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</head>
<body lang="EN-US" link="#0563C1" vlink="#954F72">
<div class="WordSection1">
<h1><img width="150" height="57" id="Picture_x0020_1" src="cid:image001.png@01D6F94F.2BDEC280"></h1>
<p class="MsoNormal"><o:p> </o:p></p>
<table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" style="border-collapse:collapse">
<tbody>
<tr>
<td width="624" valign="top" style="width:6.5in;border:none;border-bottom:solid #002060 1.0pt;padding:0in 5.4pt 0in 5.4pt">
<p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height:normal">
<span style="font-family:"Arial",sans-serif">February 2, 2021<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height:normal">
<span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin-bottom:6.0pt;line-height:normal"><span style="font-family:"Arial",sans-serif">To: Department Benefits Representatives (DBRs)<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom:6.0pt;line-height:normal"><span style="font-family:"Arial",sans-serif">From: HR Benefits Office
<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom:6.0pt;text-indent:-.7pt;line-height:normal">
<span style="font-family:"Arial",sans-serif">Re: Availability of 1095 Forms for 2020<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td width="624" valign="top" style="width:6.5in;border:none;padding:0in 5.4pt 0in 5.4pt">
<p class="MsoNormal" style="mso-margin-top-alt:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:0in;margin-bottom:.0001pt;text-align:justify;line-height:110%">
<span style="font-family:"Arial",sans-serif">In accordance with requirements of the Affordable Care Act (ACA) and various reporting requirements of other jurisdictions; UC employees will receive 1095-B and/or 1095-C forms verifying their health coverage for
2020. The forms are informational only and are not to be filed with tax returns.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height:normal">
<span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin-bottom:6.0pt;line-height:normal"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#002060">General Reminders Regarding 1095-Cs and 1095-Bs</span></b><span style="font-family:"Arial",sans-serif">
<o:p></o:p></span></p>
<p class="MsoListParagraph" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:3.0pt;margin-left:25.9pt;text-align:justify;text-indent:-25.9pt;mso-text-indent-alt:-.25in;line-height:110%;mso-list:l11 level1 lfo9">
<![if !supportLists]><span style="font-size:12.0pt;line-height:110%;font-family:Symbol;color:#002060"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman"">
</span>·<span style="font:7.0pt "Times New Roman""> </span></span></span><![endif]><span style="font-family:"Arial",sans-serif">Employees defined as full-time under the ACA (those who work 75% time or more) will receive the 1095-C from UC. Parts I and
II of the 1095-C will be populated for all employees; only those enrolled in UC’s self-insured plans (Core, Health Savings Plan, UC Care, the Resident program administered by UC Health) will have Part III populated.<o:p></o:p></span></p>
<p class="MsoListParagraph" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:3.0pt;margin-left:25.9pt;text-align:justify;text-indent:-25.9pt;mso-text-indent-alt:-.25in;line-height:110%;mso-list:l11 level1 lfo9">
<![if !supportLists]><span style="font-size:12.0pt;line-height:110%;font-family:Symbol;color:#002060"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman"">
</span>·<span style="font:7.0pt "Times New Roman""> </span></span></span><![endif]><span style="font-family:"Arial",sans-serif">Employees defined as not full-time under the ACA who are plan members of UC’s self-insured plans (Core, Health Savings Plan,
UC Care, the Resident program administered by UC Health) will receive Form 1095-B.<o:p></o:p></span></p>
<p class="MsoListParagraph" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:3.0pt;margin-left:25.9pt;text-align:justify;text-indent:-25.9pt;mso-text-indent-alt:-.25in;line-height:110%;mso-list:l11 level1 lfo9">
<![if !supportLists]><span style="font-size:12.0pt;line-height:110%;font-family:Symbol;color:#002060"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman"">
</span>·<span style="font:7.0pt "Times New Roman""> </span></span></span><![endif]><span style="font-family:"Arial",sans-serif">All plan members of UC’s fully insured plans (Health Net and Kaiser Permanente) will receive Form 1095-B directly from the
plan. <o:p></o:p></span></p>
<p class="MsoListParagraph" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:0in;margin-left:25.9pt;margin-bottom:.0001pt;text-align:justify;text-indent:-25.9pt;mso-text-indent-alt:-.25in;line-height:110%;mso-list:l11 level1 lfo9">
<![if !supportLists]><span style="font-size:12.0pt;line-height:110%;font-family:Symbol;color:#002060"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman"">
</span>·<span style="font:7.0pt "Times New Roman""> </span></span></span><![endif]><span style="font-family:"Arial",sans-serif">All forms will be sent via paper copy – no electronic copies will be available for the 2020 tax year. Employees should expect
to receive their 1095s over the next few weeks (USPS delays notwithstanding).<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height:normal">
<span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin-bottom:6.0pt;line-height:normal"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#002060">Questions, Corrections and Reprints<o:p></o:p></span></b></p>
