ALERT. Customers inquiring about the letter must be asked if he/she has filed 2014 tax return and:

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1 ALERT Customers who received a premium tax credit in 2014 and are preparing to renew his/her health coverage for 2016 are required to have filed his/her 2014 taxes in order to continue receiving his/her premium tax credit. PDD The tax credit is paid directly to the health insurance company by the Internal Revenue Service (IRS) on the customers behalf, which is why those who receive premium tax credits must file taxes. Beginning mid-july, the Internal Revenue Service (IRS) will be sending Non-Tax Filer Outreach letters (Letter 5591) (see attached example letters) to all individuals who failed to file 2014 taxes, which includes Covered CA customers. Customers inquiring about the letter must be asked if he/she has filed 2014 tax return and: If... Yes, No, Then respond... If you filed your 2014 tax return with Form 8962, you may disregard the letter. Customers who received a premium tax credit in 2014 to help pay for health insurance are required to file a 2014 Federal Income Tax return. If you did not file a tax return, you will not be eligible for a premium tax credit or cost-sharing reductions to help pay for your health insurance when you renew coverage for If you filed for an extension or filed late, you will need to allow the IRS time to complete the processing of their return which may take several weeks. FLYER # (07/15) SB:GC:ker

2 Department of the Treasury Internal Revenue Service Kansas City, MO Date: Contact telephone number: Our records show that you did not file a 2014 tax return to reconcile advance payments of the Premium Tax Credit Dear Taxpayer: Why we are sending you this letter We received a copy of Form 1095-A, Health Insurance Marketplace Statement, issued to you by your Health Insurance Marketplace showing that advance payments of the premium tax credit were made to your or your family s health insurance company to reduce your premium costs in You are required to file a 2014 federal tax return with Form 8962, Premium Tax Credit, to reconcile these advance payments of the premium tax credit. However, we have no record that you filed a federal tax return for tax year If you do not file a 2014 tax return, you will not be eligible for advance payments of the premium tax credit or cost-sharing reductions to help pay for your Marketplace health insurance coverage in What you need to do You should file your 2014 tax return with Form 8962 as soon as possible even if you don t usually have to file. You should have received Form 1095-A from your Marketplace. This form provides the information you will need to complete Form If you need a copy of your Form 1095-A, go to HealthCare.gov or your state Marketplace website and log into your Marketplace account or call your Marketplace call center. For more information on filing a 2014 tax return with Form 8962, visit IRS.gov/aca. Filing electronically is the easiest way to file a complete and accurate tax return. The software guides you through the process. Electronic filing options include: free volunteer assistance, IRS Free File, commercial software, and assistance from a paid tax preparer. For more information about Free File and e-file, please visit IRS.gov and search for free file or e-file. If, after reviewing our website, you still need further information, call IRS telephone assistance for individuals at If you have already filed your 2014 tax return with Form 8962, please disregard this letter. OVER Letter 5591 (7-2015)

3 The Premium Tax Credit If you, your spouse, or any dependent you can claim on your tax return enrolled in 2014 health insurance coverage through the Health Insurance Marketplace, you may be eligible for the premium tax credit. This tax credit can help make health insurance coverage more affordable for people with moderate incomes. The Form 1095-A sent to us by your Health Insurance Marketplace indicates that you chose to have advance payments of the premium tax credit paid to your or your family s health insurance company. If you don t file a tax return If you do not file a 2014 tax return, you will not be eligible for advance payments of the premium tax credit or cost-sharing reductions to help pay for your Marketplace health insurance coverage in This means you will be responsible for the full cost of your monthly premiums and all covered services. In addition, we may contact you to pay back some or all of the 2014 advance payments of the premium tax credit. Because Marketplaces will determine eligibility for advance tax credit payments and cost-sharing reductions for the 2016 coverage year this fall, it will substantially increase your chances of avoiding a gap in receiving this help if you file your 2014 tax return with Form 8962 electronically within 30 days from receiving this letter. Visit to read this letter in English (Visite para leer esta carta en Español). Thank you for your cooperation. Sincerely, Frank Nolden Field Director, Accounts Management Letter 5591 (7-2015)

