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📋 '''1095-C''' is a tax form used in the United States that employers with 50 or more full-time employees must furnish to individuals and file with the Internal Revenue Service (IRS) to report information about the [[Definition:Health insurance | health insurance]] coverage offered under an [[Definition:Employer-sponsored health plan | employer-sponsored health plan]]. The form is a direct product of the [[Definition:Affordable Care Act (ACA) | Affordable Care Act]]'s employer mandate provisions and serves as the primary mechanism for verifying whether an [[Definition:Applicable large employer (ALE) | applicable large employer]] has met its obligations to offer [[Definition:Minimum essential coverage | minimum essential coverage]] that is affordable and provides [[Definition:Minimum value | minimum value]]. For insurers and benefits administrators operating in the U.S. group health market, the 1095-C is a critical compliance artifact that links underwriting, enrollment data, and regulatory reporting.

⚙️ Each year, an employer completes a 1095-C for every full-time employee, detailing month-by-month whether coverage was offered, the employee's share of the lowest-cost [[Definition:Self-only coverage | self-only premium]], and whether the employee actually enrolled. Part III of the form is used by employers that self-insure their health plans to report which individuals — including dependents — were covered in each month. [[Definition:Third-party administrator (TPA) | Third-party administrators]], [[Definition:Insurance carrier | carriers]], and [[Definition:Insurtech | insurtech]] platforms that manage enrollment and eligibility data often play a central role in generating the underlying data that populates the form. Errors or late filings can trigger IRS penalties under Section 6721/6722, making data accuracy a significant operational concern for any entity involved in group health administration.

🔍 The form's significance extends beyond mere tax compliance. It is the enforcement backbone of the ACA's [[Definition:Employer shared responsibility provision | employer shared responsibility provision]] — commonly known as the "employer mandate" — and is used by the IRS to determine whether penalty assessments (under Section 4980H) are warranted. For [[Definition:Health insurance | health insurers]] and benefits technology vendors, the ability to produce accurate 1095-C data at scale has become a competitive differentiator, particularly as employers increasingly expect their insurance partners to handle regulatory reporting as part of the service bundle. Because the 1095-C is a U.S.-specific requirement with no direct equivalent in other major insurance markets, its relevance is confined to carriers, administrators, and employers operating within the American health benefits ecosystem.

'''Related concepts:'''
{{Div col|colwidth=20em}}
* [[Definition:Affordable Care Act (ACA)]]
* [[Definition:Employer-sponsored health plan]]
* [[Definition:Applicable large employer (ALE)]]
* [[Definition:Minimum essential coverage]]
* [[Definition:Third-party administrator (TPA)]]
* [[Definition:Health insurance]]
{{Div col end}}

Definition:1095-C - Revision history

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