Tax Form 1095-C

IU reports 1095-C data to the IRS for the following individuals:

1. Employees who were full-time (defined by the ACA as 30 service hours per week) for one month or more in 2025.
2. Subscribers who were enrolled in any of the following IU-sponsored medical plans for at least one month in 2025:
   • Employee plans (Anthem PPO HDHP or Anthem PPO $500 Deductible Plan)
   • IU Student Academic Appointee (SAA) PPO Plan
   • IU Resident PPO Plan (for medical and optometry residents)
   • COBRA plans
   • Anthem Under 65 PPO HDHP (for IU retirees under age 65)

IU does not report 1095-C data for the following individuals:

• Fellowship Recipients. You will receive a 1095-B directly from Anthem.
• Anthem Blue Retiree participants (for IU retirees aged 65 and over). Assuming you’re enrolled in Medicare, you will receive a 1095-B from Medicare. However, for your first year of Medicare eligibility, if you were enrolled in an employee plan (including COBRA) for any part of the year, you can expect to receive a 1095-C from IU for those months.
• International and professional students with IU-sponsored medical insurance. You will receive a 1095-B directly from Anthem.

No. 1095-C data is only reported for the primary subscriber (typically the employee); however, each covered dependent is included on the primary subscriber’s form.

If you do not have access to the Employee Center, you can submit a Duplicate Statement Request Form to receive a paper copy of your 1095-C.

If you are the primary statement recipient, you can request a 1095-C form by:

• Consenting to electronic delivery, then logging in to the 1095-C Statement task in One.IU
• Requesting a paper statement through the mail by submitting a Duplicate Statement Request Form.

No. The dollar amount listed on Line 15 is the lowest monthly cost for self-only coverage that was available to you in that calendar month. It is not necessarily what you actually paid for coverage that month.

These codes provide information to the IRS about the coverage offered to you by Indiana University, the affordability of the coverage offered, and the reason why you were or were not offered coverage for each month. Explanations for each code can be found in the instructions on the back of Form 1095-C.

Report any errors to IU Human Resources at askHR@iu.edu or +1-812-856-1234.