![]() |
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.
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. If you have (or had) six or more employees in Massachusetts in any month during the past 12 months preceding the due date of the HIRD form (December 15th of the reporting year) must submit a HIRD form.
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.
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.
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:
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.
Material contained in ComplianceDashboard is a compilation of generally published information by the Department of Labor and other public agencies regulating employee benefit plans and employee benefit issues. It is not legal advice, and should not be construed as legal advice. If legal advice or other professional assistance is or may be required with regard to any issues referenced in this website, the services of a competent legal or tax professional should be immediately sought. The inclusion of links within the ComplianceDashboard website is for informational purposes only. ComplianceDashboard does not warrant the accuracy of information outside this website that is found as a result of following links contained herein, nor does the inclusion of those links herein constitute endorsement of the content of any other website. If you have questions regarding this disclaimer, please contact us at 877-328-7880.