Form 1095-C plays a crucial role in health insurance reporting for employees and employers under the Affordable Care Act (ACA).
“Form 1095-C started with the Affordable Care Act, requiring employers to send a statement of health coverage to each employee,” says TurboTax.
Whether you’re an employee wondering why you received this form, or an employer trying to stay compliant, understanding the 1095-C is essential.
Here’s a comprehensive guide to what the 1095-C is, who sends and receives it, what information it contains, how it differs from other similar forms, and what to do if you don’t receive one.
Form 1095-C, officially titled “Employer-Provided Health Insurance Offer and Coverage,” is a tax form required by the ACA.
It documents the health insurance coverage that an employer offered to each eligible employee during the previous calendar year.
The form provides both the IRS and employees with details about the type of health coverage offered, the cost of coverage, and the months it was available.
Applicable Large Employers (ALEs) -- businesses with 50 or more full-time employees or full-time equivalents -- are required to file Form 1095-C for each full-time employee.
The form is prepared by the employer or, in some cases, by a third-party administrator or payroll provider.
Every full-time employee who was eligible for health coverage at any point during the year should receive a 1095-C by mid-March, regardless of whether they enrolled in the employer’s health plan.
Part-time employees receive a Form 1095-C only if they participated in a self-insured employer plan.
The form is sent by mail or electronically (if the employee has consented to electronic delivery).
The 1095-C form is divided into three parts, each containing specific information:
Employer’s name, address, Employer Identification Number (EIN), and contact details.
This information helps the IRS verify employer compliance with the ACA and determine if employees are eligible for premium tax credits or subject to penalties.
While both forms relate to health coverage, they serve different purposes and are issued by different entities.
Form 1095-B is sent by insurance companies, small self-insured employers, or government programs (Medicaid, Medicare, CHIP) to individuals who had minimum essential coverage.
Form 1095-C is sent by ALEs to full-time employees, documenting the offer of health coverage (not just actual enrollment).
Employers must send Form 1094-C as a “cover sheet” when submitting 1095-C forms to the IRS.
The 1094-C summarizes the employer’s information, including the number of 1095-C forms filed, total employees, and contact details.
Employees do not receive the 1094-C; they only receive the 1095-C.
Employees should retain Form 1095-C for their records. Employees do not need to attach the 1095-C to their tax return, but they should retain it in case the IRS requests proof of coverage or if there are questions about their health insurance status.
You can file your taxes even if you haven’t received the form, as long as you know your coverage status.
However, the form may be helpful if you purchased Marketplace coverage and received a premium tax credit, as it helps determine eligibility for that credit.
Not every employee will receive the Form 1095-C. You may not receive a 1095-C if:
If you think you should have received a 1095-C but haven’t by mid-March, contact your employer to check its status.
Remember, not all employers are required to provide this for -- only ALEs must do so.
The deadlines for Form 1095-C are as follows:
Employers face substantial IRS penalties for failing to file or furnish Form 1095-C:
The IRS uses payroll and tax return data to identify employers who should have filed these forms. Noncompliance can trigger IRS notices and further penalties.
No, but they should keep it for their records. The form can help resolve any future questions about health coverage.
They will still receive a 1095-C if they were eligible for coverage.
Dependents do not receive their own 1095-C; the primary insured employee receives the form, which may list covered dependents if the employer is self-insured.
Form 1095-C is a vital ACA reporting document sent by large employers to full-time employees.
It details the health coverage offered, helps the IRS enforce ACA compliance, and should be kept for tax records.
Employers must also file a 1094-C with the IRS. Missing or incorrect forms can result in significant penalties for employers, so timely and accurate distribution is essential for compliance.
PRT Staffing is now offering 1095-C Forms upon request instead of mailing them directly to employees. If you need a copy of your 1095-C Form, please submit your request using one of the following options: