1095-C Form FAQs Template

  • 1. I received a 1095-C form– what is it? Form 1095-C is a new IRS tax form that you received

    Form 1095-C is a new IRS tax form that you received because your employer is subject to the employer shared responsibility provision in the Affordable Care Act. A sample form is available on the IRS website.

  • 2. What does the 1095-C form include?
    Form 1095-C includes information about the health plan coverage offered to you by your employer and will be reported to the Internal Revenue Service. Part II, includes information about the offer of coverage and coverage, if any, your employer offered to you and your spouse and dependent(s), if any.
  • 3. How do I know if my health insurance plan from SHBP meets the minimum essential coverage requirements of the ACA?
    All health insurance plans offered through SHBP meet the minimum essential coverage requirements.
  • 4. I did not receive a 1095-C form – why?
    1095-C forms are prepared for employees that were full-time as defined by the ACA or were under an offer of coverage during 2016. If you think you should have received a form from your employer, please call ACA Inquiry Services at (855) 314-4222.
  • 5. Does this count as income on my taxes?
    No, this form has no dollar amounts to report on your personal income tax return.
  • 6. What should I do with this form?

    Retain this form with your other important tax records. Depending on your hire date and/or your position within the state, you may need some information from this form in order to file your personal income tax return on Form 1040 (though you can also get that information from other data sources). Please do not attach Form 1095-C to your personal income tax return. Upon receipt of the Form 1095-C, please check the following for accuracy. If any of the information is incorrect, please contact to provide the correct information for data revisions.

    • Address
    • Offer of Coverage and Coverage information
    • All members of your household that received coverage through your employer are listed on the 1095-C Form
    • Social security numbers
  • 7. How many forms might I receive?
    You may receive multiple 1095-C Forms if you had multiple employers (or agencies) during the calendar year that were Applicable Large Employers (an ”ALE” is defined as an employer that employed an average of at least 50 full-time employees during the preceding calendar year). In that situation, each Form 1095-C would have information only about the health plan coverage offered to you by the employer identified on the form.
  • 8. Am I eligible for a Premium Tax Credit?

    Please consult your tax advisor/tax preparer or contact the Federal Marketplace at https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/The-Health-Insurance-Marketplace for information regarding individual Premium Tax Credits.

  • 9. Could I get a penalty if I didn’t have coverage?

    Please consult your tax advisor/preparer or contact the Federal Marketplace https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/The-Health-Insurance-Marketplace for information regarding individual Affordable Care Act penalties.

  • 10. What if I have additional questions, what do I do?

    There is a phone number located in Box 10 of the Form 1095-C (1-855-314-4222). Please dial this number for more information. You can also visit the IRS website at http://www.irs.gov/ACA.