T company Logo o: All health benefits eligible Employees [or All Employees] Subject: Employer-Provided Health Insurance Offer of Coverage

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o: All health BENEFITS Eligible Employees [or All Employees]

Subject: Employer-Provided Health Insurance Offer of Coverage

Employee Communication


You may receive one or more 1095-A, 1095-B or 1095-C Forms issued by: (1) current or past employers; (2) a health insurance company; (3) your spouse’s employer; (4) a Federal / State Public Health Insurance Exchange; showing information about your health insurance coverage during calendar year 2015.

Form 1095-A will be issued to you if you or a family member had health insurance through a Public Health Insurance Exchange.

Form 1095-B may be issued by a health insurance company or an employer (or both).

Form 1095-C may be issued to all health benefit eligible employees, who were offered health insurance by [Company Name] (or past employer) that meet certain affordability and coverage requirements.

If you had health insurance from more than one employer or had other types of qualified health insurance coverage during 2015, you may receive more than one 1095 Form.

The 1095 Form issued by [Company Name] helps you and the company comply with the “Affordable Care Act”, sometimes referred to as Health Care Reform and/or ObamaCare laws. Not all employees will be receiving this form from us, if you are part-time, or otherwise not eligible for [Company Name] health insurance benefits, you will not receive a 1095 Form from the company. If you are covered or waived health benefit coverage you will receive a 1095 Form from us.

Personal Tax Filing

The 1095 Forms are for your 2015 tax records and are not to be attached to your 2015 Personal (1040) Income Tax Return.

If you (and your dependents) had health insurance coverage for all 12 months during 2015 you will be asked to check a box on your 1040 Tax return (no other information is required).

If for some reasons, you (and/or your dependents) did not have health benefit coverage you may be subject to IRS tax penalties depending on how many months you did not have health benefit coverage during the 2015 calendar year. Details on the Tax penalties are found in the 1040 Instruction booklet or you may seek advice from your tax preparer.

If you are listed as a dependent under someone else’s health benefit policy, you may obtain a copy of the 1095 Form from the primary covered individual.

Employees don’t have to wait to file their income tax returns if you have not received a 1095 Form; complete your personal tax forms timely. The IRS has delayed the processing of the employer reporting, extended the time allowed for employers to file their report with the IRS and to provide notice to employees.

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