- Loading...
IRS Release Status: FINAL
Sample Excel Import File: 1095-C 2020.xlsx 
Import Form Fields:
Field Name | Size | Type | Description | Notes | Part |
|---|---|---|---|---|---|
| See Form Filer Common Fields | Filer fields common to all form types. | ||||
| See Recipient Common Fields | Recipient fields common to all form types. | ||||
| Record Type | 1 | Text | Record Type is a required field and it indicates if a record is the Responsible Individual/Employee. | Use E for Employee/Responsible Individual & C for Covered Individual | |
| Box 1 - 6 Employee | Character | Employee | Recipient info | Part I | |
| Rcp Account | 25 | Character | Recipient Account Number | ||
| Last Name/Company | 40 | Character | Employee last name/Company Name | ||
| First Name | 40 | Character | Employee First name | ||
| Rcp TIN | 11 | TIN | Recipient Tax ID Number | ||
| Address Deliv/Street | 40 | Character | Employee Delivery address | ||
| Address Apt/Suite | 40 | Character | Employee Apartment Suite | ||
| City | 40 | Character | Employee City | ||
| State | 23 | Character | Employee State | ||
| Zip | 15 | Character | Employee Zip | ||
| Box 14-17 Employer Offer and Coverage | Character | Employer Offer and Coverage | Filer Info | Part II | |
| Emp Age Jan 1st | 3 | Numeric | If the employee was offered an individual coverage HRA, enter the employee’s age on January 1, 2020 | Age range 1 to 120 | Part II |
| Plan Start Month | 2 | Numeric | Enter the two-digit number (01 through 12) indicating the calendar month during which the plan year begins of the health plan in which the employee is offered coverage | (Required Field) If there is no health plan under which coverage is offered to the employee, enter “00.” | Part II |
| All Months Coverage | 2 | Code | Box 14: Offer of Coverage (enter required code) | 1A / 1B / 1C / 1D / 1E / 1F / 1G / 1H / 1J / 1K (All12Months or Jan - Dec) | Part II |
Jan Offer Coverage | 2 | Code | Box 14: Offer of Coverage (enter required code) | 1A / 1B / 1C / 1D / 1E / 1F / 1G / 1H / 1J / 1K (All12Months or Jan - Dec) | |
| Feb Offer Coverage | 2 | Code | Box 14: Offer of Coverage (enter required code) | 1A / 1B / 1C / 1D / 1E / 1F / 1G / 1H / 1J / 1K (All12Months or Jan - Dec) | |
| Mar Offer Coverage | 2 | Code | Box 14: Offer of Coverage (enter required code) | 1A / 1B / 1C / 1D / 1E / 1F / 1G / 1H / 1J / 1K (All12Months or Jan - Dec) | |
| Apr Offer Coverage | 2 | Code | Box 14: Offer of Coverage (enter required code) | 1A / 1B / 1C / 1D / 1E / 1F / 1G / 1H / 1J / 1K (All12Months or Jan - Dec) | |
| May Offer Coverage | 2 | Code | Box 14: Offer of Coverage (enter required code) | 1A / 1B / 1C / 1D / 1E / 1F / 1G / 1H / 1J / 1K (All12Months or Jan - Dec) | |
| Jun Offer Coverage | 2 | Code | Box 14: Offer of Coverage (enter required code) | 1A / 1B / 1C / 1D / 1E / 1F / 1G / 1H / 1J / 1K (All12Months or Jan - Dec) | |
| Jul Offer Coverage | 2 | Code | Box 14: Offer of Coverage (enter required code) | 1A / 1B / 1C / 1D / 1E / 1F / 1G / 1H / 1J / 1K (All12Months or Jan - Dec) | |
| Aug Offer Coverage | 2 | Code | Box 14: Offer of Coverage (enter required code) | 1A / 1B / 1C / 1D / 1E / 1F / 1G / 1H / 1J / 1K (All12Months or Jan - Dec) | |
