University Human Resources
New Tax Form: 1095-C
1095-C statements were mailed to recipients’ home addresses as of March 28, 2016.
Questions and Answers
The Affordable Care Act requires nearly all Americans to have health insurance. The 1095-C statements that will be generated by Indiana University serve as documentation to the IRS about coverage offered to you. The form includes information about offers of health insurance along with information about covered individuals.
- If you enrolled in Indiana University coverage in 2015, the Form 1095-C provides the information needed to support your income tax return that you (and your spouse and dependents, if applicable) had qualifying health coverage for some or all months during the year (see Form 1040, line 61; Form 1040A, line 38; Form 1040EZ, line 11).
- If you were an ACA full-time employee in at least one month of 2015, Form 1095-C includes information about the health coverage, if any, Indiana University offered to you in 2015.
- If you purchased health insurance coverage through your state health insurance marketplace or HealthCare.gov in 2015 and wish to claim the premium tax credit, the form provides information that will help you determine whether you’re eligible, and the amount of such premium tax credit (if any).
Any employee who was determined to be full-time for one month or more in 2015 will receive a 1095-C statement from Indiana University. Note that per the ACA, an average of 30 service hours/week is considered to be full-time.
Additionally, individuals enrolled in Indiana University self-insured health plans during 2015 will receive these statements. This includes individuals covered by these plans:
- Employee PPO and HDHP medical plans
- Graduate Appointee plan (GA PPO)
- Graduate Medical Education/Medical Resident and Fellows plan (GME PPO)
- COBRA participants
- IU Retirees Under 65 plan
The following are brief descriptions of each section contained in the Form 1095-C. Instructions will be included with the Form to help recipients understand how the information contained in the Form 1095-C may affect their annual tax preparation. These instructions are provided by the IRS.
Part I – Employee
- Information about the recipient of the Form 1095-C, including:
- Full name
- Social Security Number (for privacy protection, only the last four digits of an SSN are shown)
- The recipient’s last known address on file with Indiana University
Part I – Applicable Large Employer Member (Employer)
- Information about Indiana University, including:
- Federal Employer Identification Number (EIN)
- Contact information to reach Indiana University with questions or corrections
Part II – Employee Offer and Coverage
- Offer of Coverage: Indicates the coverage Indiana University offered to you and your family
- Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage: Depending on the offer of coverage, this line may contain the monthly premium amount of the lowest-cost, self-only healthcare coverage offered to you
- Applicable Section 4980H Safe Harbor: An indicator code used by Indiana University for reporting to the IRS under the Employer Shared Responsibility provisions of the ACA
Part III – Covered Individuals
- List of individuals who were covered under an Indiana University self-insured healthcare plan for which the recipient of the Form 1095-C was the Primary Insured or Responsible Individual
- If an individual has a Taxpayer Identification Number (TIN) on file with Indiana University, a truncated version (only including the last 4 digits) is shown – If no TIN has been provided, the individual’s Date of Birth is listed instead
- The months in which each individual was covered by the Form 1095-C recipient
All statements were mailed as of March 28, 2016. Please allow up to one week for postal delivery (international address delivery may take longer).
Electronic copies and re-mailing of statements are available as of March 31, 2016 – see “How can I get a copy of the statement?” below for more information.
Please contact the HR team at or call 812-855-2334 and a specialist will assist you.
- The IRS has stated that taxpayers can file their tax returns (and specifically attest to having qualifying health coverage and/or claim the premium tax credit, if applicable) before receiving Form 1095-C and in most cases will not have to file an amended tax return later based on information reported on this form. See question 14 on Questions and Answers about Health Care Information Forms for Individuals for details.
- You don’t attach the form to your income tax return – just keep it with your other tax records.
If you need another copy of your statement you have two options:
- Employee Self Service is available for ACTIVE employees only. (Electronic version, requires IU network login)
- Request for Duplicate Statement (Mailed)
- Only the primary statement recipient will be able to request a duplicate statement (you will need to provide some limited personal information to confirm your identity)
- Complete the Duplicate Statement Request Form to request a copy of your statement
- You may call 812-855-2334 to request a copy
If you still have access to One.IU, you can check/update the address on file via the Employee Center.
- Log into one.iu.edu
- Search for Employee Center
- Click on Employee Information
- (to change) Click EDIT button for home address
- Choose Add a new Home address
- Input information
If you no longer have access to One.IU, please complete and return the address change form found here: hr.iu.edu/pubs/forms/hrms/change.pdf. Mail completed form to UHR-1095-C, 400 E 7th, E165, Bloomington, IN 47405 or fax to 812-855-3409.
No, the 1095-C document doesn’t need to be mailed to the IRS with your return, but you do need to retain a copy for your personal tax records.
No. The 1095-C statements are only sent to the person who is the primary individual insured policyholder. If your dependents are filing their own personal tax returns, you will need to provide them with a copy of the 1095-C statement for their tax records.
- You will each receive a separate 1095-C statement.
- On your statement in “Part III – Covered Individuals”, there will be no one listed.
- On your spouse’s statement in “Part III – Covered Individuals”, your spouse and you will both be listed.
- You will each receive a separate 1095-C statement.
- On your statement in “Part III – Covered Individuals”, only you will be listed.
- On your spouse’s statement in “Part III – Covered Individuals”, only your spouse will be listed.
IU’s Employer Identification Number is displayed within Part I of the form in the APPLICABLE LARGE EMPLOYER’S identification number (EIN) box.