1095-C Form Review – Line 14, 15, 16 & Part III

1095-C Form Review – Line 14, 15, 16 & Part III

KB14-086

The purpose of this document is to assist in reviewing the accuracy of your 1095 forms.

Line 14 – Offer of Coverage

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

• Whether or not health insurance coverage 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 in Line 16.
 
**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 should only be populated if line 14 has a code of 1B, 1C, 1D, 1E, 1J or 1K on line 14. 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.
 
* 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).

 

**For further information: KB14-087 “Let’s Look At the Most Common 1095-C Coverage Scenarios”

 

Questions / Resources

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Last Review: 10/16/2018 – Revision: 0.0

Applies To: ACA Compliance Solution

Categories: Year End – 1095-C and Filing, Import of Data

Keywords: 1095-C, Line 14, Line 15, Line 16, Part III

 

 

2018-10-17T07:53:55+00:00October 16th, 2018|0 Comments

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