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NJ Health Insurance Mandate

Claim Exemptions

Some people are exempt from the health care coverage requirement for some or all of 2019. Exemptions are available for reasons such as having income below a certain level, having a short gap in coverage, having no affordable coverage options, or experiencing a hardship – (see Types of Coverage Exemptions below). If you qualify for an exemption, you can claim the exemption when you file your 2019 New Jersey Income Tax return (Form NJ-1040) using Schedule NJ-HC in early 2020. Exemptions that you may have received in the past from Healthcare.gov will be available to claim on Schedule NJ-HC of the NJ-1040.

Individuals who are not required to file a New Jersey Income Tax return are automatically exempt and do not need to file just to report coverage or claim the exemption.

    This chart shows all of the coverage exemptions available, including descriptions of each and the associated code that will be used to claim the exemption on Schedule NJ-HC of Form NJ-1040.

    If you received a coverage exemption from the Health Insurance Marketplace for 2018, you will be able to claim this exemption for 2019. You will need to enter the Exemption Certificate Number (ECN) provided by the Marketplace on Schedule NJ-HC and Form NJ-1040.

    Income Related
    Coverage Exemption Type Exemption Code
    Marketplace Affordability A-1
    Coverage is considered unaffordable if the lowest cost Bronze-level plan available to you through the Marketplace in the tax year is more than 8.05% of your household income.

    Unaffordability based on projected income: It is determined that you do not have access to coverage that is considered affordable based on your projected household income for the following tax year.

    If you can claim this exemption, it may apply to the dependent(s) you claim on your tax return who didn’t have coverage in the year.

    Job Based Affordability A-2

    Coverage is considered unaffordable if:

  • For the employee: The annual premium for the lowest cost self-only plan (a plan that covers only you and not other members of your family) is more than 8.05% of household income.
  • For the employee’s family: The annual premium for the lowest cost family plan is more than 8.05% of household income.
  • Unaffordability based on projected income: It is determined that you do not have access to coverage that is considered affordable based on your projected household income for the following tax year.

    If you can claim this exemption, it may apply to the dependent(s) you claim on your tax return who didn’t have coverage in the year.

    Income Below Tax Filing Threshold A-3

    To be below the tax filing threshold, your New Jersey Gross Income must be less than:

  • $20,000 if your filing status is Married/CU Couple, filing joint return, Head of household, or Qualifying widow(er); or
  • $10,000 if your filing status is Single or Married/CU Partner, filing separate return.
  • You are not required to file a state tax return if your income is below the filing threshold.

    Choose this exemption if your income is below the filing threshold, but you’re filing a New Jersey tax return to claim a tax credit or refund.

    Health Coverage Related
    Coverage Exemption Type Exemption Code
    Gap in Coverage Less than 2 Consecutive Months B-1
  • You’re considered covered if any month you had qualifying health coverage for even 1 day.
  • If your coverage gap crosses calendar years, the months without coverage of the second tax year are not counted for the exemption for the second tax year.
  • If you had 2 or more gaps in coverage during the year, you can claim this exemption only for the months of your first coverage gap. This is true even if both gaps are less than 3 months.
  • If they qualify, you can claim this exemption for the dependent(s) you claim on your tax return.

    Group Membership
    Coverage Exemption Type Exemption Code
    Religious Sect C-1

    To claim this exemption, you must be a member of a religious sect or division that:

    • Has been in existence since December 31, 1950 and is recognized by the Social Security Administration as conscientiously opposed to accepting any insurance benefits (including Social Security and Medicare). Or
    • Relies solely on a religious method of healing, and for whom the acceptance of medical health services would be inconsistent with the religious beliefs of the individual.

    If you get this exemption, you won’t have to reapply for an exemption unless you turn 21 or leave your religious sect.

    Health Care Sharing Ministry C-2

    A health care sharing ministry is a tax-exempt organization whose members:

    • Share a common set of ethical or religious beliefs, and
    • Share medical expenses in accordance with those beliefs, even after a member develops a medical condition.

    The health care sharing ministry must have been in existence and sharing medical expenses continuously since December 31, 1999.

    Federally Recognized Tribe C-3
  • Any Indian or Alaska Native tribe, Alaska Native Claims Settlement Act (ANCSA) Corporation (regional or village), band, nation, pueblo, village, rancheria, or community that the United States Department of the Interior acknowledges to exist as an Indian tribe.
  • People Eligible for Indian Health Services C-4

    You qualify for this exemption if you're:

    • A member of a federally recognized Indian tribe;
    • An Alaska Native Claims Settlement Act (ANCSA) Corporation Shareholder (regional or village);
    • Otherwise eligible for services from an Indian health care provider or through the Indian Health Service.

    You qualify for the exemption for any month you had any of these statuses for at least 1 day, or for the full year if you had the status all year.

    You can claim this exemption for yourself or any dependent(s) you claim on your tax return who qualify.

