To fulfill the the IRC Section 6056 requirement, Forms 1094-C and 1095-C are to be used by applicable large employers (ALEs), those employers with more than 50 or more full-time employees (FTEs) in the preceding year. The Coverage History Template is important for creating and properly completing the 1095-C form that must be distributed to eligible employees each year by January 31. Instructions are included for those clients that have a self-insured health plan.

The 1095-C shows employee demographic and employer details, plus indicator codes for coverage history:

• Line 14: The applicable indicator code that indicates the type of health coverage actually actually offered by the by the ALE on behalf of the employer to the employee, their spouse and dependents.
  
• Line 15: The amount of the employee share of the lowest cost monthly premium for self-only Minimum Essential Coverage (MEC) providing Minimum Value (MV) to the employee.
  
• Line 16: This provides the IRS with information codes to administer the employer mandate penalties.
  

How to complete the Coverage History Template (both Templates are included in this Article)

Most of these fields are very self-explanatory, but this will expand on the reasons for their use.  

Template Field Definitions:

• Column A: Last Name - Populates employee demographic detail on the 1095-C.
  
• Column B: First Name - Populates employee demographic detail on the 1095-C.
  
• Column C: SSN - Populates employee demographic and is used by EHX to validate important import information.
  
• Column D: Coverage Event - Identifies whether the employee enrolled in coverage, declined coverage or cancelled coverage during the calendar year.
  
• Column E: Coverage Start Date Previous Year - The date coverage began (if applicable) for an employee during the prior year. This will carry over beginning in January for the current 1095-C reporting year until a Coverage End Date (if applicable) is entered. (Mostly Off Calendar Year Plans)
  
• Column F: Coverage Start Date Current Year - The day coverage began for an employee during the current reporting year.
  
• Column G: Coverage End Date - The date that coverage ended during the current reporting year. This will apply a code for the entire month of the reporting year and enable additional codes for the remainder of the reporting year.
  

Template Field Definitions - Self-Insured Dependent Info (Tab 3)

• Column A: Dependent Last Name - Populates dependent demographic detail on the 1095-C.
  
• Column B: Dependent First Name - Populates dependent demographic detail on the 1095-C.
  
• Column C: SSN - Dependent SSN - Populates dependent demographic detail on the 1095-C and is used by EHX to validate important import information.
  
• Column D: Dependent DOB (Date of Birth) - Populates dependent demographic detail on the 1095-C.
  
• Column E: Plan Year - Plan Year Effective Date for IRS Reporting Year.
  
• Column F: Covered ALL Plan Year? - If Y (yes), the Columns G-R are not required, because that dependent was covered all plan year.
  
• Columns G-R: Month by Month Coverage History - Y/N If the dependent was not covered every month of the plan year. 
  

Follow the Instructions below to Send your Completed Template to Efficient Hire: 

Save the Coverage History Data file with your Company Name 

Open the link to our Secure Server Upload:

Enter your Company Name in the field provided - see example:

Choose File --> Click Upload File

Note: If you have multiple FEIN's and/or Locations, enter the Company Name first so we

know where the files belong! Example: "Company Name_Location Name"

Please contact the Efficient Hire ACA Team if you have any questions!

 

Updated: January 2019