1095FAQ

1095 GUIDE & FAQ
1095FAQ

Below is a list of the most frequently asked questions on the 1095 form. Click the question to take you to the information that is related to your inquiry. If you don’t see the information you need, please complete the form for a representative to contact you.

Q. What is this form?

The 1095 form is required by the IRS to provide documentation that an individual may have been offered medical coverage by their Employer. Your employer contracted with ACA Track to distribute these forms. The employer is required to distribute the forms annually to all individuals that were eligible for health care coverage as an employee.

Q. What is the difference between a 1095 A, B and C?

 Each type of 1095 form is provided by a different entity:

  • Form 1095-A, Health Insurance Marketplace Statement, is provided by the Marketplace to individuals who enrolled or who have enrolled a family member in health coverage through the Marketplace.
  • Form 1095-B, Health Coverage, is provided by insurance companies and other coverage providers (such as union groups).
  • Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, is issued by applicable large employers to their full-time employees and, in some cases, to other employees or to individuals who were not employees or dependents of employees but were covered by a self-insured plan that was provided by an applicable large employer.

Q. What if I was expecting a form but haven’t yet received it?

An employer is required to mail the1095 forms to employees no later than March 2nd of each year. Keep in mind it may take several additional days for the forms to be delivered. If it is after March 2nd and you haven’t yet received your form, please reach out to your employer.

Q. Why did I receive multiple forms?

You are likely to get more than one form if you worked for more than one employer that offered coverage. You are also likely to get more than one form if you changed employers during the year, or if different members of your family received coverage from different coverage providers. Additionally, if you remained with the same employer, but transferred divisions (different tax ID’s) with the same employer and each division has its own TAX ID, you will receive two forms.

Q. Do I need the 1095 form for my taxes?

You do not need to wait to receive your 1095 form before filing your taxes. The 1095 form is provided to assist you in reporting your health coverage and eligibility throughout the year, however, you do not need to submit the form to the IRS.

 

If you are trying to verify your coverage or eligibility information and have not yet received your 1095 form, you can use any number of other documents, including:

  • Your insurance card
  • Explanation of Benefits statement
  • A written statement from your insurance provider
  • W-2 or payroll statements
  • Receipts for any advance payments of your premium tax credit, or
  • Any other document that provides evidence of coverage and/or eligibility for you or a family member.

While you do not need to provide your 1095 form to the IRS, it is recommended that you keep the form and any other documentation used to file your taxes for your records.

Q. What should I do if I believe my form is incorrect?

The information may not be incorrect, since the information may not be the exact plan that you enrolled in, but rather the lowest cost plan you were eligible to receive. If you do believe that the form is incorrect, please reach out to your employer to determine if a correction is needed.

Q. Why aren’t my dependents listed on the form?

Dependents will only be reflected in the “Covered Individuals” section of the form if the covered individuals were insured for a portion of the year AND the employee was enrolled on a self or level funded plan. If your plan is fully funded, you should be receiving a 1095B from your medical carrier that shows your enrolled dependents.

Q. What should show on line 14?

Line 14 will show whether an individual was offered coverage, what type of coverage was offered and which months the coverage was offered. The codes you might see include:

1A

Qualifying Offer

You were made an offer for health insurance in the given month, which was considered a Qualifying Offer. A Qualifying Offer means the health insurance plan provided minimum essential coverage and minimum value coverage for the employee, and the lowest-cost self-only plan cost less than the IRS-mandated percentage of the federal poverty line.

 

A Qualifying Offer must also include an offer of minimum essential coverage to your spouse and dependents.

*NOTE. This does not indicate what coverage you enrolled in, but what coverage was offered to you.

 

1B

Employee Only Offered

You were made an offer for minimum essential coverage and minimum value coverage, at an affordable rate. Health insurance coverage was not offered for your spouse or dependents.

*NOTE. This does not indicate what coverage you enrolled in, but what coverage was offered to you.

 

1C

No Spouse Coverage Offered

You were made an offer for minimum essential coverage and minimum value coverage, at an affordable rate. Minimum Essential Coverage was also offered for your dependents, but not for your spouse.

