Online Consent to Receive Form 1095-C for Calendar Year 2021

In accordance with the Affordable Care Act (ACA) provisions, UT Dallas will have the 2021 Form 1095-C available on or before Jan. 31, 2022. The Form 1095-C includes information about the health insurance coverage offered to employees, retirees and their dependents. You will receive the Form 1095-C if you were enrolled in the UT Medical Plan or if you worked an average of 30 or more hours per week or were considered a full-time employee in 2021.  Graduate Student employees who are covered under the UT Student Health Insurance Plan will receive 1095-B directly from Blue Cross Blue Shield.

If you provide online consent, you can access your Form 1095-C online through Galaxy. If you provided consent in the prior years, you do not have to do so again. The deadline to provide online consent is Jan. 17, 2022. If you do not provide the online consent, you will receive the form in the mail on or before the IRS deadline. The forms are expected to be available online on or before Jan. 31, 2022.

If you need to provide online consent, log in to Galaxy with your UT Dallas NetID and password. Then, go to Self Service, select ACA Form 1095-C and follow the on-screen instructions. Written instructions and FAQs are posted on the HR website for your reference.

If you have any questions, email benefits@utdallas.edu or contact the Office of Human Resources – Employee Benefits Team. If you have additional questions about your Form 1095-C, you may also visit the IRS website and the UT System Office of Employee Benefits website.

Thank you,

Office of Human Resources – The Employee Benefits Team