<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns:dt="uuid:C2F41010-65B3-11d1-A29F-00AA00C14882" xmlns:m="http://schemas.microsoft.com/office/2004/12/omml" xmlns="http://www.w3.org/TR/REC-html40">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=us-ascii">
<meta name="Generator" content="Microsoft Word 15 (filtered medium)">
<!--[if !mso]><style>v\:* {behavior:url(#default#VML);}
o\:* {behavior:url(#default#VML);}
w\:* {behavior:url(#default#VML);}
.shape {behavior:url(#default#VML);}
</style><![endif]--><style><!--
/* Font Definitions */
@font-face
        {font-family:Wingdings;
        panose-1:5 0 0 0 0 0 0 0 0 0;}
@font-face
        {font-family:"Cambria Math";
        panose-1:2 4 5 3 5 4 6 3 2 4;}
@font-face
        {font-family:Calibri;
        panose-1:2 15 5 2 2 2 4 3 2 4;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
        {margin:0in;
        margin-bottom:.0001pt;
        font-size:11.0pt;
        font-family:"Calibri",sans-serif;
        mso-ligatures:standardcontextual;}
a:link, span.MsoHyperlink
        {mso-style-priority:99;
        color:#0563C1;
        text-decoration:underline;}
a:visited, span.MsoHyperlinkFollowed
        {mso-style-priority:99;
        color:#954F72;
        text-decoration:underline;}
p.MsoListParagraph, li.MsoListParagraph, div.MsoListParagraph
        {mso-style-priority:34;
        margin-top:0in;
        margin-right:0in;
        margin-bottom:0in;
        margin-left:.5in;
        margin-bottom:.0001pt;
        font-size:11.0pt;
        font-family:"Calibri",sans-serif;}
.MsoChpDefault
        {mso-style-type:export-only;
        font-family:"Calibri",sans-serif;}
@page WordSection1
        {size:8.5in 11.0in;
        margin:.3in .3in .2in .3in;}
div.WordSection1
        {page:WordSection1;}
/* List Definitions */
@list l0
        {mso-list-id:48188280;
        mso-list-type:hybrid;
        mso-list-template-ids:1544571056 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l0:level1
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l0:level2
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l0:level3
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l0:level4
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l0:level5
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l0:level6
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l0:level7
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l0:level8
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l0:level9
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l1
        {mso-list-id:142699873;
        mso-list-type:hybrid;
        mso-list-template-ids:429416576 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l1:level1
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l1:level2
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l1:level3
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l1:level4
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l1:level5
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l1:level6
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l1:level7
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l1:level8
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l1:level9
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l2
        {mso-list-id:224684233;
        mso-list-type:hybrid;
        mso-list-template-ids:-1891570282 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l2:level1
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l2:level2
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l2:level3
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l2:level4
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l2:level5
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l2:level6
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l2:level7
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l2:level8
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l2:level9
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l3
        {mso-list-id:233046892;
        mso-list-type:hybrid;
        mso-list-template-ids:953066220 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l3:level1
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l3:level2
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l3:level3
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l3:level4
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l3:level5
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l3:level6
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l3:level7
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l3:level8
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l3:level9
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l4
        {mso-list-id:1217232773;
        mso-list-type:hybrid;
        mso-list-template-ids:-240096384 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l4:level1
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l4:level2
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l4:level3
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l4:level4
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l4:level5
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l4:level6
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l4:level7
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l4:level8
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l4:level9
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l5
        {mso-list-id:1363242286;
        mso-list-type:hybrid;
        mso-list-template-ids:-1561314478 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l5:level1
