Schedule HCI: Health Care Information Schedule (2024)
Virginia · Virginia Tax · Used for tax years 2024
The 2024 Virginia Schedule HCI is a Health Care Information Schedule for individual tax filers who consent to sharing certain tax return information with state agencies. It records your agency selections, preferred contact information, and dependent information for determining el
Who files this form
Schedule HCI is optional. Use it if you consented on your Virginia individual income tax return to share certain tax return information and would like to be contacted about health coverage or medical assistance eligibility.
Choose which listed agencies should receive your information, and complete the required information for yourself, your spouse if married filing jointly, and your dependents.
What you'll need
Have your Virginia individual income tax return and the following information available:
- Your Social Security number and name or names as shown on your Virginia return.
- Your preferred contact information: email address, daytime phone number, or mailing address. The form also has a field for your spouse’s email address.
- A mailing address if it differs from the address on page one of your Virginia income tax return.
- Each dependent’s first name, last name, and birth date.
How to file
- Enter your Social Security number and name or names as shown on your Virginia return.
- If you provided consent on your tax return and want to be contacted, select the listed agencies you want to receive your information.
- Fill in the oval for your preferred contact method and provide the requested contact details.
- Complete the required information for yourself, your spouse if married filing jointly, and your dependents.
- Enclose Schedule HCI with your individual return.
The schedule does not provide a filing address or e-file instructions.
Common mistakes
Follow these reminders printed on the schedule:
- Complete the required information for yourself, your spouse if married filing jointly, and your dependents.
- Fill in the appropriate oval for your preferred contact method and provide your contact information.
- Provide a mailing address below the contact choices if it differs from the address on page one of your Virginia income tax return.
- Enclose the schedule with your individual return.
Questions people ask
Is sharing my tax return information optional?
Yes. The form says taxpayers have the option to agree on their individual tax return to share certain tax return information for themselves and/or their dependents.
Which agencies can receive my information?
You can select the Department of Medical Assistance Services (DMAS) and the Department of Social Services (VDSS) to determine eligibility for medical assistance services. You can also select the Virginia Health Benefit Exchange (VHBE) to determine eligibility for health coverage through Virginia’s Insurance Marketplace.
How can I ask to be contacted?
The form offers email, phone, and mail contact choices. Fill in the appropriate oval and provide your contact information. It also includes a field for your spouse’s email address.
What information does the form request for dependents?
It requests each dependent’s first name, last name, and birth date, with spaces for up to 10 dependents.