" "

1095-C tax form

About Form 1095-C

In late February, the Public Employees Benefits Board (PEBB) Program, on behalf of your employer, will mail IRS tax Form 1095-C and an explanatory insert to:

  • Retirees, COBRA, PEBB Continuation coverage and employee subscribers enrolled in Uniform Medical Plan for at least one month in 2016.

    AND

  • State agency, higher education and commodity commission employees who met the full-time federal guideline in 2016.

Form 1095-C FAQs

Why am I getting Form 1095-C?

The individual shared responsibility provision of the Affordable Care Act (ACA) requires you, your spouse, and your dependents to have qualifying health insurance for the entire year, report a health coverage exemption, or make a payment when you file your 2016 taxes.  You may receive one or more of the following tax forms to help you prepare your federal taxes, which describe your health coverage throughout the tax year: Form 1095-A, Form 1095-B, and Form 1095-C.

What is Form 1095-C?

Form 1095-C verifies if full-time employees were made an offer of health coverage by their employer that met federal standards of affordability and minimum value.  Form 1095-C reports enrollment in an employer’s self-insured health plan (e.g. Uniform Medical Plan).

Will I receive more than one form? 

You may receive multiple 1095 forms depending on you and your family members’ coverage in 2016.  For example:

  • If you are a full time employee of a state agency, higher education institution or commodity commission, and you were enrolled in Group Health or Kaiser Permanente, you will receive both Form 1095-C from your employer and Form 1095-B from the health plan.
  • If you were employed by two or more employers during the reporting year, and you were full time (for at least one month) at each employer you may receive a From 1095-C from each employer.

Do these forms need to be filed with individual 2016 tax returns?

No. The information in a 1095 form helps you complete your tax return, but is not filed with your tax return. And, you don't need to wait to receive your 1095 before filing your tax return. Other documents such as your insurance card, or W-2 can be used when completing your tax return. Contact your tax professional or the IRS if you have questions. More information can also be found at Affordable Care Act Tax Provisions for Individuals and Families.

Why are you sending me Form 1095 when I don’t need to file it with my tax return?

Form 1095 is treated similarly to the W-2’s that employees receive every year from their employer.  Federal law requires that both you and the IRS receive a copy of Form 1095.

When you receive your form 1095, please take a few minutes to verify that the information is accurate. Please contact the number listed on Line 10 of Form 1095-C or Line 18 of Form 1095-B to report any errors.

What should I do if the information is incorrect on the enclosed 1095 form?

  • For Form 1095-C: call the contact telephone number listed on Line 10 of the form. 
  • For Form 1095-B: call the contact telephone number listed on Line 18 of the form.

Exceptions

  • Retirees of agencies, higher education institutions, community and technical colleges, commodity commissions, COBRA and Continuation Coverage, contact PEBB Customer Service at 1-800-200-1004.

  • Retirees of K-12 institutions or employer groups should contact their former employer. The contact number should be included on the 1095.

Remember! You don’t need the 1095-B or 1095-C to file your tax return.  Learn more at Affordable Care Act Tax Provisions for Individuals and Families.

I misplaced my Form 1095. How do I get a new one?

Contact your employer, or PEBB if you meet one of the exceptions described below, or the issuing medical plan. The contact information can be found on:

  • Line 10 of Form 1095-C, or
  • Line 18 of Form 1095-B.

Exceptions

  • Retirees of agencies, higher education institutions, community and technical colleges, commodity commissions, COBRA and Continuation Coverage, contact PEBB Customer Service at 1-800-200-1004.
  • Retirees of K-12 institutions or employer groups should contact their former employer. The contact number should be included on the 1095.

Remember! You don’t need the 1095-B or 1095-C to file your tax return.  Learn more at Affordable Care Act Tax Provisions for Individuals and Families.

Why does my form include this person? I want them removed from my form.

Employers are required to furnish forms 1095-B and 1095-C to the employee (subscriber) only. The 1095-C form includes information about coverage, if any, your employer offered to you and your spouse and dependent(s). The 1095-B and 1095-C forms both include information showing that you, and any individuals enrolled under your coverage, had qualifying health coverage (referred to as “minimum essential coverage”) for some or all months during the year. The IRS expects you to provide a copy of the form to any of your covered dependents if they request it for their records.

Where can I learn more about reporting health coverage information to the IRS? 

Consult your tax professional or the IRS. More information can also be found at Affordable Care Act Tax Provisions for Individuals and Families.

IRS resources to help individuals with tax reporting questions