Instructions For Forms 1094-C And 1095-C - 2017 (Page 11 of 17) in pdf

qualifying event, but an ALE Member may choose to extend a

offered to spouse (not dependent(s)). Do not use code 1D if the

similar offer of coverage to a spouse or dependent even if the

coverage for the spouse was offered conditionally. Instead use

offer is not required by COBRA.

code 1J.

1E. Minimum essential coverage providing minimum value

Example. During the applicable open enrollment period for

offered to employee and at least minimum essential coverage

its health plan, Employer makes an offer of minimum essential

offered to dependent(s) and spouse. Do not use code 1E if the

coverage providing minimum value to Employee and to

coverage for the spouse was offered conditionally. Instead use

Employee’s spouse and dependents. Employee elects to enroll

code 1K.

in employee-only coverage starting January 1. On June 1,

1F. Minimum essential coverage NOT providing minimum

Employee experiences a reduction in hours that results in loss of

value offered to employee; employee and spouse or

eligibility for coverage under the plan. As of June 1, Employer

dependent(s); or employee, spouse and dependents.

terminates Employee’s existing coverage and makes an offer of

1G. Offer of coverage for at least one month of the calendar

COBRA continuation coverage to Employee, but does not make

year to an individual who was not an employee for any month of

an offer to Employee’s spouse and dependents. Employer

the calendar year or to an employee who was not a full-time

should enter code 1E (Minimum essential coverage providing

employee for any month of the calendar year (which may include

minimum value offered to employee and at least minimum

one or more months in which the individual was not an

essential coverage offered to dependent(s) and spouse) on

employee) and who enrolled in self-insured coverage for one or

line 14 for months January – May, and should enter code 1B

more months of the calendar year.

(Minimum essential coverage providing minimum value offered

to employee only) on line 14 for months June – December.

Note. Code 1G applies for the entire year or not at all.

Therefore, if code 1G applies, an ALE Member must enter code

Note. Notwithstanding the preceding instructions for completing

1G on line 14 in the “All 12 Months” column or in each separate

line 14 of Form 1095-C, for purposes of section 4980H, an ALE

monthly box (for all 12 months).

Member is treated as having made an offer to the employee’s

1H. No offer of coverage (employee not offered any health

dependents for an entire plan year if the ALE Member provided

coverage or employee offered coverage that is not minimum

the employee an effective opportunity to enroll the employee’s

essential coverage, which may include one or more months in

dependents at least once for the plan year, even if the employee

which the individual was not an employee).

declined to enroll the dependents in the coverage and, as a

1I. Reserved.

result, the dependents later did not receive an offer of COBRA

1J. Minimum essential coverage providing minimum value

coverage.

offered to employee and at least minimum essential coverage

Post-employment (non-COBRA) coverage. An offer of

conditionally offered to spouse; minimum essential coverage not

post-employment coverage to a former employee (or to that

offered to dependent(s). (See

Conditional offer of spousal

former employee’s spouse or dependent(s)) for coverage that

coverage, above, for an additional description of conditional

would be effective after the employee has terminated

offers.)

employment (such as at retirement) should not be reported as

1K. Minimum essential coverage providing minimum value

an offer of coverage on line 14. If the ALE Member is otherwise

offered to employee; at least minimum essential coverage

required to file Form 1095-C for the former employee (because,

offered to dependents; and at least minimum essential coverage

for example, the individual was a full-time employee for one or

conditionally offered to spouse. (See

Conditional offer of spousal

more months in the calendar year in which the termination of

coverage, above, for an additional description of conditional

employment occurred), the ALE Member should enter code 1H

offers.)

(no offer of coverage) on line 14 for any month to which an offer

of post-employment coverage applies, and should also enter

Line 15. Complete line 15 only if code 1B, 1C, 1D, 1E, 1J, or 1K

code 2A (not an employee) on line 16 (see the instructions for

is entered on line 14 either in the “All 12 Months” box or in any of

line 16).

the monthly boxes. Enter the amount of the Employee Required

Contribution, which is, generally, the employee share of the

For additional information including examples about

monthly cost for the lowest-cost self-only minimum essential

reporting offers of COBRA continuation coverage and

TIP

coverage providing minimum value that is offered to the

post-employment coverage, go to

employee. For additional details on how to determine the

Affordable-Care-Act/Employers/Questions-and-Answers-about-

Employee Required Contribution, see the

Definitions

section,

Information-Reporting-by-Employers-on-Form-1094-C-and-

later. Enter the amount including any cents. If the employee is

Form-1095-C.

offered coverage but the Employee Required Contribution is

zero, enter “0.00” (do not leave blank). If the Employee Required

1A. Qualifying Offer: Minimum essential coverage providing

Contribution was the same amount for all 12 calendar months,

minimum value offered to full-time employee with Employee

you may enter that monthly amount in the “All 12 Months” box

Required Contribution equal to or less than 9.5% (as adjusted)

and not complete the monthly boxes. If the Employee Required

of mainland single federal poverty line and at least minimum

Contribution was not the same for all 12 months (for instance, if

essential coverage offered to spouse and dependent(s).

an ALE Member has a non-calendar year plan and the employee

This code may be used to report for specific months for

share of the premium changes with the new plan year that starts

which a Qualifying Offer was made, even if the

in 2017), enter the amount in each calendar month for which the

TIP

employee did not receive a Qualifying Offer for all 12

employee was offered minimum value coverage. See the

months of the calendar year. However, an ALE Member may not

definition of

Employee Required Contribution

in the Definitions

use the Alternative Furnishing Method for an employee who did

section, for more information, including on how to determine the

not receive a Qualifying Offer for all 12 calendar months.

monthly required contribution from annual data.

1B. Minimum essential coverage providing minimum value

For line 15, the amount entered might not be the amount

offered to employee only.

the employee is paying for the coverage, for example, if

TIP

1C. Minimum essential coverage providing minimum value

the employee chose to enroll in more expensive

offered to employee and at least minimum essential coverage

coverage such as family coverage or if the employee is eligible

offered to dependent(s) (not spouse).

for certain other healthcare arrangements.

1D. Minimum essential coverage providing minimum value

offered to employee and at least minimum essential coverage

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

Instructions For Forms 1094-C And 1095-C - 2017 Page 11

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