Affordable Care Act – Form 1095

The IRS 1095 Form

The IRS 1095 Form is your “proof of insurance” you may need to help you file your taxes. When filing your federal income taxes, you will be provided with the 1095 form, in addition to your W-2. This form does not replace your W-2.

If you were eligible for health benefits in 2016, you will be provided this tax document. The Form 1095 reports information about your health care coverage as required by the Affordable Care Act. Depending on your health insurance enrollment/coverage you may need this form when you file your taxes.  This form should be maintained with your other important tax documents.

 

1095 IRS Affordable Care Act Tax Form FAQ

Do I need my 1095 Form to file my taxes? 

Not necessarily; for most people who had qualified employer coverage throughout the whole year, they probably will not need a 1095 Form to file their taxes. WSU’s health plans are all qualified health plans.

If you need tax advice please contact a tax professional for additional guidance.

What is the IRS 1095 Form?

The university is required by the Affordable Care Act (ACA) to provide Form 1095 to everyone who worked at least 130 hours (full-time as defined by the ACA) for one month or more throughout the prior year. Additionally, any WSU employees who were offered/provided Public Employee Benefit Board (PEBB) benefits, even if they did not work 130 hours in a month, will also receive the 1095 form. This form is a new annual tax document in addition to your W-2 and other tax documents.

The ACA, or Health Care Reform, includes both an individual and an employer mandate. The individual mandate requires everyone have qualifying health coverage or face the possibility of a fine. The employer mandate requires employers offer coverage that meets certain standards to their ACA defined full-time employees or potentially face a fine.

There are two forms that you could receive based on your employment with WSU. The 1095-C form or the 1095-B form. See “Who will get a 1095 Form” below. 1095-C

1095-C

This form is issued by employers, and it provides information you will/may need when you file your taxes. The  1095-C Decoder provides details about the information reflected on the form, which you may find helpful. The 1095-C form is given to all employees who worked at least one month for at least 130 hours in the prior year, as well as anyone enrolled on a Uniform Plan (regardless of how many hours worked). See “Who will get a 1095 Form” below. The form includes information on the coverage that WSU offered you, the amount of the lowest cost plan available to you, and enrollment details for you and your dependents (if covered). This form will be sent to your home mailing address and will be delivered by the Health Care Authority.

If you worked for more than one employer in the prior year, there is the possibility you will receive this form from them as well.

1095-B

The 1095-B forms are issued by insurance providers, other than Uniform Medical. Therefore, if you are enrolled in Group Health Plan or Kaiser, you can expect to receive a 1095-B form directly from them as well. You may receive only a 1095-B (if you did not work 130+ hours a month), or you may receive both the 1095-C and 1095-B.  The 1095-B reports you had minimum essential coverage for yourself and any covered dependents, which is information you may need to report when you file your taxes.

Why is this important? 

Think of these forms as your “proof of insurance” for the IRS.  You should maintain them with your other important tax documents.

Who will get a 1095 Form?

There are two 1095 Forms that WSU employees may receive, depending on if they work full-time (130+ hours a month as defined by the ACA) and depending on which plan they are enrolled. Also, non-employees, such as people enrolled on COBRA benefits or retirees will receive them. The chart below explains who will get which forms:

 Hours Worked in Any MonthUniformKaiser
Group HealthMedical WaivedNot Benefit EligibleNon-Employee (COBRA, Retiree)
130 or More 1095-C1095-C & 1095-B1095-C & 1095-B 1095-C 1095-C N/A
Approximately 80-129 1095-C 1095-B 1095-B No Form No Form N/A
Approximately 79 or less N/A N/A N/A N/A N/A 1095-C

Based on your employment with WSU and your enrollment in one of the WSU plans, you could receive two different 1095 forms.

1095-C Form

All employees who worked full-time (130+ hours per month) for at least one month will receive the 1095-C form from the Health Care Authority (HCA) on behalf of WSU. You will get this form regardless of plan enrollment. Additionally all people enrolled (not as a dependent) in either the Uniform Classic or Uniform CDHP plans will get a 1095-C regardless of hours worked per month. Lastly, non-employees, such as retirees or former employee’s enrolled through COBRA, will receive a 1095-C from HCA.

1095-B Form

This form will be provided as explained in the above chart. It will be sent to employee’s homes directly by Kaiser & Group Health. It will not come from WSU or the Health Care Authority (WSU). Some people will receive both the 1095-B and the 1095-C forms.

How will I use the 1095 to complete my tax return?

When completing your federal tax return, you will need to indicate whether or not you had minimum essential coverage for all of the prior year or qualified for a health coverage exemption. If not, you may owe a tax penalty called an individual shared responsibility payment. The 1095 forms will show whether or not you had coverage.

Information on these forms may assist in preparing a return, however they are not required. Individual should file their returns as they normally would, and can prepare and file their returns using other information about their health insurance. You do not/should not attach any of the 1095 forms to your tax return.

Consult with a qualified tax advisor if you have questions about filing your tax return.

Why didn’t I get a Form 1095?

If you were not a PEBB benefit-eligible employee, or did not work more than 130 hours in a month (e.g. student employees, most non-student hourly employees, less than half time faculty) and were not enrolled in healthcare coverage through WSU/PEBB at any time during the calendar year, you should not receive a Form 1095 from WSU.

When will I get my Form 1095?

The 1095-C forms are currently scheduled to be mailed out the end of February. They will be sent directly to employees homes from the Health Care Authority (HCA).

Group Health Plan will be sending out 1095-B forms no later than March 2, 2017. They will be sent the address Group Health has on file.

Kaiser will be sending out 1095-B forms 1095-B forms no later than March 2, 2017. They will be sent to the address Kaiser has on file.

Does the 1095 form impact when or how I will get my W-2?

No. Employee W-2s are slated to be sent mid-January.

The information on my Form 1095 is wrong or I need a new copy. Who can help me? 

Contact the Human Resources either via email, hrs@wsu.edu or call 509-335-4521.

Will dependents I cover on my health plan each get their own Form 1095?

No. The university will only provide a 1095 to qualified employees, although the form includes information about covered dependents. You may need to provide a copy to any covered family members for their tax records.

The dollar amounts shown on Form 1095-C don’t match what I paid for my health benefits, why not?

Line 15 of Form 1095-C shows how much you would have paid per month for single coverage under the least expensive WSU health plan available to you in 2016. The IRS requires the university to report this information to demonstrate the affordability of your health plan options. It will not reflect your actual monthly premium in 2016 if you chose a higher-cost plan or covered any dependents.

Does Form 1095 replace my W-2

No. Form 1095 does not replace you W-2 or any other tax documents. For more information, visit irs.gov/affordable-care-act or consult with a qualified tax advisor.

Will my 1095 Form be available online/electronically?

No, they will not be available online or electronically.

I am enrolled in a Medicare Plan, will I receive a 1095 for that plan?

Some Medicare Plan participants may receive a 1095-B from the Department of Health and Human Services (DHHS). If you have questions about the form that DHHS has provided you, please contact DHHS directly.

 

Resources:

Washington State University