1095-C - Employer-Provided Health Insurance Offer and Coverage Page 1

Form 1095-C
Employers with 50+ full time equivalent employees must issue form 1095-C to employees and file with the IRS as prof of healthcare coverage.

Form 1094-C is the related transmittal sent to the IRS.

ALL Covered Individuals need to be listed on Page 2 of the 1095-C.
Either order item B1095C205 with this form or order both pages together as a kit with item number B1095C1205. 

(Approved 2023 version coming soon)

Please contact us for other quantities needed.