Vermont Form HC-2, the Declaration of Health Care Coverage, is a one-page form you complete for your employer to report whether you have health insurance and where it comes from. Your employer keeps the signed form on file and uses the information to figure out how much it owes the state under the Health Care Fund Contribution Assessment. You do not send the form to the Vermont Department of Taxes yourself.1Vermont Department of Taxes. Health Care Fund Contribution Assessment
How to Fill Out Form HC-2
The form is a downloadable PDF on the Vermont Department of Taxes website.2Vermont Department of Taxes. Vermont Form HC-2 – Declaration of Health Care Coverage Print your full legal name at the top, along with either your Employee ID or Social Security Number.
The first question asks whether you will be under 18 for the entire calendar year. If yes, check that box, sign and date the bottom, and give the form to your employer. Nothing else on the page applies to you.
If you are 18 or older at any point during the year, keep going. The rest of the form is a list of coverage situations, and you check exactly one box. The choices fall into three groups.
Your Employer Offers Coverage and You Accepted It
One box confirms you are enrolled in your employer’s health plan. Check it, sign, and date.
Your Employer Offers Coverage but You Declined It
Pick the sub-option that fits: you carry non-Medicaid coverage from another source (a spouse’s plan, a parent’s plan, or a private policy), you are a full-time employee with individual coverage through the Vermont Health Benefit Exchange, you have Medicaid, or you have no coverage at all.
Your Employer Does Not Offer You Coverage
The options here separate part-time employees (fewer than 30 hours per week) and seasonal employees (20 weeks or fewer per year) who carry their own non-Medicaid coverage from workers who are uncovered or on Medicaid. If none of the special categories describes you, check the general box for having non-employer coverage or for having none.
Pick one box only. Sign and date at the bottom, and hand the form to your employer. That’s the whole process. You keep nothing; the state receives nothing directly from you.
Who Has to Complete One
Every person who works in Vermont and is 18 or older at any point during the calendar year must fill out an HC-2 for their employer.2Vermont Department of Taxes. Vermont Form HC-2 – Declaration of Health Care Coverage That includes part-time workers, seasonal staff, and employees who already have coverage through a spouse, a parent, Medicaid, or a private policy. Where you live does not matter; only where the work is performed.
You complete a new HC-2 every year. You also fill out a fresh one during the year if your coverage changes: you drop a plan, gain Medicaid, or enroll in your employer’s insurance. Give the updated form to your employer right away.1Vermont Department of Taxes. Health Care Fund Contribution Assessment
What Your Employer Does With the Form
Your employer keeps the signed original on file for at least three years, in a format available for state review and audit.3Vermont General Assembly. Vermont Code 32 – Health Care Fund Contribution Assessment – Section: 10504 The information you report tells the employer whether your hours count toward the state assessment it owes each quarter.
This is why turning the form in matters even when you already have coverage. If you are not on your employer’s health plan and there is no HC-2 on file for you, the Department of Taxes must treat you as uncovered during an audit. The employer then pays an assessment on your hours, regardless of the coverage you actually have. A missing form is treated the same as a confirmed gap in coverage, with no grace period or appeal based on your real insurance status.1Vermont Department of Taxes. Health Care Fund Contribution Assessment Handing in the form promptly protects your employer from paying for coverage you already carry, and it keeps your file clean if the state comes asking.