Why isn’t the employee and their dependents listed in Part III of Form 1095-C when it is provided to them each year by their employer?

Form 1095-C is the form that an Applicable Large Employer (ALE) must provide to each employee detailing what coverage the employer offered. An ALE is generally any employer with 50 or more full-time plus full-time equivalent employees.

Here is a link to Form 1095-C. Some employees ask why they and their dependents are not listed in Part III of the form when they receive it from their employer. The IRS requires the employer to list the employees and dependents only if they were offered coverage under a self-insured employer plan. Many plans offered by ALEs are fully-insured and therefore the employer need not list employee and dependents in Part III.

The IRS document: Instructions for Forms 1094-C and 1095-C, provides a full explanation (see the bottom of page 12 and top of page 13).

Where do individuals get the IRS forms to show that they had qualifying health care coverage and thus have complied with the Individual Mandate?

If an individual had qualifying health care coverage, also known as minimum essential coverage, the provider of that coverage is required to send the individual a Form 1095‐A, 1095‐B, or 1095‐C (with Part III completed) that includes individuals in the family who were enrolled in the coverage and their months of coverage.

• Individuals enrolled in health care coverage through Covered California will receive a Form 1095‐A from Covered California.
• Individuals enrolled in individual plans outside of Covered California will receive a Form 1095‐B from the carrier.
• Individuals enrolled in a government‐sponsored health program will receive a Form 1095‐B from the agency that administers the program or provides the coverage.
• Individuals enrolled in fully-insured health coverage provided by their employer will receive a Form 1095‐B from the carrier.
• Individuals enrolled in self-insured health coverage provided by a small employer will receive a Form 1095‐B from their employer.
• Individuals enrolled in self-insured health coverage provided by an Applicable Large Employer will receive a Form 1095‐C from their employer.

These forms must be sent on or before January 31 of the year following the calendar year in which minimum essential coverage is provided.  Even if individuals have not received one of these forms, but had health care coverage, according to the IRS, they can rely on other information they have about their coverage to complete their tax forms.  Consult with a tax advisor to determine what documents are acceptable.

Who is required to file and furnish Forms 1094-C and 1095-C?

Applicable Large Employers (ALEs) must file Forms 1094-C and 1095-C to the IRS and provide a copy of Form 1095-C to employees. ALEs are employers that employed an average of at least 50 full-time employees (including full-time equivalent employees) on business days during the preceding calendar year.

All ALEs must report for all full-time employees even if coverage was not offered or the employee declined coverage. ALEs with self-insured coverage must also report for all other employees enrolled in the self-insured plan, including part-time employees and non-employees if they are enrolled in the plan.

For which employees are Applicable Large Employers required to report?

Applicable Large Employers must report for all full-time employees even if coverage was not offered or the employee declined coverage. ALEs with self-insured coverage must also report for all other employees enrolled in the self-insured plan, including part-time employees and non-employees if they are enrolled in the plan.

Do employers need to complete a Form 1095-C for spouses and dependents?

No, Applicable Large Employers are only reporting for all full-time employees. The IRS will know whether coverage was offered to spouses and/or dependents based on the code used on Line 14 of Form 1095-C.

Form 1094-C asks if the Applicable Large Employer is a member of an Aggregated ALE Group, what’s an Aggregated ALE Group?

If the Applicable Large Employer (ALE) is part of a controlled group or affiliated service group, the ALE is a member of an Aggregated ALE Group. The ALE would therefore need to: (1) check the yes box on Line 21 of Part II; (2) indicate in Part III, Column (d), the months during the calendar year that the ALE was part of a controlled group or affiliated service group; and (3) complete Part IV of Form 1094-C.

It’s best to seek the advice of legal and/or tax counsel to determine controlled group or affiliated service group status.

Do employers need to complete Part III of Form 1095-C regarding individuals covered by the health plan?

Applicable Large Employers (ALEs) with fully-insured plans need not complete Part III of Form 1095-C. This will be completed by the carrier on IRS Form 1095-B.

ALEs with self-insured plans must complete Part III of Form 1095-C for anyone enrolled in the self-insured plan.

What are the deadlines for filing and furnishing Forms 1094-C and 1095-C?

Applicable Large Employers must furnish Form 1095-C to individuals on or before January 31 and must file Forms 1094-C and 1095-C with the IRS on or before February 28 if filing by paper or March 31 if filing electronically.