January 13, 2009

Massachusetts: 2009 Employee HIRD Forms

The Massachusetts Division of Health Care Finance and Policy (DHCFP) has released the 2009 Employee HIRD Form.  Each employee must sign an Employee HIRD form if he/she:

  • Declined to enroll in the employer-sponsored plan; or
  • Declined to participate in the employer’s Section 125 plan.

The employee must also indicate whether he/she has an alternative source of coverage.

The Employee HIRD form is distributed by the employer and completed by the employee; and then returned to the employer.  The employer is required to give a copy of the form to the employee, and retain a copy of the forms for three years.

An employer can design its own form, but it must precisely follow in content and format as the form developed by the DHCFP.

Due Date of Employee HIRD Form

The employer must obtain a signed Employee HIRD form from each employee required to sign one, by the earlier of:

  • 30 days following the close of the applicable open enrollment period of the Employer’s plan, or its Section 125 Cafeteria plan; or
  • September 30 of the reporting year.


The information contained in this Benefit Beat is not intended to be legal, accounting, or other professional advice, nor are these comments directed to specific situations.

As required by U.S. Treasury rules, we inform you that, unless expressly stated otherwise, any U.S. federal tax advice contained in this Benefit Beat is not intended or written to be used, and cannot be used, by any person for the purpose of avoiding any penalties that may be imposed by the Internal Revenue Service.

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