The Form 1095-C confirms that the Catholic Diocese of Jackson offered full-time employees healthcare coverage during the previous year, and if so, whether you had coverage under your employer’s plan.

What Employees Need to Know About the Form 1095-C

Why am I receiving this form?

You will receive Form 1095-C as part of the requirements under the Affordable Care Act (ACA).

The ACA created two new mandates:

1. The individual mandate that requires all individuals to have healthcare coverage.
2. The employer mandate that requires applicable employers to offer coverage to all full-time employees.

The purpose of Form 1095-C is to verify the months in which you and your dependents were offered or covered by your employer’s healthcare plan, which satisfies the individual coverage requirement.

What is the form for?

Form 1095-C is an official document that employers are required to submit to the IRS each year. You also receive a copy.

When should I expect to receive the form?

You should receive your previous year’s 1095-C the beginning of February (around the same time that your annual W-2 arrives).

What do I do with the form?

Like your W-2, your 1095-C contains information that will be collected when you file your tax return. Be sure to store the form in a safe place where you can locate it when you are ready to do your taxes.

What do I do if I do not receive the form?

If you have not received your 1095-C by the end of February, contact the Benefits Office to request a copy. If you recently moved and did not update your address with HR in time, it might have been sent to your previous address. Keeping your contact information up-to-date will help prevent delivery issues.

Questions?

Contact [email protected]

New Plan Year July 1, 2022 – June 30, 2023

• CDJ-FT-Offering-07012022
  • Summary of Benefits and Coverage – Base Plan 5157
  • Summary of Benefits and Coverage – BUY UP Plan 5119
• CDJ-Priest-Offering-07012022
  • Summary of Benefits and Coverage – Priest Plan 5001
• CDJ-PT-Offering-07012022

Reta Trust (RetaEnroll) https://retatrust.org/public

• DEDUCTIBLES AND OUT-OF-POCKET ARE BASED ON CALENDAR YEAR

Plan Year July 1, 2021 – June 30, 2022

Health Insurance Plans: Reta Trust (Blue Shield) 1-888-772-1076

To file a claim or replace card, please call customer service or login to their website: www.blueshieldca.com

Resources

• ID Cards
• Wellvolution
• Engagement Point
• Member Services

Teladoc – 1.800-Teladoc (835-2362) – July 1, 2021 – June 30, 2022

• Teladoc Flyer – Base Plan 5157
• Teladoc Flyer – BUY UP Plan 5119
• Teladoc Flyer – Priest Plan 5001

Prescription Drug Plan: Reta Trust 

CVS (Caremark) – 1-800-844-0719 – July 1, 2021 – June 30, 2022

• CVS Benefits Plan Summary Plan 5157
• CVS Benefits Plan Summary 5119
• CVS Benefits Plan Summary 5001
• CVS Mobile App Flyer
• CVS Rx Delivery by Mail Flyer

Dental Insurance Plans: Reta Trust (Delta Dental) 1-800-765-6003

To file a claim or replace card, please call customer service or login to their website: https://www.deltadental.com/

• Plan Benefit Highlights
• Plan Summary
• ID Card
• Find a Network Dentist

Vision Insurance Plans: Reta Trust (VSP) 1-800-877-7195

• Benefit Summary
• Laser Vision Care Flyer
• TruHearing Flyer

Non-Reta Plans

FSA Medical and Dependent Care Plans:

Prudential Insurance (Life Claim 1-800-524-0542) (Disability Claim 1-800-842-1718)

• Summary of Benefits – FT Basic Term Life and ADD
• Summary of Benefits – Priest Term Life and ADD
• Summary of Benefits – Optional Term Life, Short Term, and Long Term Disability
• Summary of Benefits – Accident Insurance
• STD Disability Brochure
• LTD Disability Brochure

Allstate Cancer (Claims 1-800-348-4489)

• Allstate Wellness Claim Form
• Allstate Cancer Brochure
• MyBenefits – Assistance 24 Hours a Day
• MyBenefits – Claim Filing Flyer

Some of the statutes and regulations enforced by the U.S. Department of Labor require that notices be provided to employees and/or posted in the workplace. Free electronic copies of the required posters and some of the posters are available by clicking the links below.

Visit the websites for the U.S. Department of Labor and the Mississippi Department of Employment Security for posters available in languages other than English, and for other posters that may not be listed below:

• Equal Opportunity Employer (EEO)
• Employee Polygraph Protection Act (EPPA)
• Employee Rights with Disabilities
• E-Verify_Participation
• Fair Labor Standards Act (FLSA)
• Family Medical Leave Act (FMLA)
• Right To Work (IER)
• Occupational Safety and Health Administration (OSHA)
• Uniformed Services Employment and Reemployment Rights Act (USERRA)
• Notice of Coverage – English
• Notice of Coverage – Spanish
• Families First Coronavirus Response Act

Nationwide 401K

• 401K Summary Plan Description (10-29-2019 update)

Other Forms

• Nationwide Retirement Plans Form

• CDJ Form
• COBRA Rates 2021

We have a NEW email address to send information and forms to the Payroll and Benefits Offices:

[email protected]

The Family and Medical Leave Act (FMLA) provides eligible employees up to 12 workweeks of unpaid leave a year, and requires group health benefits to be maintained during the leave as if employees continued to work instead of taking leave. Employees are also entitled to return to their same or an equivalent job at the end of their FMLA leave.

For additional information regarding FMLA, visit the United States Department of Labor website.

Click this link to download FMLA forms.

• FMLA Certification – Flowchart
• HIPAA Privacy Rule and Security Standards
• Employee Guide to FMLA
• Employer Guide to FMLA

• Catholic Diocese of Jackson Chancery Personnel Policy 
• Catholic Diocese of Jackson – Schools Personnel Policy
• Catholic Diocese of Jackson – Code of Ethics Policy