Schedule HCI: Health Care Information Schedule (2025)
Virginia · Virginia Tax · Used for tax years 2025
Virginia Schedule HCI is a Health Care Information Schedule enclosed with your individual tax return. It records your choice of state agencies to receive certain tax return information, your preferred contact method, and information about your dependents.
Who files this form
Schedule HCI is optional. Use it if you gave consent 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. Complete the required information for yourself, your spouse if married filing jointly, and your dependents.
What you'll need
Have the following information ready:
- Your name or names as shown on your Virginia return and your Social Security number.
- Your preferred contact information: email address, spouse’s email address, daytime phone number, or mailing address.
- A mailing address if you choose mail and it differs from the address on page one of your Virginia income tax return.
- Each dependent’s first name, last name, and birth date. The schedule has space for 10 dependents.
How to file
- Enter your name or names as shown on your Virginia return and your Social Security number.
- If you provided consent on your tax return and want to be contacted, select which listed agencies should receive your information.
- Fill in the appropriate oval for your preferred contact method and provide your contact information.
- Complete the required information for yourself, your spouse if married filing jointly, and your dependents.
- Enclose Schedule HCI with your individual return.
Common mistakes
- Do not leave out required information for your spouse if married filing jointly or for your dependents.
- Fill in the oval for your preferred contact method and provide the corresponding contact information.
- If you choose mail, provide an address when it differs from the one on page one of your Virginia income tax return.
- Remember to 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 consent on their individual tax return to sharing 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?
Choose your preferred contact method by filling in the appropriate oval and providing your information. The form lists email, spouse’s email, phone, and mail.
What information do I provide for my dependents?
Enter each dependent’s first name, last name, and birth date. There are spaces for 10 dependents.