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Form 1095-C Series 1 Code Map

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See which Series 1 code applies to a specific employee for Form 1095-C.

Published in: Recruiting & HR
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Form 1095-C Series 1 Code Map

  1. 1. “WHICH CODE APPLIES TO THIS EMPLOYEE?” ACA Reporting © benefitexpress More info on Series 1 Codes at http://bit.ly/how-to-1095-c EMPLOYEE TYPE NO FORM NO FORM CURRENT YEAR PRIOR YEAR EMPLOYEE TERMED IN PLAN OFFERED MET STANDARDS OF MINIMUM ESSENTIAL COVERAGE OFFERED AT MINIMUM VALUE? 2015 TRANSITION RELIEF NO COVERAGE EMPLOYEE’S MONTHLY CONTRIBUTION TOWARDS SELF-ONLY COVERAGE - IN RELATION TO THE FEDERAL POVERTY LINE: > 9.5% ($93.18) ≤ 9.5% ($93.18) ANY CODES A-E DETERMINED BY THE COBRA COVERAGE ELECTED WHO WAS OFFERED COVERAGE? EMPLOYEE ELECTED COBRA? NO YES WAS EMPLOYEE ELIGIBLE FOR COVERAGE? More info on Series 1 Codes at bit.ly/how-to-1095-c

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