    Incarcerated
    Coverage Exemption Type Exemption Code
    Incarcerated D-1
  • For these purposes, incarcerated means serving a term in prison or jail.
  • Incarceration doesn’t include being on probation, parole, or home confinement.
  • You’re not considered incarcerated if you’re being held but not convicted of a crime.
  • You can claim this exemption for any month you are incarcerated for at least 1 day.
  • U.S. Citizen Living Abroad and Certain Non-U.S. Citizens
    Coverage Exemption Type Exemption Code
    U.S. Citizen Abroad/Non-U.S. Citizen E-1

    You’re a U.S. citizen who either:

    • Spent at least 330 full days outside of the U.S. during a 12-month period, or
    • Was a bona fide resident of a foreign country (or countries) for a full tax year.

    You’re a resident alien who both:

    • Was a citizen or national of a foreign country with which the U.S. has an income tax treaty with a nondiscrimination clause including (1) a dual-state alien in the first year of U.S. residence or (2) a nonresident alien or dual-status who elects to file a joint return with a U.S. spouse, and
    • Was a bona fide resident of a foreign country for the tax year.

    You’re not lawfully present in the U.S. This includes "Dreamers."

    If one of these applies to you, you don’t have to pay the fee for the months you didn’t have health coverage.

    Hardships
    Coverage Exemption Type Exemption Code
    Child Medically Supported by Another Party F-1

    You need to retain for your records copies of these documents:

    • A court order that covers the months you want to claim this exemption, and
    • A denial notice that shows the child was denied coverage through either Medicaid or the Children’s Health Insurance Program (CHIP) in the tax year.

    This exemption applies only to the child, not you. You and other members of your household who don’t have coverage but don’t qualify for this exemption must qualify for a different exemption or pay the Shared Responsibility Payment.

    Homeless F-2
  • You don’t have to retain documentation to get this exemption.
  • A homelessness exemption could apply to you and everyone on your tax return.

    Evicted or Facing Eviction/Foreclosure F-3
  • The eviction or foreclosure must have occurred in the last 3 years.
  • You’ll need to retain for your records an eviction or foreclosure notice when you apply for this exemption.
  • An eviction or foreclosure hardship could apply to you and the dependent(s) you claim on your tax return.

    Utility Shut-Off F-4
  • The utility shut-off must have occurred in the last 3 years.
  • You’ll need to retain for your records a copy of a notice from an electric, gas, or water utility company that says a service was or will be shut off.
  • Domestic Violence F-5

    To qualify for this exemption:

    • You must have experienced domestic violence.
    • You don’t need to provide any documentation to claim this exemption.

    A domestic violence hardship could apply to you and the dependent(s) you claim on your tax return.

    Death of Close Family Member F-6

    To qualify for this exemption:

    • The death of the close family member must have occurred in the last 3 years.
    • You must retain for your records one of these forms of documentation:
      • Death certificate
      • Death notice from a newspaper
      • Funeral service program
      • Document showing funeral expenses
      • Coroner’s report
      • Military notification of death
      • Other official notice of death

    A death of a close family member hardship could apply to you and the dependent(s) you claim on your tax return.

    Fire, Flood, or Other Disaster F-7

    To qualify for this exemption:

    • You must have experienced the disaster within the last 3 years.
    • You need to retain for your records copies of a police record, fire record, insurance claim, or other document from a government agency, private entity, or news source about the event.

    An exemption due to a disaster could apply to you and the dependent(s) you claim on your tax return.

    Filed for Bankruptcy F-8

    To qualify for this exemption:

    • You must have filed for bankruptcy in the last 3 years.
    • You must retain for your records copies of official bankruptcy filing documents from a court of law.

    A bankruptcy hardship could apply to you and the dependent(s) you claim on your tax return.

    Unpaid Medical Expenses F-9
  • You need to retain copies of medical expenses you were unable to pay.
  • Increased Expenses Caring for a Family Member F-10

    To qualify for this exemption:

    • You must have experienced an increase in expenses for caring for a family member in the last 3 years.
    • You need to retain for your records copies of bills or receipts for services related to care. You can send copies of medical bills, statements for home care services, or transportation receipts.

    This hardship could apply to you and the dependent(s) you claim on your tax return.

    Uncovered Waiting for a Successful Appeal F-11

    To qualify for this exemption:

    • You need to retain for your records a copy of the appeal decision showing that in the months you didn’t have coverage you were eligible for at least one of these:
      • Enrollment in a qualified health plan (QHP) through the Marketplace
      • Advance payments of the premium tax credit to lower costs on your monthly premiums
      • Cost-sharing reductions that lower your out-of-pocket costs
    You Had Another Hardship (Not Listed) F-12

    To qualify for this exemption:

    • You must have experienced a hardship not currently listed.
    • You must provide an explanation of the hardship on your exemption application.

Last Updated: Thursday, 12/06/18