Minimum essential coverage and 1095 IRS reporting forms
The Affordable Care Act requires most U.S. citizens to have health coverage that meets a government standard — known as minimum essential coverage — or be subject to a potential tax penalty.
Starting in January, health plan subscribers will get one or more 1095 tax forms for the previous tax year, depending on their plan.
The forms apply to everyone with health coverage, except those who purchased a catastrophic plan through a health insurance marketplace such as Covered California. The form they’ll receive depends on the type of health plan they have:
Type of plan
Individual and family through a marketplace
Individual and family direct from carrier
Small group (50 or fewer employees)
Fully insured large group (more than 50 employees)
1095-B and 1095-C
Self-funded large group (more than 50 employees)
Filing tax returns
When your employees fill out their tax returns, they should report any federal financial assistance they received toward health coverage. Additional tax forms will determine if the taxpayer receives a credit or owes payment. Subscribers will need to file Form 8962 to claim the premium tax credit or if advance payments were made to Kaiser Permanente.
Subscribers may have to pay a tax penalty if they:
- had a coverage gap lasting more than 3 months
- had more than one coverage gap in 2016
- can’t claim an exemption in 2016
Subscribers may receive corrected forms, so it’s important to use the most current forms to ensure accuracy of information. Also note that not filing a return could affect a subscriber’s eligibility for federal assistance.
Review our fact sheet and Q&A for more information on minimum essential coverage and employer reporting or see below for information on each form.
1095-A, Health Insurance Marketplace Statement
- For subscribers in plans purchased through a marketplace only. Excluding those who purchased a catastrophic plan.
- The marketplace will mail out 1095-A forms starting in January 2017.
- If a subscriber has questions about their form or need a corrected form, they need to contact the marketplace.
- Reconciles advance premium tax credit to verify income and eligibility for assistance.
- Needed to complete IRS form 8962.
- The 1095-A requires the subscriber to file a 1040 tax form rather than a 1040EZ.
- Lists all dependents along with the subscriber.
- Lists coverage periods.
- Subscribers with multiple plans will get separate forms for each plan. Nondependent children may get their own 1095-A.
1095-B, Health Coverage
- For subscribers who purchased individual and family plans directly from Kaiser Permanente, including Charitable Hospital Coverage. Also for fully insured small and large group subscribers.
- 2015 tax year forms were mailed by Kaiser Permanente between February 26 and March 15, 2016.
- 2015 tax year form corrections: Corrected 1095-B forms were produced and mailed in April. They will continue to be produced and mailed on an ongoing basis, as corrections come in through December 31, 2016.
- 2016 tax year forms will be mailed by Kaiser Permanente in January 2017.
- Medicare, Medi-Cal, or Children’s Health Insurance Program subscribers receive their forms from the respective government agency.
- Kaiser Permanente subscribers will also get a cover letter that explains:
- what 1095-B is and why they’re getting it
- what they need to do
- contact information for replacement forms
1095-C, Employer-Provided Health Insurance Offer and Coverage
• For employees in large group plans who were eligible for benefits at least one month in 2015.
• Mailed by the end of March 2016 by the employer or plan sponsor.
• Employers who self-fund must also report which employees and dependents are covered.
• 1095-C identifies:
o Employee and employer
o Months during the year the employee was offered group coverage
o Cost of the cheapest monthly premium the employee could have paid under the plan
o Months of coverage in which the employee and/or dependents were enrolled in a self-funded plan
• If subscribers had benefits-eligible jobs with more than one employer during 2015, they’ll get a separate 1095-C from each employer.
• If subscribers weren’t eligible for benefits but averaged 30 or more hours per week in at least one calendar month during 2015, they should get a 1095-C.
• Subscribers and dependents covered through a self-funded plan will need to fill out Part 3 of 1095-C to show months of coverage.
• Subscribers in fully insured large group coverage will get both 1095-C from their employer and 1095-B from Kaiser Permanente:
o 1095-C tells subscribers the months of the previous year they were offered coverage by their employer
o 1095-B tells subscribers the months of the previous year they had coverage in a fully insured plan issued by Kaiser Permanente (including Kaiser Permanente Insurance Company)
• Subscribers in self-funded large group coverage will only get a 1095-C, sent from their employer.
• Those who waived coverage will get a 1095-C from their employer showing they were offered coverage.
- For questions about 1095-A, visit Covered California or call 800-300-1506.
- For 1095-A duplicate forms, the subscriber must contact the marketplace.
- For questions about 1095-B, contact Kaiser Permanente Member Services at 844-477-0450.
- For questions about 1095-C, subscribers should ask the employer.
- For more info on 1095-B from Kaiser Permanente, visit kp.org/proofofcoverage .
- For more info on 1095-B from a government agency, visit the appropriate agency website.
- Registered members can download duplicate or receive electronic forms at kp.org/proofofcoverage .
- For tax information, visit IRS.Gov/aca or call the IRS at 800-829-1040.
- For information on tax exemptions, visit healthcare.gov .
‡ Kaiser Permanente cannot give legal or financial advice. To find out more about claiming the subsidy as an offset against payroll taxes, contact the Internal Revenue Service .