As part of the final preparation for submitting and mailing your 1095-C forms to employees, you should carefully review the information on each employee’s form, to ensure all of the information is accurate and no necessary information has been omitted.
During the Tax Preparation process, you will have the opportunity to download the 1095-C forms for each division.
Note: Once you approve a 1095-C batch and send it for printing, that action cannot be undone. Therefore, it is very important that you carefully review each form beforehand.
Company Information
The left side of each 1095-C form contains identifying and contact information for your company and the employee. The company information includes the company name, address, phone number, and Employer Identification Number (EIN).
You should review this information to ensure it is accurate. If your company has more than one division (with different EINs), make sure the correct division is listed for the employee.
Employee Information
When checking the employee information, it is particularly important to make sure their address is correct, since this is where the 1095-C forms will be mailed. You should also check for any misspellings or incorrect SSNs.
Line 14 – Offer of Coverage
Line 14 on the 1095-C document is used to report on the coverage made available to the employee for each month of the year, including:
- Whether or not the individual was offered health insurance coverage.
- The type of coverage that was offered to the employee.
- The months in which that coverage was offered.
Line 14 does NOT indicate whether an offer of coverage was accepted. Coverage details are provided in Line 16.
In the above example, the employee had the same coverage available for the entire year, so the response is listed only once, at the top of the column. If the available coverage changed during the year, a separate response would be entered for each month.
Line 14 Codes
A Line 14 response is reported for each month of the year, and may contain one of the following codes:
1A – Qualifying offer
This response indicates that the employee was 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 9.66% of the federal poverty line.
A Qualifying Offer must also include an offer of minimum essential coverage to the employee’s spouse and dependents.
1B – Employee Only Offered
This response indicates that the employee was made an offer for minimum essential coverage and minimum value coverage, at an affordable rate. Health insurance coverage was not offered for their spouse or dependents.
1C – No Spouse Coverage Offered
This response indicates that the employee was made an offer for minimum essential coverage and minimum value coverage, at an affordable rate.
Minimum Essential Coverage was also offered for dependents, but not for a spouse.
1D – No Dependent Coverage Offered
This response indicates that the employee was made an offer for minimum essential coverage and minimum value coverage, at an affordable rate.
Minimum Essential Coverage was also offered for a spouse, but not for dependents.
1E – Spouse or Dependent Coverage Offered
This response indicates that the employee was made an offer for minimum essential coverage and minimum value coverage, at an affordable rate.
Minimum Essential Coverage was also offered for their spouse and dependents.
1F – Plan Does Not Cover 60% of Estimated Claims
This response indicates that the employee was offered Minimum Essential Coverage, but that the offer did not provide Minimum Value to the employee, spouse, and/or dependents.
1G – Insured Non-Full-time Employee
This code indicates that insurance coverage through a self-funded plan was offered to and accepted by an individual that is not a full-time employee. This code is commonly used for retirees.
1H – No Offer of Coverage
This response indicates that no health insurance coverage was offered to the employee, or the offer did not include Minimum Essential Coverage.
1J – Conditional Spouse Coverage - Spouse Coverage Offered, No Dependents Coverage Offered
For plans with conditional spousal coverage. This code is used when Minimum Essential Coverage was offered for a spouse, but not dependents. This code is used in place of 1D.
1K – Conditional Spouse Coverage - Dependents Coverage Offered, No Spouse Coverage Offered
For plans with conditional spousal coverage. This code is used when Minimum Essential Coverage was offered for dependents, but not a spouse. This code is used in place of 1C.
Line 15 – Employee Required Contribution
Line 15 reports the employee’s required contribution for each month. The Employee Required Contribution is the price of the lowest-cost, self-only coverage available under the plan.
This section only need information if line 14 has a response code of 1B, 1C, 1D, 1E, 1J, or 1K. If line 14 has one of those responses for “All 12 Months,” there should be a line 15 entry for all 12 months as well. If line 14 has any months without one of these responses, line 15 should be blank for the corresponding months.
Note: The Employee Required Contribution does not indicate the amount the employee actually paid, since the employee could have chosen a higher-priced plan and/or purchased insurance for their spouse and dependents.
Line 16 - Eligibility
Line 16 on the 1095-C form is used to report on an individual’s eligibility for health insurance coverage and their coverage status for the given month.
Line 16 addresses the following:
- Whether the individual was employed, and whether that employment was full-time or not.
- Whether the employee was enrolled in health insurance coverage.
- Whether the employer was eligible for any form of relief because of contributions to a union health plan or because the employee was in a limited non-assessment period. The most common limited non-assessment period is a new hire waiting period.
- Whether the offered coverage was affordable, and which IRS safe harbor was used to determine affordability.
In the above example, the employee had the same eligibility for the entire year, so the response is listed only once, at the top of the column. If their eligibility changed during the year, a separate response would be entered for each month.
Line 16 Codes
A Line 16 response is reported for each month of the year, and may contain one of the following codes:
2A – Not Employed
This response indicates that the individual was not employed during the reported month.
2B – Employed but Not Full Time for the Entire Month
This response indicates that the individual was employed during the month but not on a full-time basis; therefore, they were not eligible for health insurance benefits through their employer for the entire month.
2C - Enrolled
This response indicates the individual was employed during the reported month and covered under a health insurance plan.
2D – Waiting Period
This response indicates the employee was 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 Sponsored Plan
This response indicates the employee was 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 – Waived Coverage
This response indicates the employee waived coverage for the reported month, and the employer used Form W-2 Safe Harbor to determine affordability.
2G – Waived Coverage
This response indicates the employee waived coverage for the reported month, and the employer used Federal Poverty Line Safe Harbor to determine affordability.
2H – Waived Coverage
This response indicates the employee waived coverage for the reported month, and the employer used Rate of Pay Safe Harbor to determine affordability.
Covered Individuals
For self-insured plans, the covered employee along with any insured dependents or spouses will be listed in the “Covered Individuals” section of the 1095-C.
If the individuals were covered all year, there will be an X in the “Covered all 12 mos.” box. Otherwise, each month they were covered will be marked separately.
You should carefully review this section to ensure dependents are correctly listed with the appropriate employee.
Note: This section only pertains to self-insured health plans. Dependents and spouses will not be listed on a fully-insured plan, as they will receive separate documentation directly from the health insurance provider.
See Also: Sample 1095-C Forms