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Form 1095-C: Employee Questions Answered

By: Mike Petrasek, Marketing Communications Consultant

2015 marks the first year applicable organizations are required by law to file Forms 1094-C and 1095-C. As a result, many employers have spent the bulk of their time huddled away in offices learning the ins and outs of each form to ensure year-end filings meet the Internal Revenue Service’s requirements (IRS).

But, just as employers are working through details, employees are beginning to wonder what they’ll need to know about this new year-end paperwork. What is a 1095-C? Why did I get a 1095-C? Do I need a 1095-C to file my taxes?

To help, we’ve outlined what we believe to be some of the most commonly asked questions and corresponding answers below.

As always, if you have any questions or things to add, reach out via Facebook or Twitter and we’ll be sure to get you an answer and add it to the list.

What is the Form 1095-C?

New for 2015, the Form 1095-C is a required year-end reporting document that will be provided to all full-time employees of organizations who classify as Applicable Large Employers (ALEs) under the Affordable Care Act (ACA). Much like how you are provided a W-2 to report your 2015 earnings, you will now be provided a Form 1095-C to report the healthcare coverage offered to you by your employer for 2015. This form is important because the Internal Revenue Service (IRS) will use the information on it to determine whether you or your employer may have to pay a fine for failing to meet the healthcare coverage requirements under the ACA.

In addition to the 1095-C, most employees will also receive a Form 1095-A or 1095-B to report your specific coverage details. However, it’s important to understand that the 1095-C serves as the primary document used by the IRS to determine whether or not you or your employer failed to meet ACA coverage requirements.

Do I get a Form 1095-C?

The ACA requires that ALEs – any organization with 50 or more full-time employees (including full-time equivalents (FTEs) – provide each full-time employee, as well as any employee who was enrolled in their health insurance plan with a Form 1095-C.

So, for example, if you were a full-time employee, regardless of whether or not you were enrolled in your organization’s healthcare coverage plan, you will receive a Form 1095-C.

What is on the Form 1095-C?

The Form 1095-C is made up of three parts:

  1. Part I: Employee and Employer Information – This section will include basic information (name, address, etc.) for both you and your employer.
  2. Part II: Employee Offer and Coverage – This section includes the coverage offered to you by your employer, the affordability of that coverage and the reason why you were not offered coverage (if applicable). What’s important to understand is that this section only includes the coverage you were offered, not necessarily the coverage you signed up for. The specific details of your coverage will be provided in a separate document (either a 1095-B or 1095-A; more on those below).
  3. Part III: Covered Individuals – This section includes information about those covered under your plan and will only be filled in if your employer offers a self-insured plan. If your employer provided you or a family member health coverage through an insured health plan or other manner, or if you or a family member enrolled in a qualified health plan through a Health Insurance Marketplace, you will receive an additional form (either a 1095-B or 1095-A; more on those below).

Why did I get a Form 1095-C?

All full-time employees – those working an average of 30 hours or more each week or 130 hours at an ALE each month – as well as those enrolled in a company-sponsored health insurance plan are required to receive a Form 1095-C.

Why didn’t I get a Form 1095-C?

There are a few reasons you may not receive a Form 1095-C, including:

  • If your employer does not classify as an ALE then you will not receive a Form 1095-C. However, you may receive another type of year-end paperwork (Form 1095-A or Form 1095-B) depending on how you have obtained health coverage.
  • If you don’t classify as a full-time employee – working less than an average of at least 30 hours each week or 130 hours each month – and were not enrolled in healthcare coverage through your employer at any time during 2015, you will not receive a Form 1095-C.
  • If you were not the primary individual who was insured. For instance, you wouldn’t receive a Form 1095-C if you were listed as a spouse or dependent under another family member’s plan.

Why did I get more than one Form 1095-C?

There are a few reasons you may receive multiple Forms 1095-C, including:

  • If you worked for multiple companies in 2015. For instance, if you changed jobs at some point during the year and were enrolled in coverage with both employers, you would receive a Form 1095-C for each employer.
  • If you work for an employer who has different franchises or companies. In that instance, you may also receive a Form 1095-C from each company.

Why is Part III of my Form 1095-C blank?

If Part III of your Form 1095-C is blank, don’t panic. It just means that you fall into one of the below three scenarios:

  1. Your employer provided you or a family member coverage through a fully-insured health plan or other manner. In this case, the issuer of the insurance or the sponsor of the plan providing the coverage will provide you with coverage information separately via Form 1095-B.
  2. You or a family member obtained minimum essential coverage (MEC) from another source – this could be a government-sponsored program, individual marketplace or miscellaneous coverage designated by the Department of Health and Human Services. In this case, the provider of the coverage will provide you with complete details via Form 1095-B.
  3. You or a family member enrolled in a qualified health plan through a Health Insurance Marketplace. In this case, the actual Health Insurance Marketplace will report the information about that coverage via Form 1094-A.

When should I get my Form 1095-C?

Originally, employers were required to send all eligible employees their Form 1095-C for tax year 2015 on or before February 1, 2016. However, the IRS has issued an extension and employers now have until March 31, 2016, to provide employees with their Forms 1095-C.

What should I do with my 1095-C? Do I need my 1095-C to file my taxes?

Because information from your Form 1095-C may be needed to complete your 2015 taxes, we recommend that you keep it in a safe place, preferably with your 2015 tax information. In order to complete your 2015 tax filing, both your W-2 and Form 1095-C may be needed and, if applicable, your 1095-A or 1095-B.