2019 Form NJ-1040
1
Line 52 – Shared Responsibility Payment
Beginning in 2019, New Jersey residents who are
required to le a return (and all members of their
tax household) must have minimum essential health coverage
for the entire year unless they qualify for an exemption. Part-
year residents must have coverage or qualify for an exemption
for each month of their New Jersey residency. If you or anyone
in your tax household did not have the required coverage and
does not qualify for an exemption, you owe a shared responsi-
bility payment.
If your income on line 29 is $20,000 or less ($10,000 if your
ling status is single or married/CU partner ling separate re-
turn), you do not owe a shared responsibility payment. Do not
complete line 52. Part-year residents, use income for the entire
year, not just the period of New Jersey residency.
Tax Household. This includes you, your spouse (if ling a
joint return), domestic partner claimed on your return, and any
individuals you claim as dependents on your NJ-1040. It also
includes any individuals you can, but do not, claim as depen-
dents on your return.
Minimum Essential Health Coverage. This is the amount
of coverage you need to satisfy the minimum essential health
coverage requirement. It includes, but is not limited to:
Any health plan bought through the Health Insurance
Marketplace
Individual health plans bought outside the Health Insur-
ance Marketplace, if they meet the standards for quali-
ed health plans
Any “grandfathered” individual insurance plan you’ve
had since March 23, 2010, or earlier
Most job-based plans, including retiree plans and
COBRA coverage
Medicare Part A
Most Medicaid coverage, except for limited coverage
plans
The Children’s Health Insurance Program (CHIP)
Coverage under a parent’s plan
Most student health plans (check with your school to see
if the plan counts as qualifying health coverage)
Health coverage for Peace Corps volunteers
Certain types of veterans health coverage through the
Department of Veterans Affairs
Most TRICARE plans
Department of Defense Nonappropriated Fund Health
Benets program
Refugee Medical Assistance
For more information on whether your plan qualies as mini-
mum essential health coverage, see IRS Form 8965.
Exemptions. If at any time during the year (part-year residents
consider only months as a New Jersey resident) you or anyone
in your tax household did not have minimum essential health
coverage, visit nj.gov/treasury/njhealthinsurancemandate/ex-
emptions.shtml to determine if an exemption applies. Exemp-
tions are available for income and healthcare related reasons,
group membership, incarceration, living abroad, and various
hardship reasons. If an exemption applies, complete the NJ
Insurance Mandate Coverage Exemption Application to get an
exemption number. You will need an exemption number for
each person who meets the requirements for an exemption. An
individual may have more than one exemption number if dif-
ferent exemptions applied to different parts of the year. Enter
the exemption number(s) on Schedule NJ-HCC. (See “Com-
pleting Line 52” below.)
Note: If an individual had coverage for any part of a month,
they are considered to be covered for the entire month. No ex-
emption is needed for that month.
Completing Line 52
If your income on line 29 (part-year residents use income for
the entire year) is at or below the ling threshold (see page 3),
you do not owe a shared responsibility payment. Make no en-
try on line 52 and continue with line 53.
Dependent on Another Person’s Return. If someone can
claim you as a dependent on their return, you do not owe
a shared responsibility payment. Complete only Part I of
Schedule NJ-HCC, lling in the “Yes” oval. Fill in the oval
at line 52, NJ-1040, and enclose Schedule NJ-HCC with your
return. If you are ling a joint return but one of you can be
claimed as a dependent on another person’s return, do not in-
clude information for that spouse on schedule NJ-HCC.
Full-Year Coverage. If you and everyone in your tax house-
hold had minimum essential health coverage for the entire year
(part-year residents consider only months as a New Jersey
resident), you do not owe a shared responsibility payment.
Complete only Part I of Schedule NJ-HCC. Fill in the oval at
line 52, NJ-1040, and enclose Schedule NJ-HCC with your
return.
Part-Year Coverage OR No Coverage. If at any time dur-
ing the year (part-year residents consider only months as a
New Jersey resident) you or anyone in your tax household did
not have minimum essential health coverage, you may owe a
shared responsibility payment. Complete Schedule NJ-HCC.