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l5:level2
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l5:level3
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l5:level4
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l5:level5
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l5:level6
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l5:level7
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l5:level8
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l5:level9
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l6
        {mso-list-id:1647199846;
        mso-list-type:hybrid;
        mso-list-template-ids:1787852694 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l6:level1
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l6:level2
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l6:level3
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l6:level4
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l6:level5
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l6:level6
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l6:level7
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l6:level8
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l6:level9
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l7
        {mso-list-id:1891453633;
        mso-list-type:hybrid;
        mso-list-template-ids:26143710 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l7:level1
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l7:level2
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l7:level3
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l7:level4
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l7:level5
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l7:level6
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
@list l7:level7
        {mso-level-number-format:bullet;
        mso-level-text:\F0B7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Symbol;}
@list l7:level8
        {mso-level-number-format:bullet;
        mso-level-text:o;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:"Courier New";}
@list l7:level9
        {mso-level-number-format:bullet;
        mso-level-text:\F0A7;
        mso-level-tab-stop:none;
        mso-level-number-position:left;
        text-indent:-.25in;
        font-family:Wingdings;}
ol
        {margin-bottom:0in;}
ul
        {margin-bottom:0in;}
--></style><!--[if gte mso 9]><xml>
<o:shapedefaults v:ext="edit" spidmax="1026" />
</xml><![endif]--><!--[if gte mso 9]><xml>
<o:shapelayout v:ext="edit">
<o:idmap v:ext="edit" data="1" />
</o:shapelayout></xml><![endif]-->
</head>
<body lang="EN-US" link="#0563C1" vlink="#954F72">
<div class="WordSection1">
<p class="MsoNormal"><span style="mso-ligatures:none"><img width="159" height="60" id="_x0000_i1025" src="cid:image001.jpg@01DA584D.BA09EE30"></span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:6.0pt;font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif">February 5, 2024<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" width="723" style="width:542.5pt;border-collapse:collapse">
<tbody>
<tr style="height:27.0pt">
<td width="103" valign="top" style="width:76.95pt;padding:0in 5.4pt 0in 5.4pt;height:27.0pt">
<p class="MsoNormal" style="mso-margin-top-alt:3.0pt;margin-right:0in;margin-bottom:3.0pt;margin-left:0in">
<span style="font-family:"Arial",sans-serif">To:<o:p></o:p></span></p>
</td>
<td width="621" valign="top" style="width:465.55pt;padding:0in 0in 0in 0in;height:27.0pt">
<p class="MsoNormal" style="mso-margin-top-alt:3.0pt;margin-right:0in;margin-bottom:3.0pt;margin-left:0in">
<span style="font-family:"Arial",sans-serif">Department Benefits Representatives (DBRs)<o:p></o:p></span></p>
</td>
</tr>
<tr style="height:29.7pt">
<td width="103" valign="top" style="width:76.95pt;padding:0in 5.4pt 0in 5.4pt;height:29.7pt">
<p class="MsoNormal" style="mso-margin-top-alt:3.0pt;margin-right:0in;margin-bottom:3.0pt;margin-left:0in">
<span style="font-family:"Arial",sans-serif">From:<o:p></o:p></span></p>
</td>
<td width="621" valign="top" style="width:465.55pt;padding:0in 0in 0in 0in;height:29.7pt">
<p class="MsoNormal" style="mso-margin-top-alt:3.0pt;margin-right:0in;margin-bottom:3.0pt;margin-left:0in">
<span style="font-family:"Arial",sans-serif">Central HR Benefits Office on behalf of UC Office of the President<o:p></o:p></span></p>
</td>
</tr>
<tr style="height:22.55pt">
<td width="103" valign="top" style="width:76.95pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:22.55pt">
<p class="MsoNormal" style="mso-margin-top-alt:3.0pt;margin-right:0in;margin-bottom:3.0pt;margin-left:0in">
<span style="font-family:"Arial",sans-serif">Re:<o:p></o:p></span></p>
</td>
<td width="621" valign="top" style="width:465.55pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 0in 0in 0in;height:22.55pt">
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif">2024 1095 Forms Availability</span><span style="color:#1A475F"><o:p></o:p></span></p>
</td>
</tr>
</tbody>
</table>
<p class="MsoNormal"><b><span style="font-size:6.0pt;font-family:"Arial",sans-serif"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><b><span style="font-family:"Arial",sans-serif">DBRs, please share this updated information via your internal listserv.<o:p></o:p></span></b></p>
<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 employees will receive 1095-B and/or 1095-C forms verifying
 their health coverage for 2023. The forms are informational only and for employee records; 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-C and 1095-B</span></b><span style="font-family:"Arial",sans-serif">:
