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Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

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If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

We protect your documents and personal data by following strict security and privacy standards.
Insurance coverage No federal laws require insurance companies to cover a risk-reducing mastectomy. Some state laws require coverage for a risk-reducing mastectomy, but coverage varies state to state. It's best to check with your insurance company to learn about your plan's coverage.
In 2013, Angelina Jolie disclosed in the New York Times (NYT) that she had undergone risk-reducing bilateral mastectomy (RRBM) after learning that she was a BRCA1 mutation carrier.
What about alternatives? Alternatives to preventive mastectomy include high-risk screening which usually means a woman undergoes a clinical exam by her doctor every six months along with screening mammography and MRI on a prescribed schedule.
Minimum Creditable Coverage (MCC) is the minimum level of benefits that you need to have to be considered insured and avoid tax penalties in Massachusetts.
What is MCC? MCC establishes the lowest health plan benefit threshold an individual must have, in order to meet the requirement for Massachusetts residents to have health insurance.
Minimum Essential Coverage is defined as the type of health insurance coverage that you must have in order to comply with the individual mandate set forth by the Affordable Care Act (ACA) . From January 1, 2014, and onward, individuals must have MEC insurance or they will be subject to a tax penalty.
Required Coverage Required CoverageRequired Minimum Limit Bodily Injury to Others $20,000 per person; $40,000 per accident Personal Injury Protection $8,000 per person, per accident Bodily Injury Caused by an Uninsured Auto $20,000 per person; $40,000 per accident Damage to Someone Else's Property $5,000 per accident
You must complete and enclose this Schedule HC with your return. Full-year residents and certain part-year residents must complete and enclose Schedule HC with return.
Typically, taxpayers are subject to a penalty for each month they didn't carry MCC insurance. Taxpayers who carried MCC insurance for some (but not all) of the year receive a 3-month penalty exemption for the year during which MCC insurance lapsed.
Typically, taxpayers are subject to a penalty for each month they didn't carry MCC insurance. Taxpayers who carried MCC insurance for some (but not all) of the year receive a 3-month penalty exemption for the year during which MCC insurance lapsed.