FAQ/Resources

FAQ/Resources

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Why are my dependents not on the form?

This likely means your employer has a Fully-Insured plan, in which case your Medical Carrier should provide a separate 1095-B form for you and your dependents to document their enrollment.

Do I Need the 1095-C Form for my taxes?

You do not need to wait to receive your 1095-C form before filing your taxes. The 1095-C form is provided to assist you in reporting your health coverage and eligibility throughout the year, in order to prove you met the individual mandate or to claim the premium tax credit; 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-C 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-C form to the IRS, it is recommended that you keep the form and any other documentation used to file your taxes for your records.

My cost information on the form Is Not Correct!

Part Two: Line 15

Line 15 Cost Information:

Single Only Contribution or Single Only Premium

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.

1095-C FAQ

When will I receive these health care tax forms?

Forms Must Be Postmarked By January 31

Employers are required to mail 1095 forms to employees no later than January 31. Keep in mind it may take several additional days for the forms to be delivered.

*NOTE. The IRS may provide an extension to some or all employers for a given year. Check with your HR department if you believe your form is overdue.

Will I get more than one form?

Maybe. 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 coverage or employers during the year, or if different members of your family received coverage from different coverage providers.

*NOTE. If you transferred divisions with the same employer and each division has its own TAX ID, you will receive two forms.

I have received multiple types of 1095 forms. How are the forms different?

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. However, if your coverage was insurance purchased through the Marketplace or was a type of coverage referred to as “self-insured coverage” that was provided by an applicable large employer, you will receive a different form.
  • 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.

My form is incorrect!

If the information on your form appears to be incorrect, please contact your Human Resource Department.

*NOTE. The Employee Required Contribution (Line 15) on your 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.

Line 14

Line 14 addresses:

1. Whether an individual was offered coverage.
2. What type of coverage was offered.
3. Which months that coverage was offered.

1A: Qualifying Offer

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.

Line 16

Line 16 of Form 1095-C Documents:

Whether the individual was employed and, if so, whether he or she was full time or part time.
Whether the employee was enrolled in coverage.
Whether the employer is eligible for transition relief as a contributor to a union health plan.
Whether coverage was affordable and, if so, based on which IRS safe harbor.

2A: Not Employed

You were not employed during the reported month.

*NOTE. This information only pertains to the reporting employer. If you were employed somewhere else during this month, you should receive a separate 1095 form from that employer.

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 offered benefits but opted not to enroll.

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

Examples

1095-C Line 14, 15 and 16

All examples assume your company’s health benefits meet minimum value, are not part of a qualifying offer outlined in 1A above, and are offered unconditionally to both spouses and dependent children.

Hired Mid-Year as a full-time employee

If you were hired mid-year, you may have been required to go through a waiting period before becoming eligible for health benefits. In this case, your 1095-C form will show:

  1. During the period of time you were not employed at the reporting company, the value in line 14 will be 1H (no offer of coverage), line 15 will be blank, and line 16 will be 2A (not employed).
  2. Once you are hired, line 16 will be changed to indicate you were in a waiting period (2D).
  3. When you become eligible for insurance, line 14 will change to indicate that an offer was given, line 15 will reflect the price of the lowest-cost single-only coverage option offered to you, and line 16 will indicate whether you accepted the insurance.

Mid-Year Termination

If you ceased employment with the company (voluntarily or not) during the year, your form will differ depending on whether the company offered a self-insured plan or a fully insured plan.

Fully-Insured Plan
Under a fully-insured plan, your employer will only report coverage offered while you were still employed. In this case, your 1095-C form will show your specific insurance status up to your term month, and then change to a 1H/2A (No Offer of Coverage/Not-Employed) status for the remainder of the year.
If you received COBRA coverage after that time, that coverage information will be reported on a separate form, which you should receive from your insurance provider.

Self-Insured Plan
Under a self-insured health plan, your employer is required to report whether you received COBRA coverage after your employment ended. Just like Fully-insured plans, your 1095-C form will also show your specific insurance status up to your term month, and then change to a 1H/2A(No Offer of Coverage/Not-Employed) status for the remainder of the year.

If you received COBRA coverage after that time, you will see the boxes checked in the lower section for each month in which you or your dependents were covered under the self-funded plan for at least one day of that month.

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.