II (employee offer and coverage) or Part II (covered individuals), please contact the ADOA Benefits Services Division at 602-542-5008 and describe the mistake. A representative will investigate and respond to your inquiry as soon as possible.
PLEASE NOTE: These frequently asked questions (FAQ’s) and corresponding answers are not intended to be tax advice. If you have any tax questions, you should contact your tax adviser.
