Edit Forms 1095-C screen Field Reference
A reference for completing or changing the field values in the Edit Forms 1095-C screen.
This screen reference describes the following:
Select Employees
Each row in the grid is an employee who had earnings within 30 months of the last day of the tax year. Earnings include Holiday hours.
Most of the fields are display only. The only exception is the checkbox in the Print 1095-C column. Use the remaining fields on the tab to identify the employees for whom you want to create a Form 1095-C.
Field | Description |
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Print 1095-C | Select the checkbox to indicate that you want to create a Form 1095-C for the employee. Only employees for whom you have selected the checkbox will appear on the remaining tabs on the screen. Note: The checkbox is automatically selected for employees who have been full-time for at least one day in the specified tax year.
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Part I
Each row in the grid is an employee who was selected on the Select Employees tab.
Most of the fields are display only. The only exception is the checkbox in the Enrolled in Employer Provided Self-Insurance Coverage column.
Field | Description |
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Employee These values come from the Employee screen. | |
Enrolled in Employer Provided Self-Insurance Coverage | Select the checkbox to indicate that the employee was enrolled in employer provided self-insurance coverage. You must select this checkbox for the employee to appear on the Part III tab. |
First Name | The employee's first name. |
Initial | The employee's middle initial. |
Last Name | The employee's last name. |
Suffix | The employee's suffix. |
Social Security Number | The employee's social security number. |
Street Address 1 | The first line of the employee's street address. |
Street Address 2 | The second line of the employee's street address. |
City or town | The city for the employee's address. |
State or province | The state for the employee's address. |
ZIP or foreign postal code | The ZIP for the employee's address. |
Date of Birth | The employee's date of birth. |
Part II Line 14
Field | Description |
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Employee Offer and Coverage, Offer of Coverage (enter required code) | |
All Employees - Use this area to set the offer of coverage for all employees. This sets the default coverage offered to employees. You can override this information for a specific employee in the Employee Overrides section. Complete either the All 12 Months field or the fields for each month. | |
Plan Start Month | Select the default month in which coverage started. This field is required. |
All 12 Months | Select the indicator that specifies the type of coverage offered to employees for the entire year. Use this field if the coverage offered to employees was the same in every month of the year. If you select a value in the All 12 Months field, the fields for the months are disabled.
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January - December | Select the indicator that specifies the type of coverage offered to employees in each month of the year. Use these fields if the coverage offered to employees was different in different months of the year. If you select a value in a month field, the All 12 Months field is disabled.
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Employee Overrides - Each row in the grid is an employee who was selected on the Select Employees tab. Most of the fields are display only. Use the grid to enter offer of coverage information specific to individual employees, which will override the default information entered above. Tip: Select
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Print From | Defaults to All Employees Section, which will use the default offer of coverage information entered above for the employee. Select the coverage information to print on the Form 1095-C for each employee.
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Plan Start Month | Select the month in which coverage started for the employee. |
All 12 Months | Select the indicator that specifies the type of coverage offered to the employee for the entire year. Use this field if the coverage offered to the employee was the same in every month of the year. If you select a value in the All 12 Months field, the fields for the months are disabled.
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Jan - Dec | Select the indicator that specifies the type of coverage offered to the employee in each month of the year. Use these fields if the coverage offered to the employee was different in different months of the year. If you select a value in a month field, the All 12 Months field is disabled.
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Part II Line 15
Field | Description |
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Employee Offer and Coverage, Employee Share of Lowest Cost Monthly Premium, for Self Only Minimum Value Coverage | |
All Employees - Use this area to set the employee share for all employees. This sets the default amount for the employee share for employees. You can override this information for a specific employee in the Employee Overrides section. Complete either the All 12 Months field or the fields for each month. | |
All 12 Months | Enter the amount for the employee share of the monthly premium for the lowest cost plan for self only minimum value coverage. Use this field if the employee share was the same in every month of the year. If you enter an amount in the All 12 Months field, the fields for the months are disabled. |
January - December | Enter the amount for the employee share of the monthly premium for the lowest cost plan for self only minimum value coverage in each month of the year. Use these fields if the employee share was different in different months of the year. If you enter an amount in a month field, the All 12 Months field is disabled. |
Employee Overrides - Each row in the grid is an employee who was selected on the Select Employees tab. Most of the fields are display only. Use the grid to enter offer of coverage information specific to individual employees, which will override the default information entered above. Tip: Select
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Print From | Defaults to All Employees Section, which will use the default employee share information entered above for the employee. Select the coverage information to print on the Form 1095-C for each employee.
