Form 1095-C Lines 14-16 Codes Explained
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Form 1095-C Lines 14-16 Codes Explained
You’ve managed ACA compliance all year, gathered the information you need for ACA reporting, and chose a reporting method. Now you’ve reached the step in ACA reporting where you have to choose the appropriate codes for Forms 1095-C, but which ones are correct? Let’s review the different codes you can input into lines 14-16 of Form 1095-C so you’re submitting error-free ACA reporting.
What Information You Need to Provide
Form 1095-C is intended to provide employees with information about their medical benefits for reporting purposes. Here is what you need to include on Form 1095-C for each employee:
- Line 14 - What medical benefit did you offer the employee?
- Line 15 - How much did the offer cost the employee?
- Line 16 – What did the employee do when the offer was made? OR Why was the offer not made?
Lines 14-16 Codes Explained
Every applicable large employer needs to provide a Form 1095-C with Lines 14-16 completed with the correct information. Here is a breakdown of each line and what the corresponding codes mean:
Line 14 - Offer of Coverage
Line 14 specifies the type of coverage, if any, offered to an employee, spouse, and dependents. The code chosen must indicate the coverage the employee was offered. Keep in mind, this code may not match the coverage the employee chose.
For example, if an employee is offered family coverage but enrolls in employee-only coverage, Line 14 must reflect the employee was offered family coverage but enrolls in employee-only coverage.
A code must be entered for each calendar month, even if the employee was not a full-time employee for one or more months. If the same offer applies to all 12 months, the “All 12 Months” box may be completed.
Line 15 - Employee Share of Lowest Cost Monthly Premium for Self-Only Minimum Value Coverage
For Line 15, enter the amount of the employee share of the lowest-cost monthly premium for self-only minimum essential coverage (MEC) providing minimum value (MV) offered to the employee. This amount may not equal the amount the employee is actually paying for coverage.
For example, an employee enrolled in family coverage with a monthly premium of $250.00. The monthly premium for employee-only coverage is $150.00 which is the amount that should be entered on Line 15.
| Line 14 Codes | Line 14 Code Descriptions | Line 15 Entry |
|---|---|---|
| 1A | Qualifying Offer: Minimum essential coverage (MEC) providing minimum value (MV) offered to full-time employee with Employee Required Contribution equal to or less than 9.5% (as adjusted) of mainland single federal poverty line and at least MEC offered to spouse and dependent(s). | Leave Blank |
| 1B | MEC providing MV offered to employee only. | Required |
| 1C | MEC providing MV offered to employee and at least MEC offered to dependent(s) (not spouse). | Required |
| 1D | MEC providing MV offered to employee and at least MEC offered to spouse (not dependent(s)). Do not use code 1D if the coverage for the spouse was offered conditionally. Instead, use code 1J. | Required |
| 1E | MEC providing MV offered to employee and at least MEC offered to dependent(s) and spouse. Do not use code 1E if the coverage for the spouse was offered conditionally. Instead, use code 1K. | Required |
| 1F | MEC NOT providing MV offered to employee; employee and spouse or dependent(s); or employee, spouse, and dependents. | Leave Blank |
| 1G | Offer of coverage for at least one month of the calendar year to an individual who was not an employee for any month of the calendar year or to an employee who was not a full-time employee for any month of the calendar year (which may include one or more months in which the individual was not an employee) and who enrolled in self-insured coverage for one or more months of the calendar year. NOTE: Code 1G applies for the entire year or not at all. | Leave Blank |
| 1H | No offer of coverage (employee not offered any health coverage or employee offered coverage that is not MEC, which may include one or more months in which the individual was not an employee). | Leave Blank |
| 1J | MEC providing MV was offered to employee and at least MEC conditionally offered to spouse; MEC not offered to dependent(s). | Required |
| 1K | MEC providing MV offered to employee; at least MEC offered to dependents; and at least MEC conditionally offered to spouse. | Required |
Line 16 - Section 4980H Safe Harbor Codes and Other Relief for ALE Members
Line 16 provides an opportunity for an employer to indicate an exception to a penalty. The following are the available codes in Code Series 2 an employer may choose from and what they mean. If the same code applies for all 12 calendar months, you may either enter the code in the “All 12 Months” box and not complete the monthly boxes. If none of the codes apply for a calendar month, leave the line blank for that month.
| Line 16 Code | Line 16 Code Descriptions |
|---|---|
| 2A | Employee not employed during the month |
| 2B | Employee is not a full-time employee |
| 2C | Employee enrolled in coverage offered |
| 2D | Employee is in a limited non-assessment period |
| 2E | Multi-employer interim rule relief |
| 2F | Section 4980H affordability Form W-2 safe harbor |
| 2G | Section 4980H affordability federal poverty line safe harbor |
| 2H | Section 4980H affordability rate of pay safe harbor |
If more than one code applies to Line 16, use the following guidelines:
- If 2E and any other Code series 2 applies, enter 2E
- If 2C and any other Code series 2 applies other than Code 2E, enter 2C
- If 2B and 2D apply, enter 2D
Note
There is no code to enter on Line 16 to indicate that a full-time employee offered coverage either did not enroll in the coverage or waived the coverage.
Linda
Business Administrator, Christ’s Church
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