<o:p></o:p></span></p>
<ul style="margin-top:0in" type="disc">
<li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l3 level1 lfo3"><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 Residents & Fellows benefits program) will have Part III populated.<o:p></o:p></span></li><li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l3 level1 lfo3"><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, and
 the Residents & Fellows benefits) 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 medical plan. <o:p></o:p></span></p>
<p><b><span style="font-family:"Arial",sans-serif">Below is the current status (as of January 29, 2024) for Form 1095s issued by UC:<o:p></o:p></span></b></p>
<p><b><span style="font-family:"Arial",sans-serif">For 2023 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 lfo4;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">Employees who opted-in for electronic distribution of 1095s before January 1, 2024, 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 they 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. Except for Residents & Fellows Benefits members, all employees can now access a duplicate copy of their 1095 forms through UCPath. Please note that Form 1095s from 2023 are also available
 on UCPath. All other previous years are not available electronically, but can be requested for printing and mailing.</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 lfo4;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]><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 prior to separation.</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>
<ul type="disc">
<li class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l5 level1 lfo5">
<span style="font-family:"Arial",sans-serif">UC Care, CORE, UC Health Savings Plan (UC HSP), and Residents & Fellows Benefits: COBRA members in self-funded plans will be sent a paper form reflecting their COBRA coverage. No electronic copies will be available
 for the 2023 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:l5 level1 lfo5">
<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
 2023 tax year.<o:p></o:p></span></li></ul>
<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>
<ul style="margin-top:0in" type="disc">
<li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l2 level1 lfo7"><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>
<ul style="margin-top:0in" type="disc">
<li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l0 level1 lfo8"><span style="font-family:"Arial",sans-serif">If you receive requests for corrections:<o:p></o:p></span></li></ul>
<p style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:6.0pt;margin-left:1.0in;text-indent:-.25in">
<span style="font-family:"Arial",sans-serif">o   Forms issued by the fully insured plans, employees should call the plan; benefits professionals may be required to work with the plan to confirm the correction.<o:p></o:p></span></p>
<ul style="margin-top:0in" type="disc">
<ul style="margin-top:0in" type="circle">
<li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l0 level2 lfo8"><span style="font-family:"Arial",sans-serif">Forms issued by UC through UCPath, UCPath representatives must confirm the correction and generate a new 1095. Corrected forms will be sent
 out after March 1, 2024. <o:p></o:p></span></li><li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l0 level2 lfo8"><span style="font-family:"Arial",sans-serif">For forms issued by UC to COBRA members, forward the request to the UCPath Center. COBRA members
<b>should not </b>be referred directly to UCPath.</span><span style="font-family:"Arial",sans-serif;mso-ligatures:none"><o:p></o:p></span></li><li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l0 level2 lfo8"><span style="font-family:"Arial",sans-serif">For forms issued to Residents & Fellows Benefits members, trainees should request corrections by e-mail to
<a href="mailto:ucresidentbenefits@ucop.edu">ucresidentbenefits@ucop.edu</a><o:p></o:p></span></li></ul>
<li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l0 level1 lfo8"><span style="font-family:"Arial",sans-serif">If you receive requests for duplicate copies:<o:p></o:p></span></li><ul style="margin-top:0in" type="circle">
<li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l0 level2 lfo8"><span style="font-family:"Arial",sans-serif">Employees: Duplicate copies of 1095s are available on UCPath as of February 1, 2024. For employees requesting a mailed duplicate copy of their
 1095, those will be available as of March 1, 2024.<o:p></o:p></span></li><li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l0 level2 lfo8"><span style="font-family:"Arial",sans-serif">COBRA Members: If a COBRA member needs a duplicate copy, those requests can be forwarded to the UCPath Center who will then coordinate with
 UnifyHR to distribute duplicate copies.<o:p></o:p></span></li><li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l0 level2 lfo8"><span style="font-family:"Arial",sans-serif">Forms issued to Residents & Fellows Benefits members, trainees should request duplicate copies by email to
<a href="mailto:ucresidentbenefits@ucop.edu">ucresidentbenefits@ucop.edu</a><o:p></o:p></span></li></ul>
<li class="MsoNormal" style="margin-bottom:6.0pt;mso-list:l0 level1 lfo8"><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>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif"><a href="https://ucnet.universityofcalifornia.edu/news/2024/01/your-tax-forms-for-2023.html">FAQ: IRS Form 1095</a></span></p>
</div>
</body>
</html>