Contents of the Manage 1095-C Data Screen
Use the fields and options to configure the Manage 1095-C Data screen.
Contents
| Field | Description |
|---|---|
| Employee |
Enter, or click
|
| Calendar Year |
Enter the 4-digit calendar year for which the 1095-C was created. |
| Taxable Entity |
Enter, or click
|
| Void |
Select this check box to void the 1095-C record. |
| Corrected |
If correcting information on a Form 1095-C that was previously filed with the IRS, file a fully completed Form 1095-C including the correct information and enter an X in the CORRECTED check box. File a Form 1094-C Transmittal (DO NOT mark the CORRECTED check box on the Form 1094-C) with corrected Form(s) 1095-C. Furnish the employee a copy of the corrected Form 1095-C, unless the employer is eligible to use the Qualifying Offer Method or the Qualifying Offer Method Transition Relief for 2015. For more information, see Alternative Method of Furnishing Form 1095-C to Employees under the Qualifying Offer Method or Alternative Method of Furnishing Form 1095-C to Employees under the Qualifying Offer Method Transition Relief. |
| Sequence Number |
This field displays the sequence number of the 1095-C for the specified employee / calendar year / taxable entity combination. If the 1095-C does not yet exist in the Manage 1095-C Data table, then a Sequence Number of 1 (one) will be assigned. The sequence number will be incremented by one for any correcting or voided 1095-Cs entered for the same employee / calendar year / taxable entity combination. |
| File Accepted |
This check box displays as selected when you processed this record on the Create 1094-C and 1095-C Electronic File screen using the Confirm Records as Accepted by the IRS processing option. The record is disabled and no longer editable if this check box is selected. |
| Record ID |
This field displays the XML record ID which is the unique identifying number that designates the 1095-C record’s location in the XML file submitted to the IRS. |
| Generation ID |
This field displays the data file generation key created when an electronic file is generated for 1094-C and 1095-C transmission. This ID is used when you process the record on the Create 1094-C and 1095-C Electronic File screen using the Confirm Records as Accepted by the IRS processing option. |
Part I
This group box contains employee and applicable large employer member information.
Employee
| Field | Description |
|---|---|
| 1 Name of Employee |
This field displays the name of the employee for which the 1095-C record is being entered. This field loads the Displayed Name assigned to the employee on the Manage Employee Information screen. |
| 2 Social Security Number |
This field displays the Social Security Number (SSN) of the employee for which the 1095-C record is being entered. This field loads the SSN assigned to the employee on the Manage Employee Information screen |
| 3 Street Address (including apt number) |
This field displays the street address (including apartment number) of the employee for which the 1095-C record is being entered. This field loads the Mailing Address-Address Line 1, Address Line 2, and Address Line 3 assigned to the employee on the Manage Employee Information screen. |
| 4 City or Town |
This field displays the city or town of the employee for which the 1095-C record is being entered. This field loads the Mailing Address City assigned to the employee on the Manage Employee Information screen. |
| 5 State/Province |
This field displays the State/Province of the employee for which the 1095-C record is being entered. This field loads the Mailing Address State/Province assigned to the employee on the Manage Employee Information screen. |
| 6 Country and ZIP or Foreign Postal Code |
This field displays the Country and Postal Code of the employee for which the 1095-C record is being entered. This field loads the Mailing Address Country and Postal Code assigned to the employee on the Manage Employee Information screen. |
Applicable Large Employer Member (Employer)
| Field | Description |
|---|---|
| 7 Name of Employer |
This field displays the name of the employer for which the 1095-C record is being entered. This field loads the name assigned to the taxable entity on the Configure Company Information screen. |
| 8 Employer Identification Number |
This field displays the Employer Identification Number (EIN) of the employer for which the 1095-C record is being entered. This field loads the tax ID assigned to the taxable entity on the Configure Company Information screen. |
| 9 Street Address (including room or suite number) |
This field displays the Street Address (including room or suite number) of the employer for which the 1095-C record is being entered. This field loads the Address Line 1, Address Line 2, and Address Line 3 assigned to the taxable entity on the Configure Company Information screen. |
| 10 Contact Telephone Number |
Enter the Contact Telephone Number of the taxable entity for which the 1095-C record is being entered. This field loads the telephone number assigned to the taxable entity on the Configure Company Information screen. |
