Cat. No. 60705M Form 1095-C 2015 600215 Page 2 Instructions for Recipient You are receiving this Form 1095-C because your employer is an Applicable Large Employer subject to the employer shared responsibility provision in the Affordable Care Act. 1095-C Form Department of the Treasury Internal Revenue Service Part I Information Applicable Large Employer Member Employer 1 Name of employee 2 Social security number SSN 3 Street address including apartment no. 5 State or province 4 City or town...
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Who needs an IRS 1095-C Form?

The Internal Revenue Service obliges Large Employers (ALEs) having 50 employees or more to provide insurance coverage to their full-time workers and sometimes their family members. Such insurance coverage must be reported to the IRS on a yearly basis and for the previous year. An employer must file as many 1095-C forms as many employees they employ.

What is the IRS 1095-C Form for?

The IRS Form 1095-C is an Employer-Provided Health Insurance Offer and Coverage report. The information from the form is used by the IRS to make sure, that large employers do offer insurance coverage to their employees and employee receive at least the minimum essential coverage.

Is 1095-C Form accompanied by other forms?

When sending the completed form to an employee, there is no need to accompany it by any other forms, but the copies that must be delivered to the IRS are mandatory to be supported by Form 1094-C.

When is the Employer-Provided Health Insurance Offer and Coverage Form due?

The copy that is designated to the IRS must be filed by the end of February (if sent by mail), or by March 31st (if delivered electronically). The employer is obligated to deliver employees’ copies of Form 1095-C by March 31st, too. It should be mentioned that the form has to cover the information for the previous year.

How do I fill out 1095-C Form?

The properly completed form 1095-C is to state the following:

  • Employee details (name, SSN, address)
  • Employer details (name, address, EIN)
  • Insurance coverage details
  • Covered individuals (employee’s covered family members)

Where do I send the IRS 1095-C Form?

The Employer-Provided Health Insurance Offer and Coverage Form on every employee should be filed in two copies, one of them is to be sent to the IRS local office, and the other is meant for an employee.

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Please select a version for Fillable IRS 1095-C form
  • 2018 IRS 1095-C Fillable
  • 2017 IRS 1095-C Fillable
  • 2016 IRS 1095-C Fillable
  • 2015 IRS 1095-C Fillable
  • 2014 IRS 1095-C Fillable
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