1095-C - Employer Provided Health Insurance Offer and Coverage (Covered Individuals) Page 2 Deposit tickets Self-insured employers with less than

Self-insured employers with less than 50 full-time equivalent employees or the insurer must issue 1095-B ot the responsible individual and file with the IRS as proof of the healthcare coverage

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2 Forms Per Page         4 Part  Set

(Approved 2025 version coming soon)

Use this blank laser paper for printing condensed employee W-2 forms

1095-C - Employer Provided Health Insurance Offer and Coverage (Covered Individuals) Page 2 Deposit tickets Self-insured employers with less thanForm 1095 C, Part III Covered Individuals. Use this form in addition to item B1095C05 when reporting covered individuals. IRS Section 6056 defines the reporting requirements for large employers (50 or more full time equivalent employees) to provide their employees with documentation outlining any applicable offer of health coverage. Form 1095 C is a statement issued by employers with 50 or more full time employees (including FTEs) to employees and the