Form 1095-C

What is Form 1095-C: Employer-provided Health Insurance Offer and Coverage?

ACA Form 1095-C is a tax form under the Affordable Care Act (ACA) in the United States, specifically for employers. This form is used by large employers, generally those with 50 or more full-time employees, to report information about the health care coverage they offer to their employees. The information provided in Form 1095-C is used by the Internal Revenue Service (IRS) to determine whether the employer owes a payment under the employer shared responsibility provisions. Additionally, it aids in determining the employees' eligibility for the premium tax credit. Employees receive a copy of Form 1095-C, which may be used in conjunction with their personal tax return, to confirm they had the minimum essential coverage during the year.

What type of information is reported on ACA Form 1095-C?

ACA Form 1095-C is used to report specific information about the health care coverage offered by large employers (those with 50 or more full-time employees) to their employees. Here's what is typically reported on the form:

1. Employer Information: This includes the name, address, and Employer Identification Number (EIN) of the employer.
2. Employee Information: This part includes details about the employee, such as name, Social Security Number (SSN), and address.
3. Offer of Coverage: This section describes the type of health coverage offered to the employee, the employee's share of the lowest-cost monthly premium, and the number of months coverage was available.
4. Covered Individuals: If the employee enrolled in the employer's health coverage, this part provides information about the covered individuals, including dependents, and the months they were covered.
5. Safe Harbor and Other Relief Codes: These codes may be used to indicate specific situations that affect the employer's responsibility under the ACA.
6. Full-Time Employee Status: This part reports whether the employee was considered full-time for each month of the year.
7. Minimum Essential Coverage: The form also indicates whether the offered coverage meets the minimum essential coverage standards set by the ACA.

Form 1095-C is essential in determining whether the employer meets its obligations under the ACA's employer mandate, and for employees, it helps in understanding the coverage offered and their eligibility for certain tax provisions.

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What is the difference between 1095-B and 1095-C?

Forms 1095-C and 1095-B are both related to the Affordable Care Act (ACA) in the United States, but they serve different purposes and are used by different entities:

1. Form 1095-C:
   • Used By: Employers with 50 or more full-time employees (large employers).
   • Purpose: To report information about the health coverage offered to employees and their dependents.
   • Contents: Includes information about the offer of health coverage, the employee's share of the lowest-cost monthly premium, the number of months coverage was available, and other details related to the employer's responsibility under the ACA.
2. Form 1095-B:
   • Used By: Insurance providers, including small employers that provide self-insured health coverage.
   • Purpose: To report information about individuals who are covered by minimum essential coverage, including those covered by self-insured employer-sponsored coverage, government-sponsored programs, and other applicable health plans.
   • Contents: Includes details about the policyholder and the covered individuals, including the months they were covered by minimum essential coverage.

In summary, Form 1095-C is primarily concerned with the reporting of information related to the employer's offer of health coverage to its full-time employees, whereas Form 1095-B focuses on the reporting of individuals' health coverage provided by insurers or smaller self-insured employers. Employees may receive either form or both, depending on their situation, and these forms may be used in conjunction with personal tax returns to confirm compliance with the ACA's individual mandate.

When is the deadline to submit Form 1095-C to the IRS?

Employers filing electronically must submit Form 1095-C to the IRS by March 31 of the year following the calendar year to which the form pertains.

If filing by paper, the deadline is generally February 28 of the year following the calendar year to which the form pertains.

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Frequently Asked Questions

What if an employee didn't participate in the employer's health plan?

If an employee didn't participate in the employer's health plan, this situation will still be reflected on Form 1095-C if the employer is subject to the Affordable Care Act's (ACA) employer mandate (typically employers with 50 or more full-time employees).

Here's how the information would typically be reported:

1. Part II, Line 14: The employer would use specific IRS codes to indicate the type of coverage that was offered to the employee, even if the employee declined the offer.
2. Part II, Line 15: This line might still show the employee's share of the lowest-cost monthly premium for self-only minimum essential coverage, even if the employee did not enroll.
3. Part III: If the employee did not participate in the health coverage, this section, which typically reports information about covered individuals and dependents, would likely be left blank.

Form 1095-C provides information both about the coverage that was offered and about the coverage (if any) in which the employee actually enrolled. Even if the employee declined to participate in the employer's health plan, the form still serves to document the offer of coverage, which is important for both the employer's and the employee's compliance with the ACA. It's also used by the IRS to determine the employee's eligibility for premium tax credits if they purchased coverage through the Health Insurance Marketplace.

I received Form 1095-C in the mail. What am I supposed to do with it?

Recipients should keep Form 1095-C for your records, as it provides information about the health coverage offered to you by your employer. It contains important information that may be required when you file your personal income tax return. You don't need to attach the form to your tax return, but you should retain it with your other tax documents in case you need to refer to it in the future or if you are asked for it by the Internal Revenue Service (IRS).

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