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Form 1095-B

Look out for your Form 1095-B in March, 2018!

Form 1095-B

The IRS is allowing more time for Health Plans, like Health Net, to submit information on members enrolled in Minimum Essential Coverage in 2017. Health Net will send your Form 1095-B by March 2, 2018.

This form is not required to file your 2017 tax return. The IRS says these forms are for your reference and documentation.

Your 1095-B Health Coverage Statement

Important 2017 Tax Information from Health Net of California, Inc. and Health Net Life Insurance Company (Health Net).

Health Net will mail tax Form 1095-B to everyone who had individual or group health coverage with us in 2017. This includes:

  • Individual & Family Plans, off-exchange
  • Catastrophic plans, on-exchange
  • Small Business Group
  • Covered California for Small Business
  • Large Business Group

If you are enrolled in an individual on-exchange plan (with the exception of Catastrophic Plans), a Medicare, or a Medi-Cal plan, you will not receive a Form 1095-B from Health Net.

Health Net also sends the information on this form to the Internal Revenue Service (IRS). The IRS recommends that you save this form with your tax records and show it to your tax preparer, if you use one.

Want to know more? Get answers to the questions members ask us most. 

What is Form 1095-B: Health Coverage?

Form 1095-B: Health Coverage is a tax form that is used to verify that you, and any covered dependents, have health insurance that qualifies as minimum essential coverage. This form shows the type of health coverage you have, any dependents covered by your insurance policy, and the dates of coverage for the tax year.

Why do I need Form 1095-B?

The Affordable Care Act's individual shared responsibility provision requires that you have minimum essential coverage, qualify for an exemption, or pay a tax penalty.  Form 1095-B shows when you had health coverage during the 2017 tax year.

When will I receive Form 1095-B?

Health Net will send you Form 1095-B no later than March 2, 2018.

What do I need to do with Form 1095-B?

Save it with your other tax-related documents so that you have it on hand when you or a tax professional prepare and file your taxes.

Do I need to include my Form 1095-B when I file my taxes?

No. You do not need to include Form 1095-B with your tax return. However, the IRS recommends that you save it with your tax records. If you use a tax preparer, you can show the form to him or her, along with your other tax information.

How does the IRS know that I had minimum essential coverage in 2017?

Health Net submits the information on Form 1095-B to the IRS to document your health coverage in 2017. We are legally required to do this for all individuals to whom we provided minimum essential coverage.

Does having Form 1095-B mean I won't have a tax penalty?

Not necessarily. If you or members of your household were uninsured for longer than two months during 2017, you may have to pay a tax penalty. The check boxes on the form will help you calculate the penalty that applies, if any.

How can I calculate my tax penalty if I have one?

The amount of the penalty is 1⁄12 of the annual penalty for each month that you do not have qualifying coverage. The tax penalty for not having coverage in 2017 is the higher of these two amounts:

  • Either – 2.5% of your yearly household Modified Adjusted Gross Income (MAGI) above the amount at which you're required to file taxes, or
  • $695 per adult and $347.50 per child up to a maximum of $2,085 for the family.

Where can I learn more about this law and my responsibility?

The Internal Revenue Service (IRS) website Internal Revenue Service (IRS) website is a good resource. You may also talk with a tax advisor.

How do I get another copy of my Form 1095-B?

If you did not receive your Form 1095-B or would like to request a replacement copy, please call us at the number on your ID card.  

What should I do if the information on my Form 1095-B is incorrect?

Give us a call. Our phone number is on your Health Net ID card. 

What if I have questions about the information on my Form 1095-B?

Give us a call. Our phone number is on your Health Net ID card. 

