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Massachusetts Health Insurance Responsibility Disclosure Form (HIRD)

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Massachusetts Health Insurance Responsibility Disclosure Form (HIRD)


Product Specifications:

  • This form is 8.5" x 11"
  • 25 Sheets/Package


Availability: In stock


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Questions? Call a compliance specialist at 800-745-9970

According to the Massachusetts Health Care Reform law, employers in Massachusetts should provide their employees with affordable health care plan options, whether those options are through private insurance plans or Section 125 cafeteria plans. The intention of the law is to reduce the number of uninsured Massachusetts residents by ensuring that they have information about and access to affordable health insurance plans.  

As of July 1, 2007, employers in the state are required to provide their employees with information about those affordable health insurance plans in which they may choose to enroll. The Massachusetts Health Care Reform law enacts Section 125 and the Health Insurance Responsibility Disclosure.

Health Insurance Responsibility Disclosure Forms

This pack of 25 Health Insurance Responsibility Disclosure forms adheres to all Massachusetts reporting regulations and is compliant with all applicable laws. Employers should make these forms available to their employees in the event that the employee declines employer-sponsored health care plans or Section 125 plans. Employers should ensure that employees complete these forms in a timely manner after declining coverage. Employers are also required to keep these completed forms for three years.

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