32
IRS REPORTING
Only the official IRS landscape format can be submitted when
reporting to the IRS.
EMPLOYER FILE COPY AND REPORTING
Employers must file with the IRS using the landscape format only.
They are also required to keep a copy on file and provide a copy to
the recipient for their records.
RECIPIENT REPORTING
Employers and Insurance Carriers may provide the employee/recipient
the approved portrait format. These are available in pre-printed or
blank form version designed to accommodate envelope 77771. We
recommend you review software compatibility.
IRS LANDSCAPE FORMAT IS NOW TWO PAGES
Please note that Form 1095-C (IRS landscape format) is two pages.
Part III, which is on self-insured coverage for employees and
dependents, has moved to page 3 (instructions are on pages 2 and 4).
Employers must purchase Form 1095-CIRSC if dependents need to be
reported, or if coverage was employer-provided, self-insured coverage.
WHAT ARE THE AFFORDABLE CARE ACT (ACA) FORMS?
Form
What’s Reported?
Who Issues?
Submit to IRS?
Recipient Copies?
1095-B Health Coverage
Which months the insured and
his or her family was covered
under the plan
Insurance carrier for employers with
employer-sponsored group health
plans
Insurance carrier submits:
Feb. 28 paper;
March 31 electronic
January 31 of the year
following the coverage
year, or 30 days after
the employee request
is received*
1095-B Health Coverage
The months the insured and
their family were covered
under the plan
Self-insured employers with fewer
than 50 full-time employees who
provide health plans
Feb. 28 paper;
March 31 electronic
January 31 of the year
following the coverage
year, or 30 days after
the employee request
is received*
1094-B Transmittal of Health Coverage
Information Returns
Summary transmittal record
of 1095-Bs
Accompanies 1095-B forms
when mailed to IRS
Feb. 28 paper;
March 31 electronic
N/A
1095-C Employer-Provided Health
Insurance Offer and Coverage
Whether or not the employer
offered health coverage to
employees
Employers with 50 or more
full-time employees
(Applicable Large Employers
Both insured and self-insured
issue 1095-C)
Feb. 28 paper;
March 31 electronic
January 31 of the year
following the coverage
year, or 30 days after
the employee request
is received*
1094-C Transmittal of Employer
Provided Health Insurance
Offer and Coverage Information
Returns
Summary transmittal record
of 1095-Cs
Accompanies 1095-Cs when
mailed to IRS
Feb. 28 paper;
March 31 electronic
N/A
1095-CIRSC Employer-Provided
Health Insurance Offer and Coverage
(Continuation Form)
Additional covered individuals
or employer-provided self-
insured coverage.
Employers with 50 or more
full-time employees
(Applicable Large Employers
Both insured and self-insured
issue 1095-C)
Filed with Form 1095-C
Filed with Form
1095-C
I State due dates may differ, employers should verify with the state directly. f any date shown falls on a Saturday, Sunday or legal holiday, the due date is the next business day.
ACA FORMS
Ordering ACA Forms
1094BT50
1094CT50
1095CIRSC50
1095CIRS50
110116
Form 1094-B
Transmittal of Health Coverage Information Returns
Department of the Treasury
Internal Revenue Service
Go to www.irs.gov/Form1094B for instructions and the latest information.
OMB No. 1545-2252
1 Filer's name
2
3 Name of person to contact
4 Contact telephone number
5 Street address (including room or suite no.)
6 City or town
7 State or province
8 Country and ZIP or foreign postal code
9 Total number of Forms 1095-B submitted with this transmittal .
.
.
.
.
.
.
.
.
.
.
.
.
.
For Official Use Only
Under penalties of perjury, I declare that I have examined this return and accompanying documents, and to the best of my knowledge and belief, they are true, correct, and complete.
Signature
Title
Date
2025
Form 1094-B (2025) Created 5/28/25
41-0852411
1094BT
RAA #1607 For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
120118
Form1094-C
Department of the Treasury
Internal Revenue Service
Transmittal of Employer-Provided Health Insurance Offer and
Coverage Information Returns
Go to www.irs.gov/Form1094C for instructions and the latest information.
OMB No. 1545-2251
2025
CORRECTED
Part I
Applicable Large Employer Member (ALE Member)
1 Name of ALE Member (Employer)
2 Employer iden
r (EIN)
3 Street address (including room or suite no.)
4 City or town
5 State or province
6 Country and ZIP or foreign postal code
7 Name of person to contact
8 Contact telephone number
9 Name of Designated Government Entity (only if applicable)
10 Employer iden
n number (EIN)
11 Street address (including room or suite no.)
12 City or town
13 State or province
14 Country and ZIP or foreign postal code
15 Name of person to contact
16 Contact telephone number
For Official Use Only
17 Reserved
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
18 Total number of Forms 1095-C submitted with this transmittal .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
19 Is this the authoritative transmittal for this ALE Member? If “Yes,” check the box and continue. If “No,” see instructions .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Part II
ALE Member Information
20
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
21 Is ALE Member a member of an Aggregated ALE Group?
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Yes
No
If “No,” do not complete Part IV.
22 Certifications of Eligibility (select all that apply):
A. Qualifying Offer Method
B. Reserved
C. Reserved
D. 98% Offer Method
Under penalties of perjury, I declare that I have examined this return and accompanying documents, and to the best of my knowledge and belief, they are true, correct, and complete.
Signature
Title
Date
Form 1094-C (2025) Created 5/21/25
RAA #1607 For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
41-0852411
1094CT
600320
Form 1095-C (2025 )
Page 3
Part III
Covered Individuals
If Employer provided self-insured coverage, check the box and enter the information for each individual enrolled in coverage, including the employee.
(a) Name of covered individual(s)
First name, middle initial, last name
(b) SSN or other TIN
(c) DOB (if SSN or other
TIN is not available)
(d) Covered
all 12 months
(e) Months of coverage
Jan
Feb
Mar
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
18
19
20
21
22
23
24
25
26
27
28
29
30
Form 1095-C (2025)
1095CIRSC
RAA #1607
41-0852411
600120
Form 1095-C
Department of the Treasury
Internal Revenue Service
Employer-Provided Health Insurance Offer and Coverage
Do not attach to your tax return. Keep for your records.
Go to www.irs.gov/Form1095C for instructions and the latest information.
VOID
CORRECTED
OMB No. 1545-2251
2025
Part I
Employee
1 Name of employee (first name, middle initial, last name)
2 Social security number (SSN)
3 Street address (including apartment no.)
4 City or town
5 State or province
6 Country and ZIP or foreign postal code
Applicable Large Employer Member (Employer)
7 Name of employer
8
9 Street address (including room or suite no.)
10 Contact telephone number
11 City or town
12 State or province
13 Country and ZIP or foreign postal code
Part II
Employee Offer of Coverage
Employee’s Age on January 1
Plan Start Month (enter 2-digit number):
All 12 Months
Jan
Feb
Mar
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
14 Offer of
Coverage (enter
required code)
15 Employee
Required
Contribution (see
instructions)
$
$
$
$
$
$
$
$
$
$
$
$
$
16 Section 4980H
Safe Harbor and
Other Relief (enter
code, if applicable)
17 ZIP Code
RAA #1607 For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
41-0852411
Form 1095-C (2025) Created 5/21/25
1095CIRS
Catalog images may not reflect official IRS revisions at the time of publication. Final products will be in compliance with official IRS revisions.
View this content as a flipbook by clicking here.