This tab allows you to manually input and track year-to-date health coverage offers and health coverage enrollment details for employees and their covered individuals.
Notes:
- You can import records by uploading a comma-delimited text (.txt) file using the Utilities > Import ACA 1095-B/1095-C Data page.
- For employees with a self-insured insurance plan, you can extract insurance data from the Maintenance > Staff Demo > Insurance tab to this page by using the Utilities > Extract Insurance Data to 1095 Data utility.
- For more information about Form 1095-C, click here to view Form 1095-C and review the Instructions for Form 1095-C.
- The page consists of two grids.
Enter 1095-C data:
| Field | Description |
|---|---|
| Calendar Year | Populated with the current calendar year; however, you can enter a different year. The year must be greater than or equal to 2015. |
| Employee | Begin typing the employee name or number. As you type the data, a drop-down list of corresponding data is displayed. Select an employee and click Retrieve. Or, click Directory to perform a search in the Employees directory. Note: The employee autosuggest field includes employees whose records were created in Personnel but do not have a Pay Info or Job Info record. |
In the top grid:
| Offer of Coverage | Make the necessary selections:
If the employee received the same offer for the entire calendar year (January-December), in the All field, click
1A - Qualifying Offer
If the employee received various offers during the calendar year, click 1095-C Forms report notes:
If the Offer of Coverage (line 14) is 1A, 1F, 1G or 1H, the Employee Share (line 15) field is blank.
|
|---|---|
| Employee Share | |
| Safe Harbor |
Click
2A - Employee not employed on any day of the month
Note: It is possible that more than one circumstance applied to the same employee in the same month; however, only one code can be selected per month.
1095-C Forms report notes: |
❏ Click Save to save the changes.
In the bottom grid:
Under Covered Individuals, complete the following fields for each covered individual:
| Self-Insured | Select if the employer-provided self-insured coverage, and then enter the necessary information for each covered individual. If selected, at least one covered individual record must exist. |
|---|---|
| Plan Start Month | Type the two-digit number (01 through 12) indicating the calendar month during which the plan year begins for the health plan in which the employee is offered coverage (or would be offered coverage if the employee were eligible to participate in the plan). If more than one plan year could apply (for instance, if the ALE Member changes the plan year during the year), enter the earliest applicable month. |
| Employee | Select to indicate that the covered individual is an employee. This field can only be selected for one covered individual. |
| First Name | Type the covered individual’s first name. The field is 17 characters. |
| Middle Name | Type the covered individual’s middle name. The field is 14 characters. |
| Last Name | Type the covered individual’s last name. The field is 25 characters. |
| Generation | Click  to select the covered individual’s generation code. |
| SSN | Type the covered individual’s nine-digit social security number. Form revision per 2016 IRS guidelines, effective for the 2016 tax year: In the SSN or Other TIN field, type the covered individual’s nine-digit social security number or other taxpayer identification number. |
| DOB | Type the covered individual’s date of birth in the MMDDYYYY format. Or, select a date from the calendar. Form revision per 2016 IRS guidelines, effective for the 2016 tax year: In the DOB (If SSN or other TIN is not available) field, type the covered individual's date of birth in the MMDDYYYY format only if the SSN or other TIN field is blank. |
| All | Select to indicate that the individual was covered for at least one day per month for all 12 months of the calendar year. Or, if the individual was not covered for all months, select the applicable month (Jan-Dec) fields in which the individual was covered for at least one day during the month. |
❏ Click Save.