| 11 City or Town |
This field displays the city or town of the taxable entity for which the 1095-C record is being entered. This field loads the city assigned to the taxable entity in the Configure Company Information screen. |
| 12 State/Province |
This field displays the state/province of the taxable entity for which the 1095-C record is being entered. This field loads the state/province assigned to the taxable entity on the Configure Company Information screen. |
| 13 Country and ZIP or Foreign Postal Code |
This field displays the country and ZIP or foreign postal code of the taxable entity for which the 1095-C record is being entered. This field loads the country and postal Code assigned to the taxable entity on the Configure Company Information screen. |
Part II - Employee Offer and Coverage
| Field | Description |
|---|---|
| Employee's Age on January 1 | Enter the age of the employee as of January 1st of the filing year. You must enter an age if the employee was offered an individual coverage HRA. |
| Plan Start Month (Two-Digit Number) |
From the drop-down list, select the beginning month of the plan year of the health plan in which is the employee is offered coverage. This may also be the month that the employee 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 employer changes the plan year during the year), enter the earliest applicable month. If there is no health plan under which coverage is offered to the employee, enter 00. |
14 Offer of Coverage
Use these fields to enter the offer of coverage that applies all 12 months of the calendar year or you can also enter the offer of coverage that applies to each month. The Lookup list will be maintained by Deltek. As of 2020, the list of valid Offer of Coverage codes are as follows:
Valid options are:
- 1A: Qualifying Offer: Minimum essential coverage providing minimum value 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 minimum essential coverage offered to spouse and dependent(s).
- 1B: Minimum essential coverage providing minimum value offered to employee only.
- 1C: Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to dependent(s) (not spouse).
- 1D: Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to spouse (not dependent(s)). Do not use code 1D if the coverage for the spouse was offered conditionally. Instead use code 1J.
- 1E: Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to dependent(s) and spouse. Do not use code 1E if the coverage for the spouse was offered conditionally. Instead use code 1K.
- 1F: Minimum essential coverage NOT providing minimum value offered to employee; employee and spouse or dependent(s); or employee, spouse and dependents.
- 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.
Code 1G applies for the entire year or not at all. Therefore, if code 1G applies, an ALE Member must enter code 1G on line 14 in the All 12 Months field or in each separate monthly field (for all 12 months).
- 1H: No offer of coverage (employee not offered any health coverage or employee offered coverage that is not minimum essential coverage, which may include one or more months in which the individual was not an employee).
- 1I: Reserved.
- 1J: Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage conditionally offered to spouse; minimum essential coverage not offered to dependent(s).
- 1K: Minimum essential coverage providing minimum value offered to employee; at least minimum essential coverage offered to dependents; and at least minimum essential coverage conditionally offered to spouse.
- 1L: Individual coverage health reimbursement arrangement (HRA) offered to you only with affordability determined by using employee's primary residence location ZIP Code.
- 1M: Individual coverage HRA offered to you and dependent(s) (not spouse) with affordability determined by using employee's primary residence location ZIP Code.
- 1N: Individual coverage HRA offered to you, spouse and dependent(s) with affordability determined by using employee's primary residence location ZIP Code.
- 1O: Individual coverage HRA offered to you only using the employee's primary employment site ZIP Code affordability safe harbor.
- 1P: Individual coverage HRA offered to you and dependent(s) (not spouse) using the employee's primary employment site ZIP Code affordability safe harbor.
- 1Q: Individual coverage HRA offered to you, spouse and dependent(s) using the employee's primary employment site ZIP Code affordability safe harbor.
- 1R: Individual coverage HRA that is NOT affordable offered to you; employee and spouse or dependent(s); or employee, spouse, and dependents.
- 1S: Individual coverage HRA offered to an individual who was not a full-time employee.
- 1T: Individual coverage HRA offered to employee and spouse (no dependents) with affordability determined using employee's primary residence location ZIP code.
- 1U: Individual coverage HRA offered to employee and spouse (no dependents) using employee's primary employment site ZIP code affordability safe harbor.
- 1V: Reserved for future use.
- 1W: Reserved for future use.
- 1X: Reserved for future use.
- 1Y: Reserved for future use.
- 1Z: Reserved for future use.