If you had coverage for any part of a month, you are consid-
ered covered for the entire month. When completing Part II,
check the box for every month each individual had minimum
essential coverage (part-year residents include only months
as a New Jersey resident). If an exemption applies for any
member(s) of your tax household (see “Exemptions” on page
37), check the box for each month to which an exemption ap-
plies, and enter the exemption number(s). If any individual
has more than one exemption number, enter only one of the
numbers for that person and check the box. If there are any
2019 Form NJ-1040
2
months without coverage that are not covered by an exemp-
tion (part-year residents consider only months as a New Jersey
resident), use Worksheet L on page 39 or the online calculator
at njtaxation.org to calculate the amount of shared responsibil-
ity payment you owe. Fill in the oval at line 52 and enter the
amount due. If no amount is due, ll in the oval and leave the
line blank. Enclose Schedule NJ-HCC with your return.
Worksheet L
Complete this worksheet to calculate the amount of your shared responsibility payment, or use the online calculator at njtaxation.org.
Do not complete this worksheet if everyone in your tax household had minimum essential health coverage for the entire year.
Part I
You will need to determine your household income for purposes of calculating your shared responsibility payment. This includes your
total income (line 27), your tax-exempt interest (line 16), and the total income and tax-exempt interest of your dependents. Include esti-
mated income for any dependents who do not le a New Jersey tax return. Do not use amounts from your federal return.
Parts II and III
Complete Part II if no one in your tax household had minimum essential coverage or qualied for an exemption for any part of the
year.
Complete Part III if anyone in your tax household had minimum essential coverage or qualied for an exemption for any part of the
year.
For purposes of calculating the shared responsibility payment, an individual who is under age 18 on January 1 is considered to be un-
der 18 for the entire year.
Enter your shared responsibility payment (Part II, line 8 or Part III, line 13) on line 52, NJ-1040, ll in the oval, and enclose Schedule
NJ-HCC with your return.
Part-Year Residents
Make the following adjustments to Schedule L to calculate your shared responsibility payment for the period of your New Jersey
residency:
Part I, Lines 13. Enter income for the entire year, not just for the period of New Jersey residency.
Part I, Line 7. Calculate your income percentage amount as indicated, and prorate the result based on the number of months you were
a New Jersey resident. For this calculation, 15 days or more is considered a month.
Calculation: Part I, line 7 x
Months NJ resident
= Prorated amount for Part I, line 7
12
Part I, Line 8. When answering the question at line 8, consider only the part of the year you were a New Jersey resident, not the entire
year.
Part II, Line 3. Add lines 1 and 2 as indicated, and prorate the total based on the number of months you were a New Jersey resident.
Calculation: Part II, line 3 x
Months NJ resident
= Prorated amount for Part II, line 3
12
Part III, Lines 1a, 2a, and 6. Multiply the number of individuals by the number of months you were a New Jersey resident. Do not
multiply by 12.
2019 Form NJ-1040
3
Worksheet L
Shared Responsibility Payment Calculation
Do not complete if everyone in your tax household had minimum essential health coverage or qualied for an exemption
for the entire year.
Part-year residents see instructions on page 38 before completing this worksheet.
Part I
1. Enter the amount from line 27 (Total Income) of your NJ-1040. Do not use income from your
federal income tax return. ............................................................................................................... 1.
2. Enter the amount from line 16b (Tax-Exempt Interest) of your NJ-1040. ..................................... 2.
3. Enter income of any dependents you claim on your return. Also include any individual(s) you
can, but do not, claim as a dependent(s) on your return.*
Enter amount from Enter amount from
Line 27, NJ-1040 Line 16b, NJ-1040
Dependent name
Dependent name
Dependent name
Dependent name
Dependent name
Total dependent income.
Add the amounts in each column
and enter the total on line 3.
+ = 3.
If more than ve dependents have income, include any additional dependents’ income in the
total on line 3.