4 Departamento del Tesoro Servicio de Impuestos Internos Kansas City, MO Fecha: Número de teléfono de contacto: Nuestros registros indican que usted no presentó una declaración de impuestos de 2014, para conciliar los pagos por adelantado del Crédito Tributario de Prima Estimado(a) contribuyente: Por qué le enviamos esta carta Hemos recibido una copia del Formulario 1095-A, Health Insurance Marketplace Statement (Declaración del mercado de seguros médicos), en inglés, emitido a usted por su Mercado de Seguros Médicos, mostrando que se hicieron pagos por adelantado del Crédito Tributario de Prima a su compañía de seguro médico o a la de su familia, para reducir sus costos de las primas en Se le requiere a usted presentar una declaración de impuestos federales de 2014 con el Formulario 8962, Premium Tax Credit (Crédito Tributario de Prima), en inglés, para conciliar estos pagos por adelantado del crédito tributario de prima. Sin embargo, no tenemos registro que usted presentó una declaración del impuesto federal para el año tributario de Si usted no presenta la declaración de impuestos de 2014, usted no tendrá derecho a los pagos por adelantado del crédito tributario de prima, o a las reducciones por costo compartido, para ayudar a pagar su cobertura de seguro médico del Mercado en Lo que debe hacer Usted debe presentar su declaración de impuestos de 2014 con el Formulario 8962 lo antes posible, aún si normalmente no tiene que presentar. Usted debe haber recibido el Formulario 1095-A de su Mercado. Este formulario proporciona la información que usted necesitará para completar el Formulario Si usted necesita una copia de su Formulario 1095-A, visite CuidadoDeSalud.gov, o la página web del Mercado en su estado e ingrese a su cuenta del Mercado, o llame al centro de asistencia al cliente de su Mercado. Para obtener más información sobre cómo presentar una declaración de impuestos de 2014 con el Formulario 8962, visite IRS.gov/aca. La presentación electrónica es la forma más fácil de presentar una declaración completa y exacta. El software le guía a través del proceso. Las opciones de la presentación electrónica incluyen: ayuda gratuita de voluntarios, Programa Free File del IRS, software comercial y ayuda de un preparador de impuestos remunerado. Para obtener más información sobre los programas e-file y Free File, por favor visite IRS.gov/espanol y busque por los términos free file o e-file. Si después de revisar nuestra página web, todavía necesita más información, llame al IRS a la línea de ayuda para las personas, al Si ya presentó su declaración de impuestos de 2014 con el Formulario 8962, por favor haga caso omiso de esta carta. Al dorso Letter 5591(SP) (X-2015)

5 El Crédito Tributario de Prima Si usted, su cónyuge o cualquier dependiente que usted puede reclamar en su declaración de impuestos, se inscribió en 2014 para la cobertura de seguro médico a través del Mercado de Seguros Médicos, usted tal vez tenga derecho al crédito tributario de prima. Este crédito tributario puede ayudar a que la cobertura de seguro médico sea más económica para las personas con ingresos moderados. El Formulario 1095-A enviado a nosotros por su Mercado de Seguros Médicos, indica que usted eligió que los pagos por adelantado del crédito tributario de prima se paguen a su compañía de seguro médico o a la de su familia. Si no presenta una declaración de impuestos Si usted no presenta una declaración de impuestos de 2014, usted no tendrá derecho a los pagos por adelantado del crédito tributario de prima, o a las reducciones por costo compartido, para ayudar a pagar su cobertura de seguro médico del Mercado en Esto significa, que usted será responsable por el costo completo de sus primas mensuales y todos los servicios cubiertos. Además, es posible que nos comuniquemos con usted para que reintegre parte o todos los pagos por adelantado del crédito tributario de prima del año Debido a que este otoño los Mercados determinarán la elegibilidad para los pagos por adelantado del crédito tributario y las reducciones por costo compartido de la cobertura para 2016, si usted presenta electrónicamente su declaración de impuestos de 2014 con el Formulario 8962, dentro de 30 días de recibir esta carta, aumentarán considerablemente sus posibilidades de evitar una interrupción en recibir esta ayuda. Visite para leer esta carta en español. Gracias por su cooperación. Atentamente, Frank Nolden Field Director, Accounts Management Letter 5591(SP) (X-2015)

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