Massachusetts HIRD Form


Reference

 

The Health Insurance Responsibility Disclosure (HIRD) form will assist MassHealth in identifying its members with access to qualifying employer-subsidized insurance (ESI) who may be eligible for the MassHealth Premium Assistance Program.

Who Is Considered an Employee

An individual is considered to be your employee if you as the employer included such individual in your quarterly wage report to the Department of Unemployment Assistance (DUA) during the past 12 months. You are required to complete the HIRD form if you reported six or more employees (includes all employment categories) in any DUA wage report during the past 12 months.

If you are an employer that is not required to file a quarterly wage report to the DUA, an individual is considered to be your employee if he or she is hired for a wage or salary in Massachusetts to perform work, regardless of full-time or part-time status.

Information Required for HIRD Reporting

The HIRD Form will collect information about the employer’s insurance offerings, including:

Employers are not required to report information about dental or vision plans, HRAs, Flexible Spending Arrangements, or HSAs.

Submitting a HIRD Form

The HIRD reporting is administered by the Massachusetts Department of Revenue (DOR) through the MassTaxConnect (MTC) web portal. The MTC is where employer-taxpayers register to file returns, forms, and make tax payments.

To file your HIRD form:

  1. Log in to your MTC withholding account
  2. Select the “File health insurance responsibility disclosure” hyperlink under the “I Want To” section.
  3. If you do not have an MTC account, or if you forgot your password or username, you may follow the instructions provided on the MTC web page or contact the DOR at 617-466-3940.

How Is the Information Used?

The HIRD form will assist MassHealth in identifying its members with access to qualifying ESI who may be eligible for the MassHealth Premium Assistance Program.

The HIRD form will not be used to impose any new fines or penalties related to employers’ ESI offerings (or lack thereof).  There are no fines or penalties related to your completed HIRD form.