Accurate 1095-C forms: A Primer The mandated IRS requirements are met through the Integrity Data ACA Solution for any ALE (Applicable Large Employer) that meets the 50 employee threshold. An ALE is, for a particular calendar year, any single employer, or group of employers treated as an Aggregated ALE Group, that employed an average of at least 50 full-time employees (including full-time equivalent employees) on business days during the preceding calendar year.

Truth is, the Affordable Care Act (ACA) reporting requirements are burdensome. Getting your 1095-Cs right can be stressful. Integrity Data’s compliance team, with guidance from the IRS, has put together this primer to help you ensure you have accurate 1095-C forms  for ACA reporting.

Form 1095-C Lines – Lines – Lines: What do they mean?

Line 14 – Offer of Coverage

Line 14 on the 1095-C form provides details of the health insurance coverage that was offered throughout the year, including:

  • Whether or not health insurance was offered.
  • The type of coverage that was offered.
  • The months in which coverage was offered.

The code on line 14 may vary as to the quality of the coverage offering. A line 14 response is reported for each month of the year. Also, line 14 codes do not indicate what coverage the employee enrolled in, instead the codes indicate what coverage was offered to the employee. You can use a code that indicates coverage if the employee was offered coverage for every day of the month. If the offer of coverage was not good for every day of the month, 1H will be applicable.

*Line 14 does NOT indicate whether coverage was accepted. That information is reported on Line 16.

Line 14 Offer of Coverage
**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. *Please review this KB article for detailed descriptions of each line 14 code.

Line 15 – Employee Required Contribution

Line 15 provides the amount of the employee required monthly contribution. The amount listed on line 15 may not be reflective of the medical plan cost that the employee actually enrolled in. This amount should represent the cost for the lowest-cost, self-only coverage offered to that employee.

Line 15 – Employee Required Contribution
Line 15 should only be populated if line 14 has a code of 1B, 1C, 1D, 1E, 1J or 1K. If one these codes is listed in the “All 12 Months” column on line 14, there should also be a line 15 entry for all 12 months as well. If line 14 does not have one of these codes for any given month(s), line 15 should be left blank for that month. *Please review this KB article for additional details on line 15.

Line 16 – Eligibility

Line 16 provides information about the employees’ eligibility for health coverage and the coverage status for each month of the calendar year. Similar to line 14, a coverage code can only be used if the employee was actually enrolled for every day of the month. Otherwise, a different code will need to be used.

Line 16 – Eligibility
*Please review this KB article for detailed descriptions of each line 16 code.

Part III – Covered Individuals

Part III is only required to be populated by employers with self-insured health plans. Therefore, if your plan is fully-insured, this section will not be populated. This section should list the employee and all of their covered dependents during the calendar year. If the individuals were covered all 12 months, there should be an “X” in column (d). Unlike Part II, if the individuals were not covered all 12 months, but were covered at least one day during any given calendar month, there will be an “X” in the corresponding month(s).

Part III – Covered Individuals

Most Common 1095-C Coverage Scenarios

Full-Time Employees: Enrolled All Year

In this example, the full-time employee was offered & enrolled