What are the new health coverage forms required by the Affordable Care Act?
The Affordable Care Act (ACA) is a law designed, in part, to extend access to affordable healthcare coverage to more Americans. As required by the ACA, you must receive 1095 Forms reporting on offers of health coverage and actual health coverage received in the prior year (please note that other benefits such as dental plans, life insurance or disability benefits will not be reported on 1095 forms). One copy is sent to the Internal Revenue Service (IRS), and one copy is sent to you. A 1095 Form is similar to a W-2 Form. A W-2 Form reports your annual earnings. The 1095 Form will show that you and your family members either did or did not have an offer of health coverage and/or actual health coverage during each month of the past year. Because of the ACA, every person who is not otherwise exempt must obtain health insurance or pay a penalty to the IRS.
What is a Form 1095-C and why might I receive one?
Most people have to report to the federal government that they, along with their tax dependents, had medical insurance coverage during the previous year. Form 1095-C is a tax form (like a W-2) that a large employer must send to certain employees that includes information about the health coverage offered and actual plan enrollment during the calendar year. Receiving Form 1095-C does not mean you owe income taxes on the value of the healthcare benefits you receive. Your Form 1095-C is proof that you and any covered dependents had medical coverage for at least one or more months of the year. You should keep your Form 1095-C with all your tax records as supporting documentation (please note too that other forms of documentation would also be acceptable proof of insurance coverage, such as wage statements showing health insurance deductions, insurance cards, explanations of benefits and statements from insurers). IRS states in the Form 1040 instructions that you do not have to attach a Form 1095 to your tax return.
Who will get Form 1095-C?
Every employee who was a full-time employee during any month in calendar year (January 1 - December 31) will receive Form 1095-C, providing information about any health coverage the employer offered during the calendar year. If you are married and your spouse is a full-time employee, it's possible your spouse may also receive a Form 1095-C from his/her employer. "Full-time employee" for this purpose means you have generally averaged over 30 hours per week over the applicable determination period. Note that if you were a full-time employee for more than one employer during the calendar year, you could receive a separate Form 1095-C from each employer. Form 1095-C will not be provided to the following employees, unless the employee or the employee's family member was enrolled in a self-insured plan sponsored by the large employer (as explained below):
- An employee who was not a full-time employee in any month of the calendar year; or
- An employee who was in a limited non-assessment period for all 12 months of the calendar year. A limited non-assessment period for this purpose generally means a waiting period or measurement period for full-time status tracking purposes.
Every employee (whether full-time or not) who had coverage under our self-insured health plan for any month of the year will receive the form, providing plan enrollment information about who was covered and when for each month of the year for the employee and any covered family member. Therefore, part-time employees and some non-employees also may receive a Form 1095-C if they are covered under our self-insured plan. If you were not a full-time employee for any month of the year and you did not have coverage under our self-insured plan for any month of the year, you will not receive a 1095-C.
Note that if you or a family member enrolled in medical coverage during the calendar year on an insured basis under an individual policy or another employer plan, you may also receive a Form 1095-B from that other provider reporting the actual enrollment information. This information is reported on a separate Form 1095-B, which will be sent to you by the insured medical provider. The Centers for Medicare & Medicaid Services (CMS) will send Form 1095-B to individuals enrolled in Medicare. TRICARE will send a Form 1095-B to individuals enrolled in TRICARE (individuals enrolled in marketplace coverage will receive a Form 1095-A).
What do I do with the form(s)?
You should keep your forms with your tax records. You don't need to include the form in order to file your taxes, but you will be required to indicate whether or not you had health insurance for each month of the calendar year. Since you don't actually need the form(s) to file your taxes, you don't have to wait to receive it to file your taxes if you already know what months you did or did not have health insurance.
How many forms will I get and when should I receive the form(s)?
You may receive multiple forms if you had coverage from more than one coverage provider, if you worked for more than one employer during the calendar year or if you enrolled for coverage in the marketplace for a portion of the year and received coverage from another source for part of the calendar year.
Where can I go for more information?
Should my spouse or dependents or other non-employees receive a Form 1095-C?
Generally, no. If you covered a spouse or children, they will be included on the Form 1095-C under Part III - Covered Individuals; you will not receive a separate Form 1095-C for each of your dependents. All family members who are covered through your enrollment (for example, because you elected family coverage) should appear on the same form, which is required to be provided to you as the covered employee. However, in some instances, a spouse and/or dependent or other non-employee may receive his/her own copy of Form 1095-C if he/she independently enrolls in coverage (e.g., a non-employee director, a terminated employee receiving COBRA coverage who terminated employment in a previous calendar year, a retired employee who terminated employment in a previous calendar year, or a family member of such an individual if the family member is receiving coverage independent of the individual, such as by electing individual COBRA coverage). All family members of the individual who are covered individuals due to that individual’s enrollment (for instance, a spouse of a retiree who is enrolled in the plan because the retiree elected self plus spousal coverage) will also be included on the same Form 1095-C as the individual who enrolls in the coverage.
Isn’t my health coverage information already included on my Form W-2 using Box 12, code DD?
Your Form W-2 contains different information from your Form 1095. The information included on your Form W-2, Box 12, code DD only states the total cost of employer-sponsored health insurance you actually enrolled in during a single calendar year. It does not show the months in which you enrolled in coverage or the lowest cost employee-only coverage offered to you.
What do the codes mean on lines 14, 15 and 16 of Part II on my Form 1095-C?
The codes used on lines 14, 15 and 16 on your Form 1095-C are intended to provide information about the type of employer-sponsored coverage that is offered to you. They also provide information about the lowest cost that you could pay for employee-only health coverage that was offered under our plan that also provides minimum value insurance coverage. The codes used in line 16 help the IRS determine whether you could qualify for a premium tax credit if you were to purchase health insurance coverage through the Marketplace and also inform the IRS about whether your employer falls within any of the safe harbors from penalties under the employer mandate penalty. Explanations for the codes used can be found on the back of the Form 1095-C.
What do I do if I don’t receive a Form 1095-C, or if I lose it, or need to correct the information on the Form?
If you have determined you should receive a Form 1095-C and you do not receive your form by the end of March, or if you misplace it, you can contact your human resources department to request another copy. If you have questions about the Form 1095-C or if you need to update any incorrect information on the Form 1095-C, please contact Drexel Benefits Service Center at 1.888.971.0101, Monday through Friday, 8 a.m. to 8 p.m. EST.