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1095-C
Affordable Care Act (ACA) Employer Provided Health Insurance 50 or More Employees e-Filing. 

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.

 

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