Form 1095-C is required by the federal Affordable Care Act (ACA). The ACA requires large employers to report to the IRS on the health coverage, if any, offered to their full-time employees. Form 1095-C provides both you and the IRS with information about the health insurance coverage offered to you and, if applicable, your family.
The state will mail you a Form 1095-C if you were full-time or received health coverage through your state employment at any point during the tax year. You may receive multiple Form 1095-Cs if you worked for multiple large employers during the tax year.
Keep this form with your tax documents. You may need to submit information from the form(s) as a part of your personal income tax filing.
You will be mailed a Form 1095-C if you were full-time or received health coverage through your state employment at any point during the tax year.
Please be sure your current mailing address is in Self Service. You can change or view your address in Self Service by clicking on My Personal Information, and then Home and Mailing Address, or submit your new address to your HR/Payroll office. Contact your HR office if you need help accessing Self Service.
We will mail the Form reporting on your coverage for 2015 by March 31, 2016. Thereafter, each year the Form will be provide by January 31st (or the next business day if January 31st falls on a Saturday, Sunday, or legal holiday).
The IRS has posted information on their website that states the 1095-C may assist individuals in preparing a return but that they are not required. Individuals may file their returns as they normally would. For more information see the IRS FAQs.
Employees of entities that are not a state agency but participate in the state's employee insurance program (also known as IBUs) will receive their Form 1095-C from their employer. The 1095 reporting regulations require employers to provide the form to their employees and do not allow for MMB to report for non-state agencies. Contact your HR/Payroll office to find out when and how they will distribute the Form 1095-C to their employees.
No. Only you will receive the Form 1095-C. We will not provide a separate form to others covered on your plan, even those who do not reside with you. As the recipient of the form, you should provide a copy to any of these individuals if they request it for their records.
No, not for 2015. In future years we expect it to be available electronically.
Contact SEGIP at 651-355-0100 or firstname.lastname@example.org. Include your name, employee ID number, a phone number or email address where you can be reached, confirm your mailing address, and state that you want a replacement Form 1095-C. You will be mailed a replacement.
If you were not full-time or did not receive health coverage through SEGIP at any point during the tax year you will not receive a Form 1095-C. You will receive a form only if you were offered coverage or were full-time during any month of the year. If you did not receive a form, and believe that you should have, contact SEGIP at 651-355-0100 or email@example.com. Include your name, employee ID, a phone number or email address where you can be reached, and explain why you think you should receive a form. Please remember, that forms will not be mailed until the last week of March, 2016.
A copy of your form will be sent to the IRS as required by law.
If you still think that there may be an error, contact SEGIP at 651-355-0100 or email at firstname.lastname@example.org. We will need your name, employee ID number, confirmation of your mailing address, and a phone number or email address where you can be reached. Please explain what information you think is wrong and why. We will research the issue and contact you.
Line 15 displays the employee's share of the monthly premium for single coverage offered through SEGIP. This is required even if it does not match what you actually pay. For example, if you have family coverage the amount displayed on Line 15 will still be the employee share of the cost of single coverage and not the employee share of the cost of family coverage.
Generally, an offer of COBRA continuation coverage due to termination of employment is not reported as an offer of coverage on Part II of Form 1095-C, unless you actually enrolled in the COBRA coverage.
If you were offered COBRA due to a reduction in hours you will still receive a form and the COBRA offer will be included.
Yes. The regulations require the state to provide a form for everyone who receives coverage, even if they are not an active employee.
No. Age 65 and older retirees who are on Medicare will receive a form from Medicare. The state's coverage coordinates with Medicare and is not required to send a separate Form.
If you are an employee who is age 65 or older and enrolled in the state's active employee plan you will receive a form from SEGIP.
Yes. The State offers a self-insured group health plan for employees, which meets the federal definition of minimum essential coverage.
This is important because most individuals who do not have minimum essential coverage or an exemption for each month of the year will need to make a payment with their tax return.
Yes, the State's plan meets the minimum value standard. This means that it's designed to pay at least 60 percent of the total cost of medical services.
Yes. Coverage is considered affordable if the employee's cost for employee-only coverage does not exceed 9.5 percent of an employee's household income. The health coverage provided by the State with the full employer contribution meets this standard.
No, you will not receive a form for stand-alone dental coverage.
Yes. As required by law, your Form 1095-C will include SSNs. We will truncate the SSN (meaning the first five numbers will be displayed as an asterisk) on the form we send to you. By law, we are required to send the IRS a copy of your form that displays the full SSN for both you and any other individual included on your coverage.
Yes, there are three versions:
Completion of the 1095-C for the state did not require the use of all the codes. These are the codes we used and their definitions: