Instructions For Forms 1094-C And 1095-C - 2017 (Page 12 of 17) in pdf

post-employment coverage (enter code 2A). Do not enter code

Line 16. For each calendar month, enter the applicable code, if

2C in line 16 for any month in which the employee enrolled in

any, from Code Series 2. Enter only one code from Code Series

coverage that was not minimum essential coverage.

2 per calendar month. The instructions below address which

2D. Employee in a section 4980H(b) Limited

code to use for a month if more than one code from Series 2

Non-Assessment Period. Enter code 2D for any month during

could apply. If the same code applies for all 12 calendar months,

which an employee is in a section 4980H(b) Limited

you may enter the code in the “All 12 Months” box and not

Non-Assessment Period. If an employee is in an initial

complete the monthly boxes. If none of the codes apply for a

measurement period, enter code 2D (employee in a section

calendar month, leave the line blank for that month.

4980H(b) Limited Non-Assessment Period) for the month, and

Code Series 2—Section 4980H Safe Harbor Codes and

not code 2B (employee not a full-time employee). For an

Other Relief for ALE Members. An ALE Member enters the

employee in a section 4980H(b) Limited Non-Assessment

applicable Code Series 2 indicator code, if any, on line 16 to

Period for whom the ALE Member is also eligible for the

report for one or more months of the calendar year that one of

multiemployer interim rule relief for the month, enter code 2E

the following situations applied to the employee.

(multiemployer interim rule relief) and not code 2D (employee in

The employee was not employed or was not a full-time

a section 4980H(b) Limited Non-Assessment Period).

employee;

2E. Multiemployer interim rule relief. Enter code 2E for any

The employee enrolled in the minimum essential coverage

month for which the multiemployer arrangement interim

offered;

guidance applies for that employee, regardless of whether any

The employee was in a Limited Non-Assessment Period with

other code in Code Series 2 (including code 2C) might also

respect to section 4980H(b);

apply. This relief is described under

Offer of Health Coverage

The ALE Member met one of the section 4980H affordability

the Definitions section of these instructions.

safe harbors with respect to this employee; or

Note. Although ALE Members may use the section 4980H

The ALE Member was eligible for multiemployer interim rule

affordability safe harbors to determine affordability for purposes

relief for this employee.

of the multiemployer arrangement interim guidance, an ALE

If no indicator code applies, leave line 16 blank. In some

Member eligible for the relief provided in the multiemployer

circumstances more than one indicator code could apply to the

arrangement interim guidance for a month for an employee

same employee in the same month. For example, an employee

should enter code 2E (multiemployer interim rule relief), and not

could be enrolled in health coverage for a particular month

codes 2F, 2G, or 2H (codes for section 4980H affordability safe

during which he or she is not a full-time employee. However,

harbors).

only one code may be used for a particular calendar month. For

2F. Section 4980H affordability Form W-2 safe harbor. Enter

any month in which an employee enrolled in minimum essential

code 2F if the ALE Member used the section 4980H Form W-2

coverage, in general, indicator code 2C reporting enrollment is

safe harbor to determine affordability for purposes of section

used instead of any other indicator code that could also apply

4980H(b) for this employee for the year. If an ALE Member uses

(but see the exceptions to this rule below, regarding the

this safe harbor for an employee, it must be used for all months

multiemployer interim rule relief and enrollment in COBRA

of the calendar year for which the employee is offered health

continuation coverage or other post-employment coverage). For

coverage.

an employee who did not enroll in health coverage, there are

2G. Section 4980H affordability federal poverty line safe

some specific ordering rules for which code to use. See the

harbor. Enter code 2G if the ALE Member used the section

descriptions of the codes.

4980H federal poverty line safe harbor to determine affordability

for purposes of section 4980H(b) for this employee for any

Note. There is no specific code to enter on line 16 to indicate

month(s).

that a full-time employee offered coverage either did not enroll in

2H. Section 4980H affordability rate of pay safe harbor. Enter

the coverage or waived the coverage.

code 2H if the ALE Member used the section 4980H rate of pay

2A. Employee not employed during the month. Enter code 2A

safe harbor to determine affordability for purposes of section

if the employee was not employed on any day of the calendar

4980H(b) for this employee for any month(s).

month. Do not use code 2A for a month if the individual was an

employee of the ALE Member on any day of the calendar month.

Note. An affordability safe harbor code should not be entered

Do not use code 2A for the month during which an employee

on line 16 for any month that the ALE member did not offer

terminates employment with the ALE Member.

minimum essential coverage to at least 95% of its full-time

2B. Employee not a full-time employee. Enter code 2B if the

employees and their dependents (that is, any month for which

employee is not a full-time employee for the month and did not

the ALE member checked the “No” box on Form 1094-C, Part III,

enroll in minimum essential coverage, if offered for the month.

column (a)). For more information, see the instructions for Form

Enter code 2B also if the employee is a full-time employee for

1094-C, Part III, column (a).

the month and whose offer of coverage (or coverage if the

2I. Reserved.

employee was enrolled) ended before the last day of the month

solely because the employee terminated employment during the

Note. References to 9.5% in the section 4980H affordability

month (so that the offer of coverage or coverage would have

safe harbors and Qualifying Offer Method are applied based on

continued if the employee had not terminated employment

the percentage as indexed for purposes of applying the

during the month).

affordability thresholds under section 36B (the premium tax

2C. Employee enrolled in health coverage offered. Enter code

credit). The percentage, as adjusted, is 9.66% for plan years

2C for any month in which the employee enrolled for each day of

beginning in 2016, and 9.69% for plan years beginning in 2017.

the month in health coverage offered by the ALE Member,

Part III—Covered Individuals (Lines 17–22)

regardless of whether any other code in Code Series 2 might

also apply (for example, the code for a section 4980H

Complete Part III ONLY if the ALE Member offers

affordability safe harbor) except as provided below. Do not enter

employer-sponsored self-insured health coverage in which the

code 2C in line 16 for any month in which the multiemployer

employee or other individual enrolled. For this purpose,

interim rule relief applies (enter code 2E). Do not enter code 2C

employer-sponsored self-insured health coverage does not

in line 16 if code 1G is entered in line 14. Do not enter code 2C

include coverage under a multiemployer plan. Do not complete

in line 16 for any month in which a terminated employee is

Part III if the ALE Member offers coverage only under an insured

enrolled in COBRA continuation coverage or other

-12-

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

Instructions For Forms 1094-C And 1095-C - 2017 Page 12

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