<p class="MsoListParagraph" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:3.0pt;margin-left:25.9pt;text-align:justify;text-indent:-25.9pt;mso-text-indent-alt:-.25in;line-height:110%;mso-list:l11 level1 lfo9">
<![if !supportLists]><span style="font-size:12.0pt;line-height:110%;font-family:Symbol;color:#002060"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman"">
</span>·<span style="font:7.0pt "Times New Roman""> </span></span></span><![endif]><span style="font-family:"Arial",sans-serif">Employees with general questions about the 1095 Forms should be referred to the
<a href="https://www.irs.gov/affordable-care-act/questions-and-answers-about-health-care-information-forms-for-individuals">
Internal Revenue Service (IRS) website/Affordable Care Act/Questions and Answers about Health Care Information Forms for Individuals</a>.<o:p></o:p></span></p>
<p class="MsoListParagraph" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:3.0pt;margin-left:25.9pt;text-align:justify;text-indent:-25.9pt;mso-text-indent-alt:-.25in;line-height:110%;mso-list:l11 level1 lfo9">
<![if !supportLists]><span style="font-size:12.0pt;line-height:110%;font-family:Symbol;color:#002060"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman"">
</span>·<span style="font:7.0pt "Times New Roman""> </span></span></span><![endif]><span style="font-family:"Arial",sans-serif">Requests for corrections:<o:p></o:p></span></p>
<p class="MsoListParagraph" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:3.0pt;margin-left:44.1pt;text-align:justify;text-indent:-.25in;line-height:110%;mso-list:l4 level2 lfo12">
<![if !supportLists]><span style="font-family:"Courier New""><span style="mso-list:Ignore">o<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-family:"Arial",sans-serif">For forms issued by the fully insured plans, employees should call the plan.
<o:p></o:p></span></p>
<p class="MsoListParagraph" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:3.0pt;margin-left:44.1pt;text-align:justify;text-indent:-.25in;line-height:110%;mso-list:l4 level2 lfo12">
<![if !supportLists]><span style="font-family:"Courier New""><span style="mso-list:Ignore">o<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-family:"Arial",sans-serif">For forms issued by UC on behalf of UCPath, UCPath representatives will need to confirm the correction and generate a new 1095.
<o:p></o:p></span></p>
<p class="MsoListParagraph" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:3.0pt;margin-left:25.9pt;text-align:justify;text-indent:-25.9pt;mso-text-indent-alt:-.25in;line-height:110%;mso-list:l11 level1 lfo9">
<![if !supportLists]><span style="font-size:12.0pt;line-height:110%;font-family:Symbol;color:#002060"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman"">
</span>·<span style="font:7.0pt "Times New Roman""> </span></span></span><![endif]><span style="font-family:"Arial",sans-serif">Requesting duplicate copies – UCPath Employees:<o:p></o:p></span></p>
<p class="MsoListParagraph" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:0in;margin-left:44.1pt;margin-bottom:.0001pt;text-align:justify;text-indent:-.25in;line-height:110%;mso-list:l11 level2 lfo9">
<![if !supportLists]><span style="font-family:"Arial",sans-serif"><span style="mso-list:Ignore">1.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-family:"Arial",sans-serif">Log on to the
<i>UCPath portal</i><o:p></o:p></span></p>
<p class="MsoListParagraph" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:0in;margin-left:44.1pt;margin-bottom:.0001pt;text-align:justify;text-indent:-.25in;line-height:110%;mso-list:l11 level2 lfo9">
<![if !supportLists]><span style="font-family:"Arial",sans-serif"><span style="mso-list:Ignore">2.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-family:"Arial",sans-serif">Scroll down to the
<i>Forms Library</i><o:p></o:p></span></p>
<p class="MsoListParagraph" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:0in;margin-left:44.1pt;margin-bottom:.0001pt;text-align:justify;text-indent:-.25in;line-height:110%;mso-list:l11 level2 lfo9">
<![if !supportLists]><span style="font-family:"Arial",sans-serif"><span style="mso-list:Ignore">3.<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-family:"Arial",sans-serif">Click on
<i>Records</i> to complete a Benefits record request<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height:normal">
<span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin-bottom:6.0pt;line-height:normal"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#002060">Related Links<o:p></o:p></span></b></p>
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</span>·<span style="font:7.0pt "Times New Roman""> </span></span></span><![endif]><span style="font-family:"Arial",sans-serif">UCnet:
<a href="https://ucnet.universityofcalifornia.edu/compensation-and-benefits/health-plans/medical/affordable-care-act/1095-faq-2017.html">
FAQ: IRS Form 1095</a><o:p></o:p></span></p>
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</span>·<span style="font:7.0pt "Times New Roman""> </span></span></span><![endif]><span style="font-family:"Arial",sans-serif">UCnet:
<a href="https://ucnet.universityofcalifornia.edu/news/2021/02/availability-of-irs-form-1095-for-your-2020-taxes.html">
Availability of IRS Form 1095 for your 2020 taxes</a><o:p></o:p></span></p>
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