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All 12 Months | Enter the amount for the employee share of the monthly premium for the lowest cost plan for self only minimum value coverage. Use this field if the employee share was the same in every month of the year. If you enter an amount in the All 12 Months field, the fields for the months are disabled. |
Jan - Dec | Enter the amount for the employee share of the monthly premium for the lowest cost plan for self only minimum value coverage in each month of the year. Use these fields if the employee share was different in different months of the year. If you enter an amount in a month field, the All 12 Months field is disabled. |
Part II Line 16
Field | Description |
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Employee Offer and Coverage, Applicable Section 4980H Safe Harbor (enter code if applicable) | |
All Employees - Use this area to set the Code Series 2 for all employees. This sets the default coverage status for employees. You can override this information for a specific employee in the Employee Overrides section. Complete either the All 12 Months field or the fields for each month. | |
All 12 Months | Select the indicator that specifies the default coverage status for employees for the entire year. Use this field if the coverage status for employees was the same in every month of the year. If you select a value in the All 12 Months field, the fields for the months are disabled.
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January - December | Select the indicator that specifies the default coverage status for employees for each month of the year. Use these fields if the coverage status for employees was different in different months of the year. If you select a value in a month field, the All 12 Months field is disabled.
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Employee Overrides - Each row in the grid is an employee who was selected on the Select Employees tab. Most of the fields are display only. Use the grid to enter offer of coverage information specific to individual employees, which will override the default information entered above. Tip: Select
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Print From | Defaults to All Employees Section, which will use the default code entered above for the employee. Select the coverage information to print on the Form 1095-C for each employee.
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All 12 Months | Select the indicator that specifies the coverage status for the employee for the entire year. Use this field if the coverage status for the employee was the same in every month of the year. If you select a value in the All 12 Months field, the fields for the months are disabled.
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Jan - Dec | Select the indicator that specifies the coverage status for the employee for each month of the year. Use these fields if the coverage status for employees was different in different months of the year. If you select a value in a month field, the All 12 Months field is disabled.
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Part II Line 17
Select the pin in the column header to pin a column. A pinned column is moved to the left side of the grid and remains visible when you scroll to the right. Each column has its own pin.Field | Description |
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Zip Code | The zip code used to determine affordability for an ICHRA, if one was offered to the employee. The default value in the All 12 Months field depends on the Series One Offer Code you entered for this employee in Part II Line 14: If needed, override the default value.
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Part III
Field | Description |
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Covered Individuals - Each row in the grid is an employee who was selected on the Select Employees tab and who has the Enrolled in Employer Provided Self-Insurance Coverage checkbox selected on the Part I tab. Use the grid to specify the dependents for each employee. You can manually add dependents by adding rows under each employee, import dependent information from Excel, or copy dependents from the prior tax year. If needed, select Tip: You cannot sort the data in this grid; however, you can copy the data to paste it in Excel. Right-select on the Covered Individuals grid and select Copy Grid to Clipboard. Open Excel and paste the data. You may need to format cells as text before pasting, if the data contains leading zeros. You may need to press Esc to exit the current cell before right-clicking to copy the grid or to paste into to the grid.
Select | |
Import Dependents |
Select Import Dependents to import dependent information from Excel (XLSX or XLS files). Browse to the file you want to import and select Open. You can import dependent information more than once. If you import a line with the same employee name and dependent name as an existing line, all other information in the line is overwritten with the information from the imported file. If you import an employee line with the same name as an existing line, only the columns for All 12 Months and Jan-Dec are overwritten with the information from the imported file. An import template for covered individuals is installed in the following location:
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Copy Dependents from Prior Tax Year | Select Copy Dependents from Prior Tax Year and Yes on the confirmation message to copy dependent information from the prior tax year for all employees listed in the Part III tab. ProContractor copies dependent information as follows:
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Sort Name | The sort name for the employee. |
Employee | The code that identifies the employee. |
Name of Covered Individual | The full name of the covered individual (employee or dependent). |
Add Dependent | Select Add to manually enter a dependent for the employee. This button is not available on dependent rows. |
First Name | For an employee row, displays the employee's first name. For a dependent row, enter the dependent's first name. |
Initial | For an employee row, displays the employee's middle initial. For a dependent row, enter the dependent's middle initial. |
Last Name | For an employee row, displays the employee's last name. For a dependent row, enter the dependent's last name. |
Suffix | For an employee row, displays the employee's suffix, such as Sr., Jr., or III. For a dependent row, enter the dependent's suffix, such as Sr., Jr., or III. |
Social Security Number | For an employee row, displays the employee's social security number. For a dependent row, enter the dependent's social security number. |
Date of Birth | For an employee row, displays the employee's date of birth. For a dependent row, enter the dependent's date of birth. |
All 12 Months | Select the checkbox to indicate that the individual was covered for all 12 months of the year. Complete either the All 12 Months field or the fields for each month as needed. If you select this checkbox, the fields for each month are disabled. |
Jan - Dec | Select the checkbox in each month column to indicate in which months the individual was covered. Complete either the All 12 Months field or the fields for each month as needed. If you select a checkbox in a month field, the All 12 Months field is disabled. |
Employee/Dependent | Displays whether the individual in the row is an employee or a dependent. |