*NOTE. This does not indicate what coverage you enrolled in, but what coverage was offered to you.

 

1D

No Dependent Coverage Offered

You were made an offer for minimum essential coverage and minimum value coverage, at an affordable rate. Minimum Essential Coverage was also offered for your spouse, but not for dependents.

*NOTE. This does not indicate what coverage you enrolled in, but what coverage was offered to you.

 

1E

Spouse or Dependent Coverage Offered

You were made an offer for minimum essential coverage and minimum value coverage, at an affordable rate. Minimum Essential Coverage was also offered for your spouse and dependents.

1F

Plan Does Not Cover 60% Of Estimated Claims

You were offered Minimum Essential Coverage, but that offer did not provide Minimum Value to you, your spouse, and/or dependents.

1G

Common Code For Retirees

You were offered insurance coverage through a self-funded plan, but were not a full-time employee for any month of the calendar year. This code is commonly used for retirees.

1H

No Offer of Coverage

You were not offered health insurance coverage, or the offer did not include Minimum Essential Coverage.

1J

Conditional Spouse Coverage

Your company offered conditional spousal coverage. This code is used when Minimum Essential Coverage was conditionally offered for a spouse, but Minimum Essential Coverage was not offered to your dependents.

1K

Conditional Spouse Coverage

Your company offered conditional spousal coverage. This code is used when Minimum Essential Coverage was conditionally offered for a spouse and Minimum Essential Coverage was offered for dependents.

Q. What should show on line 15?

The cost listed on Line 15 of your 1095-C form does not represent the cost of the specific medical plan you enrolled in, but the monthly cost for single-only coverage on the lowest-cost plan offered to you by your employer. If you selected a higher-cost plan, or if you have additional family members enrolled in your plan, your actual monthly costs will be higher than what is listed on the form.  Additionally, if you were enrolled in COBRA as a result of a reduction in hours, the Single-Only Premium cost will be noted for the months enrolled in COBRA.

Q. What should show on line 16?

Line 16 should show if the individual was employed and if so, whether he or she was full time or part time. This line also shows if the individual was enrolled in coverage, or waived coverage, if the coverage was offered under a Union health plan and if the coverage was affordable, based on specific IRS safe harbors. Line 16 codes include:

2A

Not Employed

You were not employed by this employer during the reported month.

 

2B

Part-Time

You were employed during the month but not on a full-time basis; therefore, you were not eligible for health insurance benefits through the employer for the entire month or you were not employed for the entire month.

2C

Enrolled

You were employed during the reported month and covered under a health insurance plan offered as a result of that employment.

2D

Waiting Period

You were in a measurement or waiting period, prior to becoming eligible for health insurance coverage. This is sometimes referred to as a limited non-assessment period.

2E

Union Plan

You were covered under a multi-employer plan, such as a Union Sponsored Plan, for which the employer paid a fee based on a collective bargaining agreement.

2F, 2G, 2H

Waived Coverage

You waived coverage for the reported month, and the employer used the following method to determine affordability:

  • 2F: Form W-2 affordability safe harbor
  • 2G: FPL affordability safe harbor
  • 2H: Rate of Pay affordability safe harbor

Q. What if I still have more questions?

Click here to download an Employee Guide to the 1095. If you still need assistance, please complete the form below:
PLEASE NOTE THAT ACA TRACK IS UNABLE TO MAKE CHANGES TO THE FORM WITHOUT APPROVAL FROM EMPLOYER.

Please enable JavaScript in your browser to complete this form.
Name
Email
ACA TRACK is an
Approved Vendor
of the IRS for
electronic submission
ACA TRACK is an
Approved Vendor
of the IRS for
electronic submission

ACA Track's proprietary software is designed to help applicable large employers ("ALE") meet the requirements of the Affordable Care Act and IRS reporting. ACA TRACK is dedicated solely to employer reporting requirements. This focus has made us an industry leader in IRS reporting as well as State Individual Health Mandate reporting.