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]

 July 1, 2024 – June 30, 2025 Benefit Plan Year

• Benefit Offering to Full-Time Employees
  • Summary of Benefits and Coverage – Base Plan 5157
  • Summary of Benefits and Coverage – BUY UP Plan 5119
• Benefit Offering to Priests
  • Summary of Benefits and Coverage – Priest Plan 5001
• Benefit Offering to Part-Time Employees

July 1, 2025 - June 30, 2026 Benefit Plan Year

• Summary of Benefits and Coverage – PPO Priest Plan 5001
• Summary of Benefits and Coverage – PPO Base Plan 5157
• Summary of Benefits and Coverage – EPO Base Plan 5140
• Summary of Benefits and Coverage – EPO Buy Up Plan 5137

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

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

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
• Member Services

Teladoc – 1.800-Teladoc (835-2362) – July 1, 2025 – June 30, 2026

• Teladoc Flyer – PPO Priest 5001
• Teladoc Flyer – PPO Base 5157
• Teladoc Flyer – EPO Base 5140
• Teladoc Flyer – EPO Buy Up 5137

Prescription Drug Plan: Reta Trust 

CVS (Caremark) – 1-800-844-0719 – July 1, 2025 – June 30, 2026

• CVS Benefits Plan Summary PPO Priest 5001
• CVS Benefits Plan Summary PPO Base 5157
• CVS Benefits Plan Summary EPO Base 5140
• CVS Benefits Plan Summary EPO Buy Up 5137
• 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

• Benefits Summary
• Find an Eye Doctor

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
• Accident Claim Form
• 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

Federal and State of Mississippi labor and employment laws require entities affiliated with the Diocese of Jackson to notify their employees of their employment rights by displaying certain labor and employment law posters in their workplaces. Free electronic versions of the required posters are available in both English and Spanish (if available) by clicking on the links below. The posters must be displayed in a conspicuous location where they are visible to all employees - such as a break room, kitchen or any other area that is frequently visited by all employees.

Federal Department of Labor (DOL) - Required Posters
The Fair Labor Standards Act (FLSA) / Minimum Wage:

• "Employee Rights Under the Fair Labor Standards Act" Poster - Revised 4/2023
• "Employee Rights Under the Fair Labor Standards Act" Poster (Spanish version) - Revised 4/2023

The Occupational Safety and Health (OSH) Act:

• "Job Safety and Health: It's the Law" Poster - Revised 4/2019
• "Job Safety and Health: It's the Law" Poster (Spanish Version) - Revised 4/2019

The Family and Medical Leave Act (FMLA):

• "Employee Rights and Responsibilities Under the Family and Medical Leave Act" Poster - Revised 4/2023
• "Employee Rights and Responsibilities Under the Family and Medical Leave Act" Poster (Spanish Version) - Revised 4/2023

The Employee Polygraph Protection Act (EPPA):

• "Employee Rights: Employee Polygraph Protection Act" Poster - Revised 2/2022
• "Employee Rights: Employee Polygraph Protection Act" Poster (Spanish Version) - Revised 2/2022

The Uniformed Services Employment and Reemployment Rights Act (USERRA):

• "Your Rights Under USERRA" Poster - Revised 4/2017

Federal Equal Employment Opportunity Commission (EEOC) - Required Posters
Title VII of the Civil Rights Act/The Americans with Disabilities Act (ADA):

• "Know Your Rights: Workplace Discrimination is Illegal" Poster - Revised 6/27/2023
• "Know Your Rights: Workplace Discrimination is Illegal" Poster (Spanish Version) - Revised 6/27/2023

Mississippi Department of Employment Security (MDES) - Required Posters
State of Mississippi Unemployment Insurance:

• "Unemployment Insurance for Employees" Poster - Revised 3/31/2020
• "Unemployment Insurance for Employees" Poster (Spanish Version) - Revised 3/31/2020

State of Mississippi Workers' Compensation Commission (Section IV Completed by Diocesan Entity):

• Mississippi Workers' Compensation: "Notice of Coverage" Poster - Revised 2001
• Mississippi Workers' Compensation: "Notice of Coverage" Poster (Spanish Version) - Revised 2001

State of Mississippi Senate Bill 2576:

• "Notice Concerning Changes to the Workers' Compensation Law, Effective July 1, 2012" - Revised 6/14/2012

Nationwide 401K

• 401K Summary Plan Description

Other Forms

• Nationwide Retirement Plans Form

• CDJ Form
• COBRA Continuation Coverage Rates – Effective July 1, 2023

 

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 work weeks 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