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Message Box
iconsuccess
titleWhat's New for 2016
typegeneric
  • Part II Covered Individuals. Verbiage Change. Box 15 "Employee Required Contribution (see instructions)" Box 16 "Section 4980H Safe Harbor and Other Relief (enter code if applicable)" 
  • Part III Covered Individuals. Verbiage Change. Checkbox "If Employer provided self-insured coverage, check the box and enter the information for each individual enrolled in coverage, including the employee.", Column B "SSN or Other TIN", Column C "DOB (if SSN or other TIN is not available)"
  • Changes to codes. Code 1I for Form 1095-C, line 14, and code 2I for Form 1095-C, line 16, are no longer applicable and have been reserved. New codes 1J and 1K have been added for Form 1095-C, line 14. For more information, see the instructions for Form 1095-C, line 14 and line 16.
  • Notice 2016-70: This notice extends the due date for certain 2016 information-reporting requirements for insurers, self-insuring employers, and certain other providers of minimum essential coverage under section 6055 of the Internal Revenue Code (Code) and for applicable large employers under section 6056 of the Code. Specifically, this notice extends the due date for furnishing to individuals the 2016 Form 1095-B, Health Coverage, and the 2016 Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, from January 31, 2017, to March 2, 2017. This notice also extends good-faith transition relief from section 6721 and 6722 penalties to the 2016 information-reporting requirements under sections 6055 and 6056.

 

Import Form Fields:

Field NameSizeType DescriptionNotesPart
See Form Filer Common Fields  Filer fields common to all form types.  
See Recipient Common Fields  Recipient fields common to all form types.  
Box 1 - 6 Employee CharacterEmployeeFiler InfoPart I
Box 7-13 ALE MEMBER (Employer) CharacterApplicable Large Employer MemberRecipient InfoPart I

Box 1 Name

40Text

Box 1: Name of employee

 Part I
Box 2 TIN11TIN

Box 2: Social security number (ssn)

 Part I
Box 3 Address Deliv/Street40CharacterBox 3: employee address Recipient address line 1Part I

Box 4 City

40Character

Box 4: employee city

 Recipient cityPart I
Box 5 State2CharacterBox 5: employee State or province Recipient US state or Canadian province (Use state abbreviation)Part I
Box 6 Zip10CharacterBox 6: employee zip Recipient US zip or Canadian postal codePart I
Box 7 Name40CharacterBox 7: Name of employerFiler Name or company namePart I
Box 8 TIN11CharacterBox 8: Employer identification number (EIN) Filer TIN (EIN or SSN)Part I
Box 9 Address Deliv/Street40CharacterBox 9: Employer street address (including room or suite)Filer address line 1Part I
Box 10 Contact20CharacterBox 10: Contact telephone number Filer contact phone numberPart I
Box 11 City40CharacterBox 13: Employer city Filer cityPart I
Box 12 State2CharacterBox 14: Employer State Filer US state or Canadian province (Use state abbreviation)Part I
Box 13 Zip10CharacterBox 13: Employer Zip Filer US zip or Canadian postal codePart I
Box 14 Offer coverage2CodeBox 14: Offer of Coverage (enter required code) 1A / 1B / 1C / 1D / 1E / 1F / 1G / 1H / 1J / 1K (All12Months or Jan - Dec)Part II
Box 15 Month Premium12AmountBox 15: Employee Share of lowest cost monthly premium....All12Months or Jan - DecPart II
Box 16 Safe harbor2CodeBox 16: Applicable Section 408H Safe Harbor....2A / 2B / 2C / 2D / 2E / 2F / 2G / 2H / (All12Months or Jan - Dec)Part II
Box 17- 34 Covered Individuals CharacterCovered IndividualsEmployee DependentsPart III
Last Name/Company40CharacterCovered Individual last name Part III
Middle Initial12CharacterCovered Individual Middle initial Part III
First Name40CharacterCovered Individual first name Part III
Suffix2CharacterCovered Individual suffix Jr , SrPart III
Name Line 240CharacterCovered Individual name line 2 Additional name linePart III
Social Security Number11TINCovered Individual SSN Part III
Date of Birth10DateCovered Individual DOB (if SSN is not available)MM/DD/YYYY or M/D/YYYYPart III
Covered All 12 Months1CheckboxCovered Individual covered all 12 monthsX / Y / T / 1 = CheckedPart III

January Coverage

1Checkbox

January Coverage

X / Y / T / 1 = CheckedPart III
February Coverage1CheckboxFebruary CoverageX / Y / T / 1 = CheckedPart III
March Coverage1CheckboxMarch CoverageX / Y / T / 1 = CheckedPart III
April Coverage1CheckboxApril CoverageX / Y / T / 1 = CheckedPart III
May Coverage1CheckboxMay CoverageX / Y / T / 1 = CheckedPart III
June Coverage1CheckboxJune CoverageX / Y / T / 1 = CheckedPart III
July Coverage1CheckboxJuly CoverageX / Y / T / 1 = CheckedPart III
August Coverage1CheckboxAugust CoverageX / Y / T / 1 = CheckedPart III
September Coverage1CheckboxSeptember CoverageX / Y / T / 1 = CheckedPart III
October Coverage1CheckboxOctober CoverageX / Y / T / 1 = CheckedPart III
November Coverage1CheckboxNovember CoverageX / Y / T / 1 = CheckedPart III
December Coverage1CheckboxDecember CoverageX / Y / T / 1 = CheckedPart III
See Form Common Fields  Form fields common to all form types.  

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