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Important Notice

General Purpose
Health Net's National Medical Policies (the "Policies") are developed to assist Health Net in administering plan benefits and determining whether a particular procedure, drug, service, or supply is medically necessary. The Policies are based upon a review of the available clinical information including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the drug or device, evidence-based guidelines of governmental bodies, and evidence-based guidelines and positions of select national health professional organizations. Coverage determinations are made on a case-by-case basis and are subject to all of the terms, conditions, limitations, and exclusions of the Member's contract, including medical necessity requirements. Health Net may use the Policies to determine whether, under the facts and circumstances of a particular case, the proposed procedure, drug, service, or supply is medically necessary. The conclusion that a procedure, drug, service, or supply is medically necessary does not constitute coverage. The Member's contract defines which procedure, drug, service, or supply is covered, excluded, limited, or subject to dollar caps. The policy provides for clearly written, reasonable and current criteria that have been approved by Health Net's National Medical Advisory Council (MAC). The clinical criteria and medical policies provide guidelines for determining the medical necessity criteria for specific procedures, equipment and services. In order to be eligible, all services must be medically necessary and otherwise defined in the Member's benefits contract as described in this "Important Notice" disclaimer. In all cases, final benefit determinations are based on the applicable contract language. To the extent there are any conflicts between medical policy guidelines and applicable contract language, the contract language prevails. Medical policy is not intended to override the policy that defines the Member's benefits, nor is it intended to dictate to providers how to practice medicine.

Policy Effective Date and Defined Terms.
The date of posting is not the effective date of the Policy. The Policy is effective as of the date determined by Health Net. All policies are subject to applicable legal and regulatory mandates and requirements for prior notification. If there is a discrepancy between the policy effective date and legal mandates and regulatory requirements, the requirements of law and regulation shall govern. In some states, prior notice or posting on the website is required before a policy is deemed effective. For information regarding the effective dates of Policies, contact your provider representative. The Policies do not include definitions. All terms are defined by Health Net. For information regarding the definitions of terms used in the Policies, contact your provider representative.

Policy Amendment without Notice.
Health Net reserves the right to amend the Policies without notice to providers or Members. In some states, prior notice or website posting is required before an amendment is deemed effective.

No Medical Advice.
The Policies do not constitute medical advice. Health Net does not provide or recommend treatment to Members. Members should consult with their treating physician in connection with diagnosis and treatment decisions.

No Authorization or Guarantee of Coverage.
The Policies do not constitute authorization or guarantee of coverage of any particular procedure, drug, service, or supply. Members and providers should refer to the Member contract to determine if exclusions, limitations and dollar caps apply to a particular procedure, drug, service, or supply.

Policy Limitation: Member's Contract Controls Coverage Determinations.
Statutory Notice to Members: The materials provided to you are guidelines used by this plan to authorize, modify or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under your contract. The determination of coverage for a particular procedure, drug, service, or supply is not based upon the Policies, but rather is subject to the facts of the individual clinical case, terms and conditions of the Member's contract, and requirements of applicable laws and regulations. The contract language contains specific terms and conditions, including pre-existing conditions, limitations, exclusions, benefit maximums, eligibility, and other relevant terms and conditions of coverage. In the event the Member's contract (also known as the benefit contract, coverage document, or evidence of coverage) conflicts with the Policies, the Member's contract shall govern. The Policies do not replace or amend the Member contract.

Policy Limitation: Legal and Regulatory Mandates and Requirements
The determinations of coverage for a particular procedure, drug, service, or supply is subject to applicable legal and regulatory mandates and requirements. If there is a discrepancy between the Policies and legal mandates and regulatory requirements, the requirements of law and regulation shall govern.

Reconstructive Surgery
California Health and Safety Code 1367.63 requires health care service plans to cover reconstructive surgery. "Reconstructive surgery" means surgery performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following:

1. To improve function; or
2. To create a normal appearance, to the extent possible.

Reconstructive surgery does not mean "cosmetic surgery," which is surgery performed to alter or reshape normal structures of the body in order to improve appearance.

Requests for reconstructive surgery may be denied, if the proposed procedure offers only a minimal improvement in the appearance of the enrollee, in accordance with the standard of care as practiced by physicians specializing in reconstructive surgery.

Reconstructive Surgery after Mastectomy
California Health and Safety Code 1367.6 requires treatment for breast cancer to cover prosthetic devices or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy. Coverage for prosthetic devices and reconstructive surgery shall be subject to the copayment, or deductible and coinsurance conditions, that are applicable to the mastectomy and all other terms and conditions applicable to other benefits. "Mastectomy" means the removal of all or part of the breast for medically necessary reasons, as determined by a licensed physician and surgeon.

Policy Limitations: Medicare and Medicaid
Policies specifically developed to assist Health Net in administering Medicare or Medicaid plan benefits and determining coverage for a particular procedure, drug, service, or supply for Medicare or Medicaid Members shall not be construed to apply to any other Health Net plans and Members. The Policies shall not be interpreted to limit the benefits afforded Medicare and Medicaid Members by law and regulation.


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