Form REV-1882 gives uninsured Pennsylvanians an opportunity to receive information about health insurance coverage through Pennie®, Pennsylvania's official health insurance marketplace.
State > Miscellaneous Forms > Form REV-1882 Health Insurance Coverage Information Request
What Is the Purpose of Form REV-1882?
The purpose of Form REV-1882 is to help connect uninsured Pennsylvania residents with available health insurance coverage options through Pennie.
By completing this form, you authorize the Pennsylvania Department of Revenue to share certain information from your Pennsylvania tax return with Pennie so they can provide information about available health insurance plans and potential financial assistance.
For more information, please see our article here.
Who Should Complete Form REV-1882?
You may wish to complete Form REV-1882 if:
- You do not currently have health insurance coverage.
- Your spouse does not have health insurance coverage, if filing a joint return.
- One or more dependents in your household do not have health insurance coverage.
If everyone in your household has health insurance coverage, this form is generally not necessary.
What Information Is Shared?
When you complete Form REV-1882, you authorize the Pennsylvania Department of Revenue to share certain information from your state tax return with Pennie.
Information that may be shared includes:
- Household size.
- Household income.
- Contact information needed for outreach regarding health insurance options.
This information is used to determine whether you may qualify for financial assistance and to provide information about available health coverage options.
What Happens After I Complete Form REV-1882?
After Form REV-1882 is completed:
- Information from your Pennsylvania return may be shared with Pennie.
- Pennie may send information by mail regarding available health insurance plans.
- You may receive personalized information about financial assistance that could help lower healthcare costs.
- You may receive instructions on how to enroll in a qualified health insurance plan.
Completing the form does not automatically enroll you in health insurance coverage.
Does Completing Form REV-1882 Enroll Me in Health Insurance?
No.
Completing Form REV-1882 only authorizes the sharing of information with Pennie and allows Pennie to provide information about available health insurance options and potential savings.
If you wish to obtain coverage, you must complete the enrollment process through Pennie.
How Does Form REV-1882 Affect My Tax Return?
Form REV-1882 does not:
- Change your Pennsylvania tax liability.
- Increase or decrease your refund.
- Create a tax credit or deduction.
The form is used solely to provide information regarding potential health insurance coverage options.
Important Information
- Completing Form REV-1882 is voluntary.
- The form is intended to help uninsured Pennsylvanians learn about available health insurance coverage.
- Information from your Pennsylvania tax return may be shared with Pennie if authorization is provided.
- Completing the form does not automatically enroll you or members of your household in a health insurance plan.
- You may receive information about financial assistance that could reduce healthcare costs.
Additional Information
If you or members of your household are uninsured, Form REV-1882 provides an easy way to receive information about health insurance options and potential savings available through Pennie.