Instructions For Forms 1094-C And 1095-C - 2017 (Page 2 of 17) in pdf

Reporting by Employers That

(Lines 17–22), later. Form 1095-C may be used only if the

individual identified on line 1 has an SSN.

Sponsor Self-Insured Health Plans

Substitute Statements to Recipients

An employer that offers health coverage through a self-insured

health plan must report information about each individual

If you are not using the official IRS form to furnish statements to

enrolled in such coverage. For an employer that is an ALE

recipients, see Pub. 5223, General Rules and Specifications for

Member, this information must be reported on Form 1095-C,

Affordable Care Act Substitute Forms 1095-A, 1094-B, 1095-B,

Part III, for any employee who is enrolled in coverage (and any

1094-C, and 1095-C, which explains the requirements for format

spouse or dependent of that employee). See below for the

and content of substitute statements to recipients. You may

option to file Form 1094-B and Form 1095-B, rather than Form

develop them yourself or buy them from a private printer.

1094-C and Form 1095-C, to report coverage of certain

Substitute statements furnished to recipients may be in portrait

non-employees.

format; however, substitute returns filed with the IRS using paper

must be printed in landscape format.

ALE Members that offer health coverage through an

Authoritative Transmittal for ALE

employer-sponsored self-insured health plan must complete

Form 1095-C, Parts I, II, and III, for any employee who enrolls in

Members Filing Multiple Forms 1094-C

the health coverage, whether or not the employee is a full-time

A Form 1094-C must be filed when an ALE Member files one or

employee for any month of the calendar year.

more Forms 1095-C. An ALE Member may choose to file

multiple Forms 1094-C, each accompanied by Forms 1095-C for

For full-time employees enrolled in an ALE Member’s

a portion of its employees, provided that a Form 1095-C is filed

self-insured coverage, including an employee who was a

for each employee for whom the ALE Member is required to file.

full-time employee for at least one month of the calendar year,

If an ALE Member files more than one Form 1094-C, one (and

the ALE Member must complete Form 1095-C, Part II, according

only one) Form 1094-C filed by the ALE Member must be

to the generally applicable instructions, and should not enter

identified on line 19, Part I as the Authoritative Transmittal, and,

code 1G on line 14 for any month. For an employee enrolled in

on the Authoritative Transmittal, the ALE Member must report

an ALE Member’s self-insured coverage who is not a full-time

certain aggregate data for all full-time employees and all

employee for any month of the calendar year (meaning that for

employees, as applicable, of the ALE Member.

all 12 calendar months the employee was not a full-time

Example 1. Employer A, an ALE Member, files a single

employee), for Form 1095-C, Part II, the ALE Member must

Form 1094-C, attaching Forms 1095-C for each of its 100

enter code 1G on line 14 in the “All 12 Months” column or in the

full-time employees. This Form 1094-C should be identified as

separate monthly boxes for all 12 calendar months, and the ALE

the Authoritative Transmittal on line 19, and the remainder of the

Member need not complete Part II, lines 15 and 16.

form completed as indicated in the instructions for line 19, later.

An employer that offers employer-sponsored self-insured

Example 2. Employer B, an ALE Member, files two Forms

health coverage but is not an ALE Member should not file Forms

1094-C, one for each of its two operating divisions, Division X

1094-C and 1095-C, but should instead file Forms 1094-B and

and Division Y. (Division X and Division Y are units of the same

1095-B to report information for employees who enrolled in the

ALE Member, and thus both report under the same employer

employer-sponsored self-insured health coverage.

identification number (EIN); they are not members of an

Aggregated ALE Group.) Attached to one Form 1094-C are

Note. If an ALE Member is offering health coverage to

Forms 1095-C for the 200 full-time employees of Division X, and

employees other than under a self-insured plan, such as through

attached to the other Form 1094-C are Forms 1095-C for the

an insured health plan or a multiemployer health plan, the issuer

1,000 full-time employees of Division Y. One of these Forms

of the insurance or the sponsor of the plan providing the

1094-C should be identified as the Authoritative Transmittal on

coverage is required to furnish the information about their health

line 19, and should include aggregate employer-level data for all

coverage to any enrolled employees, and the ALE Member

1,200 full-time employees of Employer B as well as the total

should not complete Form 1095-C, Part III, for those employees.

number of employees of Employer B, as applicable, as required

in Parts II, III, and IV of Form 1094-C. The other Form 1094-C

Reporting of Enrollment Information

should not be identified as the Authoritative Transmittal on

line 19, should report on line 18 only the number of Forms

for Non-Employees: Option

1095-C that are attached to that Form 1094-C, and should leave

To Use Forms 1094-B and 1095-B

the remaining sections of the form blank as indicated in the

instructions for line 19, later.

ALE Members that offer employer-sponsored self-insured health

coverage to non-employees who enroll in the coverage may use

Note. Each ALE Member must file its own Forms 1094-C and

Forms 1094-B and 1095-B, rather than Form 1095-C, Part III, to

1095-C under its own separate EIN, even if the ALE Member is

report coverage for those individuals and other family members.

part of an Aggregated ALE Group. No Authoritative Transmittal

For this purpose, a non-employee includes, for example, a

should be filed for an Aggregated ALE Group.

non-employee director, an individual who was a retired

employee during the entire year, or a non-employee COBRA

Example 3. Assume that Employer A from Example 1 is a

beneficiary, including a former employee who terminated

member of the same Aggregated ALE Group as Employer B

employment during a previous year.

from Example 2. Accordingly, Employer A and Employer B are

separate ALE Members filing under separate EINs. Forms

For information on reporting for non-employees enrolled in an

1094-C should be filed in the same manner indicated in

employer-sponsored self-insured health plan using Forms

Examples 1 and 2. Employer A should include only information

1094-B and 1095-B, see the instructions for those forms.

about employees of Employer A in its Authoritative Transmittal,

and Employer B should include only information about

employees of Employer B in its Authoritative Transmittal. No

For ALE Members that choose to use Form 1095-C to report

Authoritative Transmittal should be filed for the Aggregated ALE

coverage information for non-employees enrolled in an

Group reporting combined data for employees of both Employer

employer-sponsored self-insured health plan, see the specific

A and Employer B.

instructions for Form 1095-C, Part III—Covered Individuals

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

Instructions For Forms 1094-C And 1095-C - 2017 Page 2

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