SUBJECT:

At Your Service Electronic Consent for Form 1095-C

UC At Your Service (AYSO) now offers employees who are scheduled to receive Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, the option to receive the form electronically in lieu of a printed paper copy by mail.

By default, eligible employees will receive a printed, paper copy of their 1095-C by mail. If you select electronic delivery, you will be notified at the email address you specify when your 1095-C is available for viewing. You may change your delivery method as many times as you want through December 31, 2016. Any changes that occur through December 31, 2016 will impact the 2016 Form 1095-C delivery method.

To change your delivery method, please complete the following steps (computer recommended):

- Log to At Your Service Online
(https://atyourserviceonline. ucop.edu) or see http://blink.ucsd.edu/HR/ benefits/AYSO/
- Under "Income & Taxes" (top right box), select "W-2 and 1095-C"
- On the left column, select "Select 1095-C Delivery Method (if applicable)"
- Complete the consent form and click "Submit"
- You should see a confirmation screen and receive a confirmation email.

If you cannot complete the online consent, or wish to cancel your electronic delivery, you may send a written request to the Payroll Office (payrollquestions@ucsd.edu).< p> An email address is required to be on file before you may select the electronic delivery method. You can add or change your email using the "My Contact Information" link on the AYSO Main Menu and then using "Personal Email" link on the left menu.

We have provided a couple questions and answers below for your reference.

What is the Employer-Provided Health Insurance Offer and Coverage Form 1095-C? It is a an employer provided health plan coverage form that the IRS uses to verify you have the minimum required coverage under the Affordable Care Act (ACA). This form must be filed with your 2016 tax return for the calendar year ending on December 31, 2016.

Why go Paperless?
- You can easily and conveniently access your forms via AYSO at any time for up to 2 years.
- You get your form on time without any delays.
- You cut the clutter, reduce wasted resources and will not misplace it.

Any questions regarding the 1095-C Form should be directed to (858) 534-2816 for Campus employees and (619) 543-3200 for UCSD Health employees (Health System & Health Sciences). You may also contact the IRS for more information about the 1095-C tax form at https://www.irs.gov.

Pierre Ouillet Vice Chancellor and Chief Financial Officer Cheryl A. Ross Controller/Assistant Vice Chancellor Business & Financial Services Janet Kamerman Assistant Vice Chancellor - Health Human Resources