Instructions For Forms 1094-C And 1095-C - 2017 (Page 10 of 17) in pdf

employee, the employee’s spouse, and the employee’s

Lines 9 and 11–13. Enter the ALE Member’s complete address

dependents. The term “dependent” has the specific meaning set

(including room or suite no., if applicable). This address should

forth in the

Definitions

section of these instructions. In addition,

match the address reported on lines 3–6 of the Form 1094-C.

for this purpose an offer of coverage is treated as made to an

Line 10. Enter the telephone number of the person to contact

employee’s dependents only if the offer of coverage is made to

whom the recipient may call about the information reported on

an unlimited number of dependents regardless of the actual

the form. This may be different than the contact information

number of dependents, if any, an employee has during any

entered on line 8 of Form 1094-C.

particular calendar month.

If the type of coverage, if any, offered to an employee was the

Part II—Employee Offer of Coverage

same for all 12 months in the calendar year, enter the Code

Series 1 indicator code corresponding to the type of coverage

Plan Start Month. This box is optional for the 2017 Form

offered either in the “All 12 Months” box or in each of the 12

1095-C and the ALE Member may leave it blank. This box may

be mandatory for the 2018 Form 1095-C. To complete the box,

boxes for the calendar months.

enter the two-digit number (01 through 12) indicating the

Conditional offer of spousal coverage. Codes 1J and 1K

calendar month during which the plan year begins of the health

address conditional offers of spousal coverage (also referred to

plan in which the employee is offered coverage (or would be

as coverage offered conditionally). A conditional offer is an offer

offered coverage if the employee were eligible to participate in

of coverage that is subject to one or more reasonable, objective

the plan). If more than one plan year could apply (for instance, if

conditions (for example, an offer to cover an employee’s spouse

the ALE Member changes the plan year during the year), enter

only if the spouse is not eligible for coverage under Medicare or

the earliest applicable month. If there is no health plan under

a group health plan sponsored by another employer). Using

which coverage is offered to the employee, enter “00.”

codes 1J and 1K, an ALE Member may report a conditional offer

to a spouse as an offer of coverage, regardless of whether the

Line 14. For each calendar month, enter the applicable code

spouse meets the reasonable, objective condition. A conditional

from Code Series 1. If the same code applies for all 12 calendar

offer generally would impact a spouse’s eligibility for the

months, you may enter the applicable code in the “All 12

premium tax credit under section 36B only if all conditions to the

Months” box and not complete the individual calendar month

offer are satisfied (that is, the spouse was actually offered the

boxes, or you may enter the code in each of the boxes for the 12

coverage and eligible for it). To help employees (and spouses)

calendar months. If an employee was not offered coverage for a

who have received a conditional offer determine their eligibility

month, enter code 1H. Do not leave line 14 blank for any month

for the premium tax credit, the ALE Member should be prepared

(including months when the individual was not an employee of

to provide, upon request, a list of any and all conditions

the ALE Member). An ALE Member offers health coverage for a

applicable to the spousal offer of coverage. As is noted in the

month only if it offers health coverage that would provide

definition of dependent in the

Definitions

section, a spouse is not

coverage for every day of that calendar month. Thus, if coverage

a dependent for purposes of section 4980H.

terminates before the last day of the month (because, for

An ALE Member may not report a conditional offer of

instance, the employee terminates employment with the ALE

coverage to an employee’s dependents as an offer to the

Member, or otherwise loses eligibility for coverage under the

dependents, unless the ALE Member knows that the

plan), the employee does not actually have an offer of coverage

dependents met the condition to be eligible for the ALE

for that month (and code 1H should therefore be entered on

Member’s coverage. Further, an offer of coverage is treated as

line 14). See line 16, code 2B, later, for how the ALE Member

made to an employee’s dependents only if the offer of coverage

may complete line 16 in the event that coverage terminates

is made to an unlimited number of dependents regardless of the

before the last day of the month.

actual number of dependents, if any, an employee has during

A code must be entered for each calendar month January

any particular calendar month.

through December, even if the employee was not a full-time

COBRA continuation coverage. An offer of COBRA

employee for one or more of the calendar months. Enter the

continuation coverage is reported differently depending on

code identifying the type of health coverage actually offered by

whether or not the offer is made due to an employee’s

the ALE Member (or on behalf of the ALE Member) to the

termination of employment.

employee, if any. If the employee was not actually offered

An offer of COBRA continuation coverage that is made to a

coverage, enter code 1H (no offer of coverage) on line 14.

former employee (or to a former employee’s spouse or

For reporting offers of coverage for 2017, an ALE Member

dependents) due to termination of employment should not be

relying on the multiemployer arrangement interim guidance

reported as an offer of coverage on line 14. In this situation, code

should enter code 1H on line 14 for any month for which the ALE

1H (No offer of coverage) must be entered on line 14 for any

Member enters code 2E on line 16 (indicating that the ALE

month for which the offer of COBRA continuation coverage

Member was required to contribute to a multiemployer plan on

applies, and code 2A (Employee not employed during the

behalf of the employee for that month and therefore is eligible for

month) must be entered on line 16 (see the instructions for

multiemployer interim rule relief). For a description of the

line 16), without regard to whether the employee or spouse or

multiemployer arrangement interim guidance, see

Offer of health

dependents enrolled in the COBRA coverage. However, for the

coverage

in the Definitions section. For reporting for 2017, code

month in which the employee terminates employment with the

1H may be entered without regard to whether the employee was

ALE Member, see the instructions for line 16, code 2B.

eligible to enroll or enrolled in coverage under the multiemployer

plan. For reporting for 2018 and future years, ALE Members

An offer of COBRA continuation coverage that is made to an

employee who remains employed by the ALE Member (or to that

relying on the multiemployer arrangement interim guidance may

employee’s spouse and dependents) should be reported on

be required to report offers of coverage made through a

line 14 as an offer of coverage, but only for any individual who

multiemployer plan in a different manner.

receives an offer of COBRA continuation coverage (or an offer of

similar coverage that is made at the same time as the offer of

Indicator Codes for Employee Offer of Coverage

COBRA continuation coverage is made to enrolled individuals).

(Form 1095-C, Line 14)

Generally, an offer of COBRA continuation coverage is required

to be made only to individuals who were enrolled in coverage

Code Series 1— Offer of Coverage. The Code Series 1

and would lose eligibility for coverage due to the COBRA

indicator codes specify the type of coverage, if any, offered to an

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Instructions for Forms 1094-C and 1095-C (2017)

Instructions For Forms 1094-C And 1095-C - 2017 Page 10

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