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Health Insurance Responsibility Disclosure (HIRD) Form

What is the HIRD form?

The Health Insurance Responsibility Disclosure (HIRD) is a new Massachusetts reporting requirement effective 2018. Information about your employer-sponsored insurance offerings is being collected so that MassHealth can identify the employees that are eligible for MassHealth Premium Assistance Program.

Who's required to complete the HIRD Form?

State Law requires every employer in Massachusetts with 6 or more employees to submit an HIRD form on an annual basis.

How do I submit the HIRD form?

You can complete the HIRD form by logging into your MassTaxConnect account here:

Under Accounts, select the hyperlink Withholding Tax, and click File health insurance responsibility disclosure on the right-hand side.

When do I need to submit my HIRD form?

This form is available starting Thursday, November 1st, 2018 and must be completed by Friday, November 30th, 2018

Additional Information

For more information regarding the HIRD form, please reference the FAQ:



If you have additional questions or concerns that are not answered by the FAQs, you may contact Department of Revenue’s customer service center at (617)466-3940 and choose the option to speak with an HIRD representative.

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