To help employees (and spouses) who have received a conditional offer determine their eligibility for the premium tax credit, the ALE Member should be prepared to provide, upon request, a list of any and all conditions applicable to the spousal offer of coverage. As is noted in the definition of dependent in the Definitions section, a spouse is not a dependent for purposes of section 4980H. An ALE Member may not report a conditional offer of coverage to an employee’s dependents as an offer to the dependents, unless the ALE Member knows that the dependents met the condition to be eligible for the ALE Member’s coverage. Further, an offer of coverage is treated as made to an employee’s dependents only if the offer of coverage is made to an unlimited number of dependents regardless of the actual number of dependents, if any, an employee has during any particular calendar month
This field must only be populated if the same Offer of Coverage code applies to the employee for the entire calendar year. If more than one code applies during the calendar year, leave this field blank.| Field | Description |
|---|---|
| Offer of Coverage - All 12 Months |
If the same Offer of Coverage code applies to the employee for all 12 months of the screen calendar year, enter, or click
Enter a value in this field only if the same Offer of Coverage code applies to the employee for the entire calendar year. f more than one code applies during the calendar year, leave this field blank. |
| Offer of Coverage - Jan - Dec |
If the same Offer of Coverage code does not apply to every month in the year, enter, or click
Enter a value in this field only if the same Offer of Coverage code does not apply to the employee for the entire calendar year. If the same code applies during the entire calendar year, leave this field blank. |
15 Employee Required Contribution
Use these fields to enter the Employee Required Contribution amount that applies to all months of the calendar year. If the value does not apply to all months of the calendar year, use the fields for specific months to enter the value.
According to IRS instructions, complete line 15 only if code 1B, 1C, 1D, 1E, 1J, 1K 1L, 1M, 1N, 1O, 1P, 1Q, IT, or 1U is entered on line 14 either in the All 12 Months field or in any of the monthly fields. Enter the amount of the employee share of the lowest-cost monthly premium for self-only minimum essential coverage providing minimum value that is offered to the employee. Enter the amount including any cents. If the employee is offered coverage but is not required to contribute any amount towards the premium, enter 0.00 (do not leave blank).
For an individual coverage HRA, the employee required contribution is the excess of the monthly premium based on the employee's applicable age for the applicable lowest cost silver plan over the monthly individual coverage HRA amount (generally, the annual individual coverage HRA amount divided by 12).
If the employee share of the lowest-cost monthly premium amount was the same amount for all 12 calendar months, enter that monthly amount in each monthly box; or enter that monthly amount in the All 12 Months field and do not complete the monthly fields. If the employee share of the lowest-cost monthly amount was not the same for all 12 months, enter the amount in each calendar month for which the employee was offered minimum value coverage.
| Field | Description |
|---|---|
| All 12 Months |
If the Offer of Coverage is 1B, 1C, 1D, 1E, 1J, 1K, 1L, 1M, 1N, 1O, 1P, 1Q, IT, or 1U for all 12 months and the same employee required contribution applies to all 12 months of the screen calendar year, enter the amount in this field. This field must only be populated if the same employee required contribution applies to the employee for the entire calendar year. If more than one amount applies during the calendar year, leave this field blank. |
| Jan - Dec Fields |
If the same Employee Share of Lowest Cost Monthly Premium does not apply to every month in the year, enter the amount that applies to the specific month. This field must only be populated if the same Employee Share of Lowest Cost Monthly Premium amount does not apply to the employee for the entire calendar year. If the same amount applies during the entire calendar year, leave this field blank. |
16 Section 4980H Safe Harbor & Other Relief
Use these fields to specify a Section 4980H Safe Harbor code that applies to all months of the calendar year. If the codes are not the same for the whole calendar year, specify Section 4980H Safe Harbor codes in the fields for each month.
Valid Section 4980H Safe Harbor codes are as follows:
- 2A: Employee is not employed during the month. Enter code 2A if the employee was not employed on any day of the calendar month. Do not use code 2A for a month if the individual was an employee of the ALE Member on any day of the calendar month. Do not use code 2A for the month during which an employee terminates employment with the ALE Member.
- 2B: Employee is not a full-time employee. Enter code 2B if the employee is not a full-time employee for the month and did not enroll in minimum essential coverage, if offered for the month. Enter code 2B also if the employee is a full-time employee for the month and whose offer of coverage (or coverage if the employee was enrolled) ended before the last day of the month solely because the employee terminated employment during the month (so that the offer of coverage or coverage would have continued if the employee had not terminated employment during the month).
