1095-C ACA Tax Document

 The IRS Form 1095-C reports whether CU offered you health coverage for tax year 2016 that was affordable under Affordable Care Act (ACA) standards. You do not need this form to file your taxes, but you should save it with your tax return. 

   Request a reissued 1095-C form

Select the toggles below for an explanation of each line within the form.

Lines 1-6

These lines report your name, Social Security number and residence. 

Lines 7-13

These lines report the name of your employer and its ID number and location, and the CU phone number to call if you have questions about this form. 

Line 14

The code entered on this line describes what, if any, kind of coverage CU offered you and/or your spouse and/or dependents in the last tax year.

Benefits-eligible CU employees who were enrolled in CU plans during the tax year will see one of the following codes:

1A

Minimum essential coverage providing minimum value was offered to you with an employee contribution for self-only coverage equal to or less than 9.5 percent of the 48 contiguous states' single federal poverty line and minimum essential coverage offered to your spouse and dependent(s) (referred to here as a Qualifying Offer). This code may be used to report for specific months for which a Qualifying Offer was made, even if you did not receive a Qualifying Offer for all 12 months of the calendar year.

1B

Minimum essential coverage providing minimum value was offered to you and minimum essential coverage NOT offered to your spouse or dependent(s).

1C

Minimum essential coverage providing minimum value was offered to you, and minimum essential coverage was offered to your dependent(s) but NOT your spouse.

1D

Minimum essential coverage providing minimum value was offered to you, and minimum essential coverage was offered to your spouse but NOT your dependent(s).

1E

Minimum essential coverage providing minimum value was offered to you, and minimum essential coverage was offered to your dependent(s) and spouse.

1F

Minimum essential coverage NOT providing minimum value was offered to you, or you and your spouse or dependent(s), or you, your spouse, and dependent(s).

1G

You were NOT a full-time employee for any month of the calendar year, but you were enrolled in self-insured, employer-sponsored coverage for one or more months of the calendar year. This code will be entered in the All 12 Months box on line 14.

1H

No offer of coverage (You were NOT offered any health coverage or you were offered coverage that is NOT minimum essential coverage.)

1I

CU claimed "Qualifying Offer Transition Relief" for 2015, and for at least one month of the year, you (and your spouse or dependent(s)) did not receive a Qualifying Offer. Note that CU has listed a phone number (on line 10 of this form) that you may call to request more information about the health coverage, if any, you were offered.

Line 15

This line reports your share of the lowest-cost monthly premium for self-only, minimum essential coverage that CU offered you. In the university's case, this is CU Health Plan - High Deductible, which has an employee-only premium of $0. (This amount may not be what you paid for coverage if, for example, you're enrolled in a plan other than CU Health Plan - High Deductible, or if you enrolled in employee + spouse, employee + child(ren), or family coverage.)

It reflects an amount only if code 1B, 1C, 1D or 1E is entered on line 14.

If you were offered coverage but not required to contribute any amount toward the premium, this line will report “0.00” for the amount.

Line 16

This code provides the IRS information to administer the employer-shared responsibility provisions. With the exception of code 2C, which reflects your enrollment in CU's coverage, none of this information affects your eligibility for the premium tax credit. For more information about the employer shared responsibility provisions, see www.irs.gov.

Lines 17-22

These lines report the name, Social Security number (or tax identification number for covered individuals other than the employee listed in Part I), and coverage information about each individual (including any full-time employee and non-full-time employee, and any employee's family members) covered under a CU Health Plan, if the plan is self-insured. A date of birth will be entered in column C only if a Social Security number or tax identification number is not entered in column B. Column D will be checked if you were covered for at least one day in every month of the year. For those who were covered for some but not all months, information will be entered in column E, indicating the months for which they were covered. If there are more than six covered individuals, see the additional covered individuals on Part III, Continuation Sheet(s).

Questions? Visit the IRS website, or call Employee Services at 303-860-4200.