Tax Form: 1095-C

1095-C statements for tax year 2016 will be furnished to recipients by March 1, 2017.

Employees can now sign up for electronic delivery of Form 1095-C statements.  See “How do I sign up for electronic delivery of 1095-C statements?” below for more information.

Questions and Answers

What is a 1095-C statement?

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.

Why do I need a 1095-C?
  • If you enrolled in Indiana University coverage in 2016, 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.
  • If you were an ACA full-time employee in at least one month of 2016, Form 1095-C includes information about the health coverage, if any, Indiana University offered to you in 2016.
  • If you purchased health insurance coverage through your state health insurance marketplace or in 2016 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).
Who will receive a 1095-C statement?

Any employee who was determined to be full-time for one month or more in 2016 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 2016 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
What information is contained on the 1095-C form?

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 Required Contribution:  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
Do I need my 1095-C statement in order to file my taxes?
  • 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.
How do I sign up for electronic delivery of 1095-C statements?

Like the W-2, you have the option of receiving your 1095-C statement online through Employee Self-Service. There are two ways to access electronic delivery consent (both require an IU network login and DUO authentication):

  • Go to the One.IU task page.
  • Visit the Employee Center at One.IU (go to and search “Employee Center”). Click on “Payroll & Tax”. Under the “Tax Information” heading on the right side of the page, there is a subsection called “1095-C Information”. There you will see a button to edit your 1095-C Online Delivery preference. Click that button to access the Self-Service page.

If you choose electronic delivery, you will receive a message in your IU email account when the statement is available to view and download. You will not receive a paper copy of the statement. However, as long as you’re employed by Indiana University, you will be able to access and print the statement online at any time. (See “How can I get a copy of the statement” for more information).

How do I change my delivery method back to paper mailings?

If you have already signed up for electronic delivery of your annual Form 1095-C statements and wish to instead receive paper mailings of the statement, you can withdraw your consent in one of two ways:

  • Use the same process described in the FAQ item, “How do I sign up for electronic delivery of Form 1095-C statements?” This will give you more information and provide you the option of withdrawing your consent.
  • Complete the printable withdrawal form (PDF).

Please ensure your address is up to date.

How can I get a copy of the statement?

If you need another copy of your statement you have two options:

  1. Employee Self Service is available for ACTIVE employees only. (Electronic version, requires IU network login and DUO authentication)
    1. Click here to securely access a PDF copy of your statement via One.IU
    2. Visit the Employee Center, Payroll and Tax page to view and get help with all your tax documents
  2. Request for Duplicate Statement (Mailed)
    1. 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)
    2. Complete the Duplicate Statement Request Form to request a copy of your statement
    3. You may call 812-855-2334 to request a copy
How do I check or change my address to be sure IU is mailing the form to the right address?

If you still have access to One.IU, you can check/update the address on file via the Employee Center.

  • Log into
  • Search for Employee Center
  • Click on Employee Information
  • (to change) Click EDIT button for home address
  • Choose Add a new Home address
  • Input information
  • SAVE

If you no longer have access to One.IU, please complete and return the address change form found here: Mail completed form to UHR-1095-C, 400 E 7th, E165, Bloomington, IN 47405 or fax to 812-855-3409.

Will dependents who are covered on my medical insurance also get 1095-C statements?

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.

My spouse and I both worked in full-time positions at IU during 2016. Will we each receive statements?


My spouse and I both worked in full-time positions at IU during 2016, but I am enrolled in health care benefits under my spouse’s record. What will our 1095-C statements look like?
  1. You will each receive a separate 1095-C statement.
  2. On your statement in “Part III – Covered Individuals”, there will be no one listed.
  3. On your spouse’s statement in “Part III – Covered Individuals”, your spouse and you will both be listed.
My spouse and I both worked in full-time positions at IU during 2016, and we are each enrolled separately in medical plans. What will our 1095-C statements look like?
  1. You will each receive a separate 1095-C statement.
  2. On your statement in “Part III – Covered Individuals”, only you will be listed.
  3. On your spouse’s statement in “Part III – Covered Individuals”, only your spouse will be listed.
I’m on the Fellowship Recipient plan and I didn’t get a 1095-C from IU. What should I do?
Fellowship Recipients will receive a 1095-B from Anthem, not IU. You should receive your form in February 2017.
What is IU’s Employer Identification Number (EIN)?

IU’s Employer Identification Number is displayed within Part I of the form in the APPLICABLE LARGE EMPLOYER’S identification number (EIN) box.

Who should I contact with questions?


Phone: 812-856-1234




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