- 2C: Employee is enrolled in health coverage offered. Enter code 2C for any month in which the employee enrolled for each day of the month in health coverage offered by the ALE Member, regardless of whether any other code in Code Series 2 might also apply (for example, the code for a section 4980H affordability safe harbor) except as provided below. Do not enter code 2C in line 16 for any month in which the multiemployer interim rule relief applies (enter code 2E). Do not enter code 2C in line 16 if code 1G is entered in line 14. Do not enter code 2C in line 16 for any month in which a terminated employee is enrolled in COBRA continuation coverage or other post-employment coverage (enter code 2A). Do not enter code 2C in line 16 for any month in which the employee enrolled in coverage that was not minimum essential coverage.
- 2D: Employee is in a section 4980H(b) Limited Non-Assessment Period. Enter code 2D for any month during which an employee is in a section 4980H(b) Limited Non-Assessment Period. If an employee is in an initial measurement period, enter code 2D (employee in a section 4980H(b) Limited Non-Assessment Period) for the month, and not code 2B (employee not a full-time employee). For an employee in a section 4980H(b) Limited Non-Assessment Period for whom the ALE Member is also eligible for the multiemployer interim rule relief for the month, enter code 2E (multiemployer interim rule relief) and not code 2D (employee in a section 4980H(b) Limited Non-Assessment Period).
- 2E: Multiemployer interim rule relief. Enter code 2E for any month for which the multiemployer arrangement interim guidance applies for that employee, regardless of whether any other code in Code Series 2 (including code 2C) might also apply. This relief is described under Offer of Health Coverage in the Definitions section of these instructions.
Although ALE Members may use the section 4980H affordability safe harbors to determine affordability for purposes of the multiemployer arrangement interim guidance, an ALE Member eligible for the relief provided in the multiemployer arrangement interim guidance for a month for an employee should enter code 2E (multiemployer interim rule relief), and not codes 2F, 2G, or 2H (codes for section 4980H affordability safe harbors).
- 2F: Section 4980H affordability Form W-2 safe harbor. Enter code 2F if the ALE Member used the section 4980H Form W-2 safe harbor to determine affordability for purposes of section 4980H(b) for this employee for the year. If an ALE Member uses this safe harbor for an employee, it must be used for all months of the calendar year for which the employee is offered health coverage.
- 2G: Section 4980H affordability federal poverty line safe harbor. Enter code 2G if the ALE Member used the section 4980H federal poverty line safe harbor to determine affordability for purposes of section 4980H(b) for this employee for any month(s).
- 2H: Section 4980H affordability rate of pay safe harbor. Enter code 2H if the ALE Member used the section 4980H rate of pay safe harbor to determine affordability for purposes of section 4980H(b) for this employee for any month(s).
An affordability safe harbor code should not be entered on line 16 for any month that the ALE member did not offer minimum essential coverage to at least 95% of its full-time employees and their dependents (that is, any month for which the ALE member checked the “No” box on Form 1094-C, Part III, column (a)). For more information, see the instructions for Form 1094-C, Part III, column (a).
- 2I: Reserved.
| Field | Description |
|---|---|
| Section 4980H Safe Harbor - All 12 Months |
If the same Section 4980H Safe Harbor code applies to the employee for all 12 months of the screen calendar year, enter, or click
Enter a value in this field only if the same Section 4980H Safe Harbor code applies to the employee for the entire calendar year. If more than one code applies during the calendar year, leave this field blank. |
| Section 4980H Safe Harbor - Jan - Dec Fields |
If the same Section 4980H Safe Harbor code does not apply to every month in the year, enter, or click
Enter a value in this field only if the same Section 4980H Safe Harbor code does not apply to the employee for the entire calendar year. If the same code applies during the entire calendar year, leave this field blank. |
17 ZIP Code
If the employee was offered an individual coverage health-reimbursement arrangement, enter the applicable ZIP code that the employer used for determining affordability.
If Code 1L, 1M, 1N, or 1T were used on Line 14, this will be the employee's primary residence location.
If Code 1O, 1P, 1Q, or 1U were used on Line 14, this will be the employee's primary work location.
| Field | Description |
|---|---|
| ZIP Code - All 12 Months |
Enter, or click
|
| ZIP Code - Jan - Dec | Enter, or click
 to select, the applicable ZIP code that the employer used for determining affordability. This field must only be populated if the same ZIP code does not apply to the employee for the entire calendar year. If the same ZIP code applies during the entire calendar year, leave this field blank.
|
Subtask
| Subtask | Description |
|---|---|
| Part III - Covered Individuals | Select this link to enter Covered Individuals information. |