*List estimated income, if any, of dependents who will not le a 2019 New Jersey Income Tax
return. Do not include any dependent’s income that is included on your own 2019 NJ-1040.
4. Total household income. Add lines 1 through 3 .............................................................................. 4.
5. Enter the amount listed for your ling status:
$10,000 –
Single
Married/CU partner ling separate return
$20,000 –
Married/CU couple ling joint return
Head of Household
Qualifying widow(er)/surviving CU partner 5.
6. Subtract line 5 from line 4 ............................................................................................................... 6.
7. Income Percentage Amount. Multiply the amount on line 6 by 2.5% (0.025) ............................ 7.
8.
Did you or anyone in your tax household have minimum essential health coverage or qualify for an exemption for part, but not all
of the year?
Yes. Complete Part III on page 40.
No. Complete Part II on page 40.
(Keep for your records)
2019 Form NJ-1040
4
Part II – Complete if no one in your tax household had minimum essential health coverage or qualied
for an exemption for any part of the year.
1. Number of individuals in your tax household
who were 18 or older (see instructions) x $695.00 = .................................. 1.
2. Number of individuals in your tax household
who were under age 18 (see instructions) x $347.50 = ............................... 2.
3. Add line 1 and line 2 ........................................................................................................................ 3.
4. Flat Rate Amount. Enter the lessor of line 3 or $2,085 .................................................................... 4.
5. Income Percentage Amount. Enter the income percentage amount from Part I, line 7 ................... 5.
6. Enter the greater of line 4 or line 5 .................................................................................................. 6.
7. Enter the amount listed for the size of your tax household:
1 person – $3,012 3 people – $9,036 5+ people – $15,060
2 people – $6,024 4 people – $12,048 .................................................................................... 7.
8. Shared Responsibility Payment. Enter the lesser of line 6 or line 7. Also enter on line 52,
NJ-1040 ............................................................................................................................................ 8.
Part III – Complete if any member of your tax household had minimum essential health coverage or
qualied for an exemption during any part, but not all, of the year.
Section A
1a. Number of individuals listed in Part II of Schedule NJ-HCC
who were 18 or older (see instr.) x 12 = .............
b. Number of boxes checked on Schedule NJ-HCC for
individuals included in line 1a .............................................
c. Months without minimum essential health coverage.
Subtract line 1b from line 1a ................................................
d. Multiply line 1c by $57.92 ............................................................................................................... 1d.
2a. Number of individuals listed in Part II of Schedule NJ-HCC
who were under age 18 (see instr.) x 12 = ..........
b. Number of boxes checked on Schedule NJ-HCC for
individuals included in line 2a .............................................
c. Months without minimum essential health coverage.
Subtract line 2b from line 2a ................................................
d. Multiply line 2c by $28.96 ............................................................................................................... 2d.
3. Add lines 1d and 2d ......................................................................................................................... 3.
4. Flat Rate Amount. Enter the lesser of line 3 or $2,085. ................................................................... 4.
Section B
5. Enter the income percentage amount from Part I, line 7 ................................................................. 5.
6. Number of individuals listed in Part II of Schedule NJ-HCC
x 12 = ................................................................... 6.
7. Number of boxes checked in Part II of Schedule NJ-HCC 7.
8. Months without minimum essential health coverage.
Subtract line 7 from line 6 ................................................... 8.
9. Divide line 8 by line 6 (Enter as a percentage) ................................................................................ 9.
%
10. Income Percentage Amount. Multiply the amount on line 5 by the percentage on line 9 ............... 10.
Section C
11. Enter the greater of line 4 or line 10 ................................................................................................ 11.
12. Enter the amount listed for the size of your tax household :
1 person – $3,012 3 people – $9,036 5+ people – $15,060
2 people – $6,024 4 people – $12,048 .................................................................................... 12.
13. Shared Responsibility Payment. Enter the lesser of line 11 or line 12. Also enter on
line 52, NJ-1040 ............................................................................................................................... 13.
(Keep for your records)