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Create and Complete Form 1095-C

Creating Form 1095-C

  1. Click on the Payer List button.
  2. Double click on the payer name.
  3. Highlight the recipient to add the form to.
  4. Click on the Add Form button.
  5. Choose 1095-C from the Form Type drop down menu.
  6. Fill in the necessary fields on the form
  7. Click Save.

How to Complete Lines 14, 15, and 16

Click here to access the Part 2 Filing guide. This guide can help determine which lines need to be filled out depending which codes are used on line 14.

Line 14 Is for the Offer of Coverage

Enter the appropriate code in the All 12 Months box if the same code applies to the entire calendar year.  If the offer of coverage changed during the year, enter the appropriate code in each of the individual monthly boxes. Line 14 cannot be left blank; a valid code must be entered in either the All 12 Months box or each of the individual monthly boxes.

To determine what code to enter for line 14, review each of the options below and select the one(s) that best fit the employee's situation. Select the code that best describes the offer of coverage that was given to the employee. It does not necessarily need to match what coverage option the employee selected to enroll in, if any.

  • For example, an employer offers a choice between single and family coverage (covering self, spouse, and dependents). Both options offered minimum essential coverage and contained minimum value. The employee selects to enroll in single-only coverage. However, because the employer offered the option for family (self, spouse, and dependents), this code would be entered in the appropriate box on line 14.

Line 14 Codes, as defined by the IRS 1095-C instructions

A conditional offer is an offer of coverage that is subject to one or more reasonable, objective conditions (for example, an offer to cover an employee’s spouse only if the spouse is not eligible for coverage under Medicare or a group health plan sponsored by another employer).

  • 1A - Qualifying offer: minimum essential coverage providing minimum value offered to full-time employee with employee required contribution equal to or less than 9.5% (as adjusted) of the mainland single federal poverty line and at least minimum essential coverage offered to spouse and dependent(s).
  • 1B - Minimum essential coverage providing minimum value offered to employee only.
  • 1C - Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to dependent(s) but not spouse.
  • 1D - Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to spouse but not dependent(s).
    • Do not use code 1D if the coverage for the spouse was offered conditionally, use code 1J.
  • 1E - Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to spouse and dependent(s).
    • Do not use code 1E if the coverage for the spouse was offered conditionally, use code 1K.
  • 1F - Minimum essential coverage not providing minimum value to employee; employee and spouse or dependent(s); or employee, spouse, and dependent(s).
  • 1G - Offer of coverage for at least one month of the calendar year to an employee who was not a full-time employee for any month of the calendar year (which may include one or more months in which the individual was not an employee) and who enrolled in self-insured coverage for one or more months of the calendar year.
    • Code 1G applies for the entire year or not at all.
  • 1H - No offer of coverage.
  • 1J - Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage conditionally offered to spouse.
  • IK - Minimum essential coverage providing minimum value offered to employee; at least minimum essential coverage offered to dependents; and at least minimum essential coverage conditionally offered to spouse.
  • 1L - Individual coverage HRA offered to employee only with affordability determined by using employee's primary residence location ZIP code.
  • 1M - Individual coverage HRA offered to employee and dependent(s), not spouse, with affordability determined by using employee's primary residence location ZIP code.
  • 1N - Individual coverage HRA offered to employee, spouse, and dependent(s) with affordability determined by using employee's primary residence location ZIP code.
  • 1O - Individual coverage HRA offered to employees only using the employee's primary employment site ZIP code affordability safe harbor.
  • 1P - Individual coverage HRA offered to employee and dependent(s), not spouse, using the employee's primary employment site ZIP code affordability safe harbor.
  • 1Q -Individual coverage HRA offered to employee, spouse, and dependent(s) using employee's primary employment site ZIP code affordability safe harbor.
  • 1R - Individual coverage HRA that is not affordable offered to employee; employee and spouse, or dependent(s); or employee, spouse, and dependents.
  • 1S - Individual coverage HRA offered to an individual who was not a full-time employee.

For additional information on the line 14 codes and when to use each, please view the IRS instructions for the 1095-C.

Line 15 Is for the Employee Required Contribution

Line 15 is only required if you entered code 1B, 1C, 1D, 1E, 1J, 1K, 1L, 1M, 1N, 1O, 1P, 1Q, 1T, 1U on line 14.

To complete line 15, enter the dollar value of the employee required contribution, which is generally the employee share of the monthly cost for the lowest-cost-self-only minimum essential coverage providing minimal value. lowest cost premium option offered to that employee. Even if the employee actually enrolled in a higher cost coverage option, or opted out of coverage all together, line 15 should reflect the monthly cost for the lowest-cost-self-only minimum essential coverage providing minimal value.

When entering or importing data for line 15, if the same premium applies to the entire calendar year, the value may be entered into the All 12 Months box. If the lowest cost premium varied during the calendar year, enter the correct dollar amount in each of the individual monthly boxes. If you are required to enter an amount in line 15 and if the employee was not required to contribute to the premium, enter 0.00, do not leave the box blank.

  • For example, an employer offers options of single-only coverage for $100 per month or family coverage for $200 per month. The premium entered on line 15 will be $100, even if the employee actually enrolled in family coverage.

Line 16 Is for the Applicable Section 4980H Safe Harbor

It is in the best interest of the employer to enter a valid code in line 16, if applicable, to minimize any contact from the IRS. Enter the appropriate code in the All 12 Months box if the same code applies to the entire calendar year. If the applicable section 4980H safe harbor changed during the year, enter the appropriate code in each of the individual monthly boxes.

To determine what code to enter for line 16, review each of the options below and select the one(s) that best fit the situation. If no code applies, line 16 can be left blank.

Line 16 Codes, as defined by the IRS 1095-C instructions

  • 2A - Employee was not employed during the month.
  • 2B - Employee is not a full-time employee.
  • 2C - Employee enrolled in the coverage offered.
  • 2D - Employee is in a section 4980H limited non-assessment period.
  • 2E - Multiemployer interim rule relief.
  • 2F - Section 4980H affordability Form W-2 safe harbor.
  • 2G - Section 4980H affordability federal poverty line safe harbor.
  • 2H - Section 4980H affordability rate of pay safe harbor.

For additional information on the line 16 codes and when to use each, please view the IRS instructions for the 1095-C.

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