Filling Out the Covered Individual Information on a 1095-C

Completing the Covered Individuals Section on a 1095-C

On 1095-C forms, a covered individual is anyone who was covered on a self-insured plan. If the employer provided a fully insured plan to employees, covered individual information will not be entered on the 1095-C form.

If an employee waives coverage for themselves and their dependents, the covered individual section will be left blank.

• The list of covered individuals will include all individuals who were enrolled on the plan, including the employee.
  • For example, if employee John Smith had a wife and two children who were all covered on his employer's self-insured plan, all four of those individuals would be entered in the covered individuals section on the 1095-C.
  • If John Smith's employer provided a fully insured plan, the covered individual section of the 1095-C form would be left blank.
• A dependent is defined by the IRS as an employee’s child, including a child who has been legally adopted or legally placed for adoption with the employee, who has not reached age 26.
  • A child reaches age 26 on the 26th anniversary of the date the child was born and is treated as a dependent for the entire calendar month during which he or she reaches age 26.
  • For this purpose, a dependent does not include:
    • Spouse
    • Stepchildren
    • Foster children
    • A child that does not reside in the United States (or a country contiguous to the United States) and who is not a United States citizen or national.
• A covered individual will need a Social Security Number or a Date of Birth entered.
  • If both are entered for the covered individual, the IRS will only process the information using the individual's Social Security Number.
• Check the box for each covered individual for each month the covered individual was provided self-insured coverage.
  • If the covered individual was covered at least one day for the month, that month will be checked.
  • If the covered individual was covered at least one day for each month of the year, the "Covered all 12 months" checkbox can be checked, and the individual months checkboxes can be left blank.

Adding a Covered Individual

1. Click the Payer List button.
2. Double click on the payer name.
3. Select the recipient for whom you wish to add the covered individual(s).
4. If the recipient already has a 1095 form created, double click on the 1095 form in the Form List.
   • If not, create a new 1095 for the recipient.
5. Click on the Cov Ind button on the right.
6. Enter the applicable information.
7. Click Save.
8. Click Add to add another covered individual, or OK to close the window.

Editing a Covered Individual

1. Click the Payer List button.
2. Double click on the payer name.
3. Select the recipient for whom the covered individuals need to be edited.
4. If the recipient already has a 1095 form created, double click on the 1095 form in the Form List.
   • If not, create a new 1095 for the recipient.
5. Click on the Cov Ind button on the right.
6. Make the applicable changes.
7. Click Save.
8. Click OK to close the window.

Deleting a Covered Individual

1. Click the Payer List button.
2. Double click on the payer name.
3. Select the recipient for whom the covered individual(s) need to be deleted.
4. Double click on the 1095 form in the Form List.
5. Click on the Cov Ind button on the right.
6. Highlight the covered individual to be deleted.
7. Click Delete.
8. Click OK to close the window.