General Information About Forms 1095-B and 1095-C

All employers, including government agencies and non-profits, that provide “applicable employer-sponsored coverage” have reporting requirements under the Affordable Care Act (ACA). Note that for 2015 coverage year, Covered California for Small Business (CCSB) / SHOP plans consisted of groups up to 50 full-time employees. Employers of 50 and more full-time employees (including full-time equivalent employees) are considered Applicable Large Employers (ALE). Effective for plan year 2015, employers are required to report to their employees and the IRS the value of and type of coverage offered for each month of the plan year. The 1095-B and 1095-C are the IRS statements used to report that coverage.

1095-Bs are distributed to people who received insurance through small self-funded groups, employers who use the Small Business Health Options Program (SHOP) or fully-insured employer sponsored plans.

The Affordable Care Act requires employers with 50 or more full-time employees (including full-time equivalent employees) to offer healthcare coverage to full-time employees or potentially pay a monetary penalty. The 1095-C is the government’s way of tracking this. Similar to the W-2, your 1095-C will be used to file individual taxes and communicate your health insurance information.

Employer Reporting Statements for Communicating Health Insurance Information

1095-B

  • CCSB/SHOP plan members of the Small Employer, less than 50 full-time employees, group plans will receive a 1095-B from the Healthcare Plan Provider
  • If the individual is a recipient of Medi-Cal and other Government Sponsored Health Coverage in 2015; the Government Agency will issue a 1095-B to the plan member.

1095-C

  • If the employer is an Applicable Large Employer (ALE), generally at least 50 full-time employees, they are subject to the possibility of a shared responsibility payment to the IRS if the ALE does not offer to its employees and dependents minimum essential coverage (MEC) that is affordable. All CCSB plans provide MEC. CCSB plan members of this large employer group will issue 1095-Cs to their employees.

W-2

  • All employers that provide “applicable employer-sponsored coverage” must report the value of the healthcare coverage in box 12 of the annual W-2 form.
  • Generally, Employers with 49 and less full-time employees will only report the coverage value on the employee’s W-2. See question #9.