Determining form type
The type of 1095 form that is filed by an employer is determined by the total number of full time employees and full time equivalents the employer had for the previous tax year.
A full time employee (as defined by the IRS) is an employee who, for a calendar month, is employed an average of at least 30 hours of service per week with the employer. For this purpose, 130 service hours in a calendar month is treated as the monthly equivalent of at least 30 hours per week.
A full time equivalent is a combination of employees, each of whom individually is not treated as a full-time employee because he or she is not employed on average at least 30 hours of service per week with an employer, but who, in combination, are counted as the equivalent of a full-time employee solely for purposes of determining whether the employer is an ALE.
Any employer who had 50 or more full time employees and/or full time equivalents in the previous tax year is considered an Applicable Large Employer, or an ALE. An ALE will file 1095-C forms for the current tax year.
If an employer had less than 50 full time employees and/or full time equivalents in the previous tax year, the employer will only need to file a 1095 form if the employer was self-insured.
Group health plans may be self-insured or fully insured. A plan is fully insured when all benefits are guaranteed under a contract of insurance that transfers risk to an insurer. A plan is self-insured (or self-funded) when the employer assumes the financial risk of providing health care benefits to its employees.
If an employer had less than 50 full time employees and/or full time equivalents in the previous tax year, and the employer was self-insured, the employer will file a 1095-B form to all employees who enrolled in the plan.
If you are an insurance provider, you will file 1095-B forms.
|Self-insured||More than 50 full time employees/equivalents||1095-C|
|Fully insured||More than 50 full time employees/equivalents||1095-C|
|Self-insured||Less than 50 full time employees/equivalents||1095-B|
|Fully insured||Less than 50 full time employees/equivalents||No filing requirement|
Determining who is issued a 1095
If you are filing 1095-C forms, you will need to issue a 1095-C to:
- All full time employees (who were employed outside of a waiting period*)
- Any part-time employees that enrolled in coverage, provided you are self-insured
*You will not need to file a 1095-C form to any employee who was a full time employee, but whose employment was terminated during the waiting period.
If you are filing 1095-B forms, you will need to issue a 1095-B form to any employee who enrolled in self-insured coverage, or if you are an insurance provider, to any employee who enrolled in coverage you provided.