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<body lang="EN-US" link="#0563C1" vlink="#954F72">
<div class="WordSection1">
<h1><img width="192" height="73" id="_x0000_i1025" src="cid:image001.png@01D93557.08B0C650"><o:p></o:p></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" colspan="2" valign="top" style="width:6.5in;padding:0in 5.4pt 0in 5.4pt">
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif">January 31, 2023</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif"> </span><o:p></o:p></p>
</td>
</tr>
<tr>
<td width="66" valign="top" style="width:49.5pt;padding:0in 5.4pt 0in 5.4pt">
<p class="MsoNormal" style="mso-margin-top-alt:6.0pt;margin-right:0in;margin-bottom:6.0pt;margin-left:-.7pt;text-align:justify;line-height:110%">
<span style="font-family:"Arial",sans-serif">To:</span><o:p></o:p></p>
</td>
<td width="558" valign="top" style="width:418.5pt;padding:0in 0in 0in 0in">
<p class="MsoNormal" style="mso-margin-top-alt:6.0pt;margin-right:0in;margin-bottom:6.0pt;margin-left:-.7pt;text-align:justify;line-height:110%">
<span style="font-family:"Arial",sans-serif">Department Benefit Representatives</span><o:p></o:p></p>
</td>
</tr>
<tr>
<td width="66" valign="top" style="width:49.5pt;padding:0in 5.4pt 0in 5.4pt">
<p class="MsoNormal" style="mso-margin-top-alt:6.0pt;margin-right:0in;margin-bottom:6.0pt;margin-left:-.7pt;text-align:justify;line-height:110%">
<span style="font-family:"Arial",sans-serif">From:</span><o:p></o:p></p>
</td>
<td width="558" valign="top" style="width:418.5pt;padding:0in 0in 0in 0in">
<p class="MsoNormal" style="mso-margin-top-alt:6.0pt;margin-right:0in;margin-bottom:6.0pt;margin-left:-.7pt;text-align:justify;line-height:110%">
<span style="font-family:"Arial",sans-serif">Central HR Benefits Office on behalf of UC Office of the President</span><o:p></o:p></p>
</td>
</tr>
<tr>
<td width="66" valign="top" style="width:49.5pt;padding:0in 5.4pt 0in 5.4pt">
<p class="MsoNormal" style="mso-margin-top-alt:6.0pt;margin-right:0in;margin-bottom:6.0pt;margin-left:-.7pt;text-align:justify;line-height:110%">
<span style="font-family:"Arial",sans-serif">Re:</span><o:p></o:p></p>
</td>
<td width="558" valign="top" style="width:418.5pt;padding:0in 0in 0in 0in">
<p class="MsoNormal" style="mso-margin-top-alt:6.0pt;margin-right:0in;margin-bottom:6.0pt;margin-left:-.7pt;text-align:justify;line-height:110%">
<span style="font-family:"Arial",sans-serif">Availability of 2022 Health Plan Reporting 1095 Tax Forms</span><o:p></o:p></p>
</td>
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<p><span style="font-family:"Arial",sans-serif">In accordance with requirements of the Affordable Care Act (ACA) and various reporting requirements of other jurisdictions, University of California (UC) employees will receive 1095-B and/or 1095-C forms verifying
their health coverage for 2022. The forms are for employees’ information and records only; the forms are not filed with tax returns.<o:p></o:p></span></p>
<p><b><span style="font-family:"Arial",sans-serif">General Reminders regarding 1095-Cs and 1095-Bs</span></b><span style="font-family:"Arial",sans-serif">:
<o:p></o:p></span></p>
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<li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l3 level1 lfo1"><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, UC Health Savings Plan, UC Care, the Resident program administered by UC Health) will have Part III populated.<o:p></o:p></span></li><li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l3 level1 lfo1"><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, UC Health Savings Plan, UC Care, the
Resident program administered by UC Health) will receive Form 1095-B<o:p></o:p></span></li></ul>
<p><span style="font-family:"Arial",sans-serif">All plan members of UC’s fully insured plans (UC Blue & Gold HMO through Health Net and Kaiser Permanente HMO) will receive Form 1095-B directly from the plan. <o:p></o:p></span></p>
<p><b><span style="font-family:"Arial",sans-serif">Below is the current status (as of January 27, 2023) for Form 1095s issued by UC:<o:p></o:p></span></b></p>
<p><b><span style="font-family:"Arial",sans-serif">For 2022 Active Employees:<o:p></o:p></span></b></p>
<p class="MsoListParagraphCxSpFirst" style="mso-margin-bottom-alt:auto;mso-add-space:auto;text-indent:-.25in;line-height:15.75pt;mso-list:l1 level1 lfo2;background:white">
<![if !supportLists]><span style="font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-family:"Arial",sans-serif;color:black">In previous years, all employees received a paper copy of their 1095 form. This year (2023), employees who opted-in for electronic distribution of 1095s before January 1,
2023, will not receive a paper copy of their 1095. <span style="background:white">
