Form 1095-C, Employer-Provided Health Insurance Offer and Coverage

What is Form 1095-C?

Form 1095-C is Employer-Provided Health Insurance Offer and Coverage from the IRS.

An Applicable Large Employer (ALE) Member must file it for each employee who was its full-time employee for any month of the calendar year, excluding months in a Limited Non-Assessment Period.

An ALE Member with a self-insured health plan also completes it for any employee who enrolls in that coverage, whether or not the employee was full-time.

It reports information about each employee to the IRS.

How the IRS accepts Form 1095-C

Form 1094-C transmits Forms 1095-C to the IRS.

ACA information returns can be submitted through the IRS AIR system; check the IRS instructions to see whether you must file electronically.

For paper filing, follow the IRS instructions and Publication 5223 for substitute-form requirements.

The recipient copy says not to attach it to the tax return; the IRS form page provides instructions and the latest information.

The IRS form page lists the linked form under “Current revision”.

The blank also prints “Created 5/21/25”.

The blank on this page

This Form 1095-C blank is for reporting calendar year 2025, not calendar year 2026.

You can fill in this blank in the PDFLiner editor.