IRS Form 1095-C Instructions for 2022 Tax Year

1. Instructions on How to Fill Out Form 1095-C

Form 1095-C consists of 3 parts in total.

• Part 1: Employee and Applicable Large Employer
• Part 2: Employee Offer of Coverage
• Part 3: Covered Individuals

Here are the instructions on how to complete each part of the form.

Part I - Employee and Applicable Large Employer

Part I of 1095-C is comprised of two sections that report employee and employer information. Here is how you can fill in the employee details on Form 1095-C, Part I.

Employee Details

In this part, you are required to provide basic information about the employee.

• Line 1:

  Enter the name of your employee (first name, initial, last name).

• Line 2:

  Enter the employee’s Social Security Number (SSN).

• Line 3:

  Enter the employee’s street address, including the apartment number.

• Line 4:

  Enter the employee’s city or town.

• Line 5:

  Enter the employee’s state, or province

• Line 6:

  Enter the employee’s country and ZIP or foreign postal code.

Details about Applicable Large Employer (ALE)

In this part, you need to enter the basic details of the Applicable Large Employer.

• Line 7:

  Enter the name of the employer.

• Line 8:

  Enter the Employer Identification Number (EIN).

• Line 9:

  Enter the employer’s street address, including room or suite number.

• Line 10:

  Enter the employer’s contact telephone number.

• Line 11:

  Enter the city or town.

• Line 12:

  Enter the employer’s state or province.

• Line 13:

  Enter the employer’s state or province.

Part II - Employer Offer of Coverage

In this part, you should enter the health insurance coverage details offered to the employee.

• Line 14 (Offer of Coverage):

  1095-C Codes (1A-1U) are used to describe the health insurance coverage offered to your employee. There are 21 codes available, and you should enter the applicable one based on the type of coverage offered.

• Line 15 (Employee Required Contribution)

  • This line should only be completed when the code on line 14 is 1B, 1C, 1D, 1E, 1J, 1K, 1L, 1M, 1N, 1O, 1P, or 1Q.
  • Enter the Employee Required Contribution, which is the employee’s monthly share of the lowest-cost self-only minimum essential coverage providing the minimum value that you offered your employee.

• Line 16 (Section 4980H Safe Harbor and Other Relief)

  • Enter the code related to Section 4980H Safe Harbor and Other Relief.
  • There are 11 different codes to be entered on this line, where each one defines the type of coverage provided to the employee in the previous year and how the employer meets the employer-shared provisions of Section 4980H.
  • The code you enter provides the IRS information to administer the employer-shared provisions.

  Learn more about Form 1095-C Codes

• Line 17

  Enter the ZIP code that you used to calculate the employee’s affordability. Only complete this if you have provided individual coverage HRA to the employee.

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Part III - Covered Individuals

• This section should only be completed if you offer employer-sponsored, self-insured health coverage, including an individual coverage HRA.
• The individual’s details, including any full-time employee and non-full-time employee, and any employee’s family members enrolled under the employer’s health plan should be listed here.
• The details include name, SSN, and DOB. If they are covered for all 12 months, check the box “Covered all 12 months”. If the employee was only covered for a few months of the year, check all of the applicable boxes.

• Line 18 - 30

  Enter the following information for the individuals covered under the plan.

  • (a) Name of covered individual(s) - Enter the name of the individuals covered under the employer’s health plan.
  • (b) SSN or other TIN - Enter their SSN or other TIN.
  • (c) DOB - Enter the individual’s DOB if no SSN or TIN is available.
  • (d) Covered all 12 months - If the health plan is provided for all 12 months, check this box.
  • (e) Months of coverage - If the health plan was only provided for a few months in a year, check the applicable boxes.

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• TaxBandits offers dedicated live support via live chat, phone, and email.

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