UCPath will email employees who opted-in for electronic delivery when their 1095 form(s) are available for download. If employees did not request electronic delivery, they should expect to receive their 1095 forms over the next few weeks, depending on the timing
of US Postal Service (USPS) delivery. All employees can access a duplicate copy of their 1095 forms through UCPath, which should be available in mid-February 2023. Please note that Form 1095s from previous years will not be available on UCPath.</span></span><span style="font-family:"Arial",sans-serif"><o:p></o:p></span></p>
<p class="MsoListParagraphCxSpLast" style="text-indent:-.25in;line-height:15.75pt;mso-list:l1 level1 lfo2;background:white">
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</span></span></span><![endif]><b><span style="font-family:"Arial",sans-serif;color:black">Former employees:</span></b><span style="font-family:"Arial",sans-serif;color:black"> Former employees will have access to an electronic duplicate copy of their Form
1095, reflecting their eligibility and/or enrollment in UC-sponsored medical plans.</span><b><span style="font-family:"Arial",sans-serif"><o:p></o:p></span></b></p>
<p><b><span style="font-family:"Arial",sans-serif">For COBRA Members:<o:p></o:p></span></b></p>
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<li class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l4 level1 lfo3">
<span style="font-family:"Arial",sans-serif">UC Care, CORE, and UC Health Savings Plan (UC HSP): COBRA members in self-funded plans will be sent a paper form reflecting their COBRA coverage. No electronic copies will be available for the 2022 tax year. Enrollees
should expect to receive their 1095s over the next few weeks (USPS delays notwithstanding).<o:p></o:p></span></li><li class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l4 level1 lfo3">
<span style="font-family:"Arial",sans-serif">Kaiser Permanente HMO, UC Blue & Gold HMO: COBRA members in fully-insured plans will receive a paper copy reflecting their COBRA coverage directly from the carriers. No electronic copies will be available for the
2022 tax year.<s><o:p></o:p></s></span></li></ul>
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<p style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:6.0pt;margin-left:0in">
<b><span style="font-family:"Arial",sans-serif">Other Jurisdiction Reporting<o:p></o:p></span></b></p>
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<li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l2 level1 lfo5"><span style="font-family:"Arial",sans-serif">In addition to filing with the IRS, UC is required to submit a separate filing to California, Massachusetts, New Jersey, District of Columbia,
and Rhode Island, verifying their residents’ health insurance status. Residents of Massachusetts will receive a Form 1099-HC. Residents of the other jurisdictions do not receive any additional forms.
<b><o:p></o:p></b></span></li></ul>
<p><b><span style="font-family:"Arial",sans-serif">Corrections, Reprints, and Questions:<o:p></o:p></span></b></p>
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<li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l0 level2 lfo6"><span style="font-family:"Arial",sans-serif">For forms issued by UC through UCPath, UCPath representatives will need to confirm the correction and generate a new 1095. Corrected forms
will be sent out after February 21, 2023. <o:p></o:p></span></li><li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l0 level2 lfo6"><span style="font-family:"Arial",sans-serif">Employees: Duplicate copies of 1095s will be available after February 1, 2023, in UCPath. <o:p></o:p></span></li></ul>
<li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l0 level1 lfo6"><span style="font-family:"Arial",sans-serif">Employees with general questions about the 1095 forms should be referred to the IRS website at
<a href="https://www.irs.gov/affordable-care-act/questions-and-answers-about-health-care-information-forms-for-individuals">
<span style="color:windowtext;text-decoration:none">https://www.irs.gov/affordable-care-act/questions-and-answers-about-health-care-information-forms-for-individuals</span></a><o:p></o:p></span></li></ul>
<p class="MsoNormal" style="margin-bottom:6.0pt"><span style="font-family:"Arial",sans-serif">Related Links<o:p></o:p></span></p>
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<li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l5 level1 lfo7"><span style="font-family:"Arial",sans-serif"><a href="https://ucnet.universityofcalifornia.edu/compensation-and-benefits/health-plans/medical/affordable-care-act/1095-faq-2017.html"><span style="color:windowtext">FAQs:
IRS Form 1095</span></a><o:p></o:p></span></li></ul>
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