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Explains that the form is issued because an employer is an Applicable Large Employer under the Affordable Care Act, and outlines what Part I, Part II, and Part III contain regarding employee details, employer identification, offer of coverage codes, and applicable months of minimum essential coverage. Includes recipient-focused guidance on eligibility for the premium tax credit and references to IRS resources and related forms.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/employer-provided-health-insurance-offer-and-coverage-form-1095-c-instructions/302433/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/employer-provided-health-insurance-offer-and-coverage-form-1095-c-instructions/302433.png","ImageObject",442,249,{"name":88,"@type":89},"Felix Montgomery","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-27","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",7,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"Why do recipients receive Form 1095-C?","Question",{"text":109,"@type":110},"Recipients receive Form 1095-C because their employer is an Applicable Large Employer subject to the Affordable Care Act employer shared responsibility provisions. The form provides information about health insurance coverage offered to the employee and related individuals.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What does Part I of Form 1095-C cover?",{"text":114,"@type":110},"Part I, lines 1 through 6, reports employee information, including name and social security number. It also notes that for protection the form may show only the last four digits of the SSN.",{"name":116,"@type":107,"acceptedAnswer":117},"How are the employer coverage details handled in Part II (lines 14-17)?",{"text":118,"@type":110},"Part II explains codes for line 14 that describe the coverage offered, and line 15 reports the required employee contribution. Line 16 may include codes for Section 4980H safe harbor and other relief, and line 17 relates to ZIP code.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},302433,1790212156,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":79,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":73},549768064778,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","□VOID  \n# Employer-Provided Health Insurance Offer and Coverage\n\n  OMB No.1545-2251    \n□CORRECTED  \nDo not attach to your tax return.Keep for your records.  \nInternal Revenue Service  \nGo to www.irs.gov/Form1095C for instructions and the latest information.  \n\n| Partl  \u003Cbr>Employee   |  |  |  |  |  |  |  | Applicable Large Employer Member(Employer)   |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| 1 Name of employee(first name,middle i   |  |  | nitial,last name)   |  | 2 Social security number (SSN)   |  |  | 7 Name of employer   |  |  |  |  | 8Employer identification number (EIN)   |  |  |\n| 3Street address (including apartment no.)   |  |  |  |  |  |  |  | 9 Street address (including room or suite no.)   |  |  |  |  | 10 Contact telephone number   |  |  |\n| 4 City or town   |  |  | 5 State or province   |  | 6 Country and ZIP or foreign postal code   |  |  | 11 City or town   |  |  | 12 State or province   |  | 13 Country and ZIP or foreign postal code   |  |  |\n| Employee's Age on January 1  \u003Cbr>Part II Employee Offer of Coverage   |  |  |  |  |  |  |  |  |  | Plan Start Month (enter 2-digit number):   |  |  |  |  |  |\n|  | AIl 12 Months   | Jan   |  | Feb   | Mar   | Apr   | May   | June   | July   | Aug   |  | Sept   | Oct   | Nov   | Dec   |\n| 14 Offer of  \u003Cbr>Coverage(enter  \u003Cbr>required code)   |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| 15 Employee  \u003Cbr>Required  \u003Cbr>Contribution (see  \u003Cbr>instructions)   | $   | $   |  | $   | $   | $   | $   | $   | $   | $   |  | $   | $   | $   | $   |\n| 16 Section 4980H  \u003Cbr>Safe Harbor and  \u003Cbr>Other Relief (enter  \u003Cbr>code,if applicable)   |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| 17 ZIP Code   |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n\nFom 1095-C(2025)Created 5/21/25  \nFor Privacy Act and Paperwork Reduction Act Notice,see separate instructions.  \nCat.No.60705M  \n## Instructions for Recipient\n\nYou are receiving this Form 1095-C because your employer is an Applicable Large Employer subject tothe employer shared responsibility provisions in the Affordable Care Act.This Form 1095-Cincludesinformation about the health insurance coverage offered to you by your employer.Form 1095-C,Part  \nl,includes information about the coverage,if any,your employer offered to you and your spouse anddependent(s).If you purchased health insurance coverage through the Health Insurance Marketplaceand wish to claim the premium tax credit,this information will assist you in determining whether youare eligible.If you or your family members are eligible for certain types of minimum essential coverage,you may not be eligible for the premium tax credit.For more information about the premium tax credit,see Pub.974,Premium Tax Credit(PTC).  \nYou may receive multiple Forms 1095-C if you had multiple employers during the year that wereApplicable Large Employers(for example,you left employment with one Applicable Large Employerand began a new position of employment with another Applicable Large Employer).In that situation,each Form 1095-C would have information only about the health insurance coverage offered to you bythe employer identified on the form.If your employer is not an Applicable Large Employer,it is notrequired to furnish you a Form 1095-C providing information about the health coverageit offered.Inaddition,if youor any other individual who is offered health coverage because of their relationship toyou(referred to here as family members),enrolled in your employer's health plan and that plan is a typeof plan referred to as a “self-insured”plan,Form 1095-C,Part ⅢI,provides information about you andyour family members who had certain health coverage(referred to as “minimum essential coverage”)for some or all months during the year.  \nIf your employer provided you or a family member health coverage through an insured health plan orin another manner,you may receive information about the coverage separately on For","cbCaipaDUp7YDtH9","https://ap.wps.com/l/cbCaipaDUp7YDtH9","pdf",270510,"English","# Instructions for Recipient\n## Part I. Employee\n## Part I. Applicable Large Employer Member (Employer)\n## Part II. Employer Offer of Coverage, Lines 14-17","[{\"question\":\"Why do recipients receive Form 1095-C?\",\"answer\":\"Recipients receive Form 1095-C because their employer is an Applicable Large Employer subject to the Affordable Care Act employer shared responsibility provisions. The form provides information about health insurance coverage offered to the employee and related individuals.\"},{\"question\":\"What does Part I of Form 1095-C cover?\",\"answer\":\"Part I, lines 1 through 6, reports employee information, including name and social security number. It also notes that for protection the form may show only the last four digits of the SSN.\"},{\"question\":\"How are the employer coverage details handled in Part II (lines 14-17)?\",\"answer\":\"Part II explains codes for line 14 that describe the coverage offered, and line 15 reports the required employee contribution. Line 16 may include codes for Section 4980H safe harbor and other relief, and line 17 relates to ZIP code.\"}]","Employer-Provided Health Insurance Offer and Coverage - Form 1095-C Instructions | PDF",1789792943]