JU-1, 01/16, This form is used to tell MassHealth about a new job or a change in your job., Section A. Current Job Information, 1, Current Job 1, 2, Current Job 2 (If you have more jobs and need more space, attach another sheet of paper.), Section B. Yearly Income Information, 1, What is your total expected income for the current calendar year?, 2, What is your total expected income for next calendar year, if different?, Section C. Health Insurance, 1, Are you and/or members of your family currently enrolled in health insurance from your job?, a, Insurance company name, b, Names of covered family members, c, Policy number, d, Is this COBRA coverage?, e, Is this a retiree health plan?, Section D. Signature, I certify under the pains and penalty of perjury that what is stated on this form is correct and complete to the best of my knowledge., Health Insurance Processing Center, P.O. Box 4405, Taunton, MA, 02780