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 OMB...No* 1545-2251 CORRECTED about Form 1095-C and its separate instructions is at www*irs*gov/form1095c Employee 600116 VOID Employer-Provided Health Insurance Offer and Coverage Jan 8 Employer identification number EIN 10 Contact telephone number 6 Country and ZIP or foreign postal code 11 City or town Plan Start Month Enter 2-digit number Employee Offer and Coverage All 12 Months Feb Mar Apr May June July Aug Sept Oct Nov Dec 14 Offer of Coverage enter required code 15 Employee Share of Lowest...Cost Monthly Premium for Self-Only Minimum Value Coverage 16 Applicable Section 4980H Safe Harbor enter code if applicable Covered Individuals If Employer provided self-insured coverage check the box and enter the information for each covered individual* a Name of covered individual s b SSN c DOB If SSN is not available d Covered e Months of Coverage For Privacy Act and Paperwork Reduction Act Notice see separate instructions. This Form 1095-C includes information about the health insurance...coverage offered to you by your employer. Form 1095-C Part II includes information about the coverage if any your employer offered to you and your spouse and dependent s. If you purchased health insurance coverage through the Health Insurance Marketplace and wish to claim the premium tax credit this information will assist you in determining whether you are eligible. For more information about the premium tax credit see Pub. 974 Premium Tax Credit PTC. You may receive multiple Forms 1095-C if...you had multiple employers during the year that were Applicable Large Employers for example you left employment with one Applicable Large Employer and began a new position of employment with another Applicable Large Employer. In that situation each Form 1095-C would have information only about the health insurance coverage offered to you by the employer identified on the form* If your employer is not an Applicable Large Employer it is not required to furnish you a Form 1095-C providing...information about the health coverage it offered* In addition if you or any other individual who is offered health coverage because of their relationship to you referred to here as family members enrolled in your employer s health plan and that plan is a type of plan referred to as a self-insured plan Form 1095-C Part III provides information to assist you in completing your income tax return by showing you or those family members had qualifying health coverage referred to as minimum essential...coverage for some or all months during the year.
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How to fill out IRS 1095-C
Instructions and Help about IRS 1095-C
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How to fill out IRS 1095-C
To fill out the IRS 1095-C form, gather required information first. This includes employer identification details, employee enrollment in health insurance, and the type of coverage provided. Follow these steps to complete the form:
01
Provide your employer’s name, EIN, and address.
02
Include your personal details like name and Social Security number.
03
Indicate the months you were covered under your employer's plan.
After filling, ensure all information is accurate based on your health insurance coverage during the year.
About IRS 1095-C 2015 previous version
What is IRS 1095-C?
IRS 1095-C is a tax form used by applicable large employers to report information about health insurance coverage offered to employees. This form is a requirement under the Affordable Care Act (ACA) and assists the IRS in verifying compliance with health care coverage mandates.
Who needs the form?
Applicable large employers, which generally means those with 50 or more full-time employees, must file the IRS 1095-C form. Employees who receive health coverage from those employers will also receive a copy for their records when filing their tax returns.
Components of the form
The IRS 1095-C form contains several sections, including Part I, which identifies the employer and employee, while Part II details the health coverage offered. Part III, if applicable, provides information regarding the coverage for individuals under a self-insured plan. Each section requires specific data to ensure compliance with reporting obligations.
What information do you need when you file the form?
When filing the IRS 1095-C form, you will need the employer’s name, Employer Identification Number (EIN), the employee's name, Social Security number, and details about the health coverage offered. Accurate dates and coverage type information are also essential for compliance.
Where do I send the form?
The IRS 1095-C form should be sent to the IRS at the designated address according to IRS instructions based on your filing method (paper or electronic). Additionally, a copy must be provided to the employee by the deadline established by the IRS, typically by January 31 of the following year.
What is the purpose of this form?
The purpose of the IRS 1095-C form is to inform the IRS and employees whether the employer provided health insurance coverage that meets ACA requirements. The information on this form helps determine if the employee is eligible for premium tax credits when filing their tax return.
When am I exempt from filling out this form?
Employees may be exempt from receiving the IRS 1095-C form if they work for an employer with fewer than 50 full-time employees or if they are not offered health coverage. Additionally, certain government programs and plans may also exempt individuals from receiving this specific form.
What are the penalties for not issuing the form?
Filing or issuing the IRS 1095-C incorrectly or failing to do so can result in penalties imposed on employers. The penalty can range from $50 to $550 per form, depending on the severity of the error and the length of time the form is outstanding. This reinforces the need for accuracy and compliance.
Is the form accompanied by other forms?
The IRS 1095-C form is often submitted along with IRS Form 1094-C, which is a transmittal form that summarizes the information reported on all 1095-C forms issued by the employer. This transmittal must be filed to ensure the IRS receives a complete record of the health coverage information provided.
FAQ about IRS 1095-C
What should I do if I realize I made an error on my IRS 1095-C after filing?
If you discover a mistake on your IRS 1095-C after submission, you should file a corrected return. This involves completing a new IRS 1095-C form, ensuring all information is accurate, and marking it as 'Corrected'. The IRS allows you to file these corrections electronically or via paper, depending on your original submission method.
How can I track the status of my filed IRS 1095-C?
To track the status of your IRS 1095-C, you can check with the IRS e-Services if you filed electronically. If your submission was paper-based, look for a confirmation from the IRS or your payroll provider. Be aware of common e-file rejection codes that might indicate issues with your submission that require resolution.
Are there any legal considerations regarding the e-signature on IRS 1095-C?
Yes, electronic signatures are generally acceptable for IRS 1095-C forms, provided they adhere to the IRS guidelines for electronic filing. It's important to ensure that your e-signature system complies with various requirements regarding security and verification to protect sensitive information.
What common errors should I watch for when filing the IRS 1095-C?
Common errors include incorrect Social Security Numbers, misreporting covered individuals, and failure to include all applicable months. To avoid these mistakes, verify all employee details against your records and double-check the entries made on the IRS 1095-C before submission.
What should I prepare if I receive a notice from the IRS regarding my 1095-C?
If you receive an IRS notice about your 1095-C, review the correspondence for details on the issue. Prepare to respond by gathering the original and corrected forms, any related documentation, and ensure you've met deadlines for response. Keeping clear records will help streamline the process and reduce confusion during any IRS inquiries.
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