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ACA Employer Provided Health Insurance 50 or More Employees e-Filing
Affordable Care Act (ACA) Employer Provided Health Insurance 50 or More Employees e-Filing. 


ACA 50 Plus Employees e-Filing
1095-C Employer Provided Health B1095C 
1095-C Full Page Recipient Form B95CFPREC05 
Continuation Page B1095CCON 

Available in increments of 25
Total Percent Off Per Unit
$11.25 0% $0.4500
$15.75 30% $0.3150
$27.00 40% $0.2700
$49.50 45% $0.2475
$90.00 50% $0.2250
$95.65 57.5% $0.1913
$118.13 65% $0.1575
$132.80 70.5% $0.1328
$178.80 73.5% $0.1192
$281.25 75% $0.1125
$506.50 77.5% $0.1013
$945.00 79% $0.0945

Use these forms to file the Affordable Care Act for 50 or more employees if you will be e-Filing.

ACA reporting is mandatory for the calendar year and is the responsibility of the employer.

1095-C Employer Provided Health - (landscape style) You may print a copy of this form as a hardcopy of your records if you like.  You may mail a copy of this form to each recipient or you may opt to send them the portrait style form described below (Full Page Recipient Form) Note: This Employer Provided Health form is NOT formatted to fit in a double window envelope.

1095-CCON05 Continuation Page -  (landscape style) Used for individual employees that need more than 6 covered individuals listed on their form. 

1095-C Full Page Recipient Form - B95CFPREC05 - (portrait style) You may use this page to mail to the recipients if not using the landscape style form described above.  You may print a copy of this form as a hardcopy for your records if you like.  If you opt to send this portrait style form, mail it in envelope 95DWENV05/DWENVS05.  Instructions are on the back of the form.

Three 1094-C Transmittal Forms (three copies of all three forms) are included with any order of 1095-C forms -- order additional transmittal forms if three is not enough.


Priced by the sheet. We are currently shipping 2023 forms. Image may reflect prior years.
Use envelope 95DWENV05/95DWENVS05 with the portrait style recipient form.

Please review these other products:
1094-C Employer Health Transmittal Forms

1094-C Transmittal Form that must be filed with form 1095-C. This transmittal form has 3 unique pages.

1094-C Page 1  covers parts I & II

1094-C Page 2  covers part III

1094-C Page 3 covers part IV




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