1095-C

Employer-Provided Health Insurance Offer and Coverage

Agency
IRS
Revision
2026
Fillable fields
306
Pages
4
Official source
IRS form page
Checked
October 21, 2026
Fill 1095-C online
Page 1 of form 1095-C

Form 1095-C: Employer-Provided Health Insurance Offer and Coverage

Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, is an information return completed by an employer, not by the employee. The IRS page says it is filed and furnished to any employee of an Applicable Large Employer (ALE) member who is a full-time employee for one or more months of the calendar year, and that ALE members report that information for all twelve months.

The instructions say Form 1095-C reports information about each employee to the IRS and to the employee. It is used in determining whether an ALE Member owes a payment under the employer shared responsibility provisions of section 4980H, and in determining employees' eligibility for the premium tax credit. Employers with self-insured coverage also list the covered individuals in Part III.

The PDF on this page is the 2026 Form 1095-C. When checked, the instructions linked from the IRS page were the 2025 Instructions for Forms 1094-C and 1095-C. You can fill out Form 1095-C free in your browser on this page and download it without an account.

What's on Form 1095-C

Part I: employee, lines 1 to 6

The employee's name, social security number and address.

Part I: employer, lines 7 to 13

The ALE Member's name, employer identification number, address and a contact telephone number for questions about the form.

Line 14: offer of coverage

A code for each month, or one code in the All 12 Months box, describing the coverage offered to the employee, spouse and dependents. The top of Part II also asks for the employee's age on January 1 and the plan start month.

Line 15: employee required contribution

The monthly cost to the employee for the lowest-cost, self-only, minimum essential coverage providing minimum value that the employer offered.

Lines 16 and 17

Line 16 holds section 4980H safe harbor and other relief codes. Line 17 holds the ZIP code used for an individual coverage HRA.

Part III: covered individuals

Lines 18 to 30 for self-insured coverage: each covered person's name, SSN or other TIN, date of birth if no TIN, and the months of coverage.

How the employer fills out Form 1095-C

  1. 1

    Part I

    Enter the employee's name, nine-digit SSN and address, then the ALE Member's name, nine-digit EIN and address. The instructions say these should match what is reported on Form 1094-C. Line 10 is the phone number the employee may call.

  2. 2

    Age and plan start month

    Enter the employee's age on January 1 if an individual coverage HRA was offered. For the plan start month, the 2025 instructions say to enter 01 through 12, or 00 if no health plan offers coverage to the employee.

  3. 3

    Line 14

    Enter a Code Series 1 code for each month, or one code in All 12 Months if it is the same all year. The instructions say to enter code 1H for a month with no offer and not to leave any month blank.

  4. 4

    Line 15

    Complete it only when line 14 has code 1B, 1C, 1D, 1E, 1J, 1K, 1L, 1M, 1N, 1O, 1P, 1Q, 1T or 1U. Enter the amount with cents, or 0.00 when the coverage costs the employee nothing.

  5. 5

    Lines 16 and 17

    Enter one Code Series 2 code per month, such as 2C when the employee enrolled, or leave the month blank if none applies. Line 17 takes the ZIP code when an individual coverage HRA code is on line 14.

  6. 6

    Part III

    Only for self-insured coverage: check the box, list the employee on line 18 and enrolled family members below. Check column (d) for coverage of at least 1 day in every month, or mark the months in column (e). Use extra copies of page 3 for more than 13 people.

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Where it goes and due dates

Filed with Form 1094-C

The instructions say a Form 1094-C is filed whenever an ALE Member files one or more Forms 1095-C, and Form 1094-C transmits them to the IRS.

Filing due dates

The instructions say Forms 1094-C and 1095-C are generally filed by February 28 on paper, or March 31 electronically, of the year after the calendar year reported. For calendar year 2025 they give March 2, 2026, or March 31, 2026, if filing electronically.

Furnishing to employees

For the 2025 calendar year, the instructions say an ALE Member furnishes Form 1095-C to each full-time employee by March 2, 2026, and describe an alternative of posting a website notice and sending a copy on request.

Electronic filing

The instructions say a filer with 10 or more information returns during the year files electronically, through the ACA Information Return (AIR) system, unless a waiver requested on Form 8508 is approved.

Paper filing addresses

The instructions list Department of the Treasury, Internal Revenue Service Center, Austin, TX 73301, or P.O. Box 219256, Kansas City, MO 64121-9256, depending on the state of the principal business or legal residence.

Penalties

For 2025 tax year returns, the instructions list $340 for each failure to file a correct information return and $340 for each failure to provide a correct payee statement, each capped at $4,098,500 a year.

Related forms

Who files and who receives Form 1095-C?

  • Applicable Large Employer Members

    The instructions say an ALE Member files a Form 1095-C for each employee who was full-time for any month of the year. An Applicable Large Employer is generally an employer with 50 or more full-time employees, including full-time equivalents, in the previous year.

  • Employees who receive it

    The recipient instructions say an employee gets the form because the employer is an Applicable Large Employer. The form says not to attach it to a tax return and to keep it for records.

  • Employers with self-insured plans

    The instructions say ALE Members with employer-sponsored, self-insured coverage complete Parts I, II and III for any employee who enrolls, whether or not the employee is full-time.

  • Covered family members

    Family members enrolled through the employee are listed in Part III of the employee's form. The form says employers furnish it only to the employee, who may give a copy to covered family members who ask.

  • Employers that are not ALE Members

    The instructions say an employer with self-insured coverage that is not an ALE Member files Forms 1094-B and 1095-B instead of Forms 1094-C and 1095-C.

The employer completes the form, files it with the IRS with Form 1094-C, and generally furnishes a copy to the employee. The employee does not file it.

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Questions about Form 1095-C

Do I attach Form 1095-C to my tax return?

No. The form says do not attach it to your tax return and keep it for your records.

Who sends Form 1095-C?

An Applicable Large Employer Member. The instructions describe that as generally an employer with 50 or more full-time employees, including full-time equivalent employees, in the previous year.

Why did I get more than one Form 1095-C?

The recipient instructions say this can happen if you had more than one Applicable Large Employer during the year. Each form covers only the coverage offered by the employer named on it.

What if my employer is not an Applicable Large Employer?

The recipient instructions say such an employer is not required to furnish Form 1095-C. Coverage information may come on Form 1095-B instead.

Why is only part of my SSN shown?

The recipient instructions say the form may show only the last four digits for your protection, while the employer reports the complete SSN to the IRS.

Is line 15 the amount I paid?

Not always. The recipient instructions say it may differ, for example if you chose more expensive coverage such as family coverage.

Who do I call with questions?

Line 10 gives a contact number at the employer. For questions about the Affordable Care Act, the form lists the IRS Healthcare Hotline at 800-919-0452.