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

Form 1095-C
IRS Section 6056 defines the reporting requirements for large employers (50 or more full-time equivalent employees) to provide their employees with documentation outlining any applicable offer of health coverage. Form 1095-C is a statement issued by employers with 50 or more full time employees (including FTEs) to employees and the IRS. 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 2021 version coming soon)

Please contact us for other quantities needed.

$20.71