| Sep Offer Coverage | 2 | Code | Box 14: Offer of Coverage (enter required code) | 1A / 1B / 1C / 1D / 1E / 1F / 1G / 1H / 1J / 1K (All12Months or Jan - Dec) | |
| Oct Offer Coverage | 2 | Code | Box 14: Offer of Coverage (enter required code) | 1A / 1B / 1C / 1D / 1E / 1F / 1G / 1H / 1J / 1K (All12Months or Jan - Dec) | |
| Nov Offer Coverage | 2 | Code | Box 14: Offer of Coverage (enter required code) | 1A / 1B / 1C / 1D / 1E / 1F / 1G / 1H / 1J / 1K (All12Months or Jan - Dec) | |
| Dec Offer Coverage | 2 | Code | Box 14: Offer of Coverage (enter required code) | 1A / 1B / 1C / 1D / 1E / 1F / 1G / 1H / 1J / 1K (All12Months or Jan - Dec) | |
| All Months Premium | 12 | Amount | Box 15: Employee Share of lowest cost monthly premium.... | All12Months or Jan - Dec | Part II |
| Jan Emp Cost Share | 12 | Amount | Box 15: Employee Share of lowest cost monthly premium.... | All12Months or Jan - Dec | |
| Feb Emp Cost Share | 12 | Amount | Box 15: Employee Share of lowest cost monthly premium.... | All12Months or Jan - Dec | |
| Mar Emp Cost Share | 12 | Amount | Box 15: Employee Share of lowest cost monthly premium.... | All12Months or Jan - Dec | |
| Apr Emp Cost Share | 12 | Amount | Box 15: Employee Share of lowest cost monthly premium.... | All12Months or Jan - Dec | |
| May Emp Cost Share | 12 | Amount | Box 15: Employee Share of lowest cost monthly premium.... | All12Months or Jan - Dec | |
| Jun Emp Cost Share | 12 | Amount | Box 15: Employee Share of lowest cost monthly premium.... | All12Months or Jan - Dec | |
| Jul Emp Cost Share | 12 | Amount | Box 15: Employee Share of lowest cost monthly premium.... | All12Months or Jan - Dec | |
| Aug Emp Cost Share | 12 | Amount | Box 15: Employee Share of lowest cost monthly premium.... | All12Months or Jan - Dec | |
| Sep Emp Cost Share | 12 | Amount | Box 15: Employee Share of lowest cost monthly premium.... | All12Months or Jan - Dec | |
| Oct Emp Cost Share | 12 | Amount | Box 15: Employee Share of lowest cost monthly premium.... | All12Months or Jan - Dec | |
| Nov Emp Cost Share | 12 | Amount | Box 15: Employee Share of lowest cost monthly premium.... | All12Months or Jan - Dec | |
| Dec Emp Cost Share | 12 | Amount | Box 15: Employee Share of lowest cost monthly premium.... | All12Months or Jan - Dec | |
| All Months Safe Hbr | 2 | Code | Box 16: Applicable Section 408H Safe Harbor.... | 2A / 2B / 2C / 2D / 2E / 2F / 2G / 2H / (All12Months or Jan - Dec) | Part II |
| Jan Safe Harbor Code | 2 | Code | Box 16: Applicable Section 408H Safe Harbor.... | 2A / 2B / 2C / 2D / 2E / 2F / 2G / 2H / (All12Months or Jan - Dec) | |
| Feb Safe Harbor Code | 2 | Code | Box 16: Applicable Section 408H Safe Harbor.... | 2A / 2B / 2C / 2D / 2E / 2F / 2G / 2H / (All12Months or Jan - Dec) | |
| Mar Safe Harbor Code | 2 | Code | Box 16: Applicable Section 408H Safe Harbor.... | 2A / 2B / 2C / 2D / 2E / 2F / 2G / 2H / (All12Months or Jan - Dec) | |
| Apr Safe Harbor Code | 2 | Code | Box 16: Applicable Section 408H Safe Harbor.... | 2A / 2B / 2C / 2D / 2E / 2F / 2G / 2H / (All12Months or Jan - Dec) | |
| May Safe Harbor Code | 2 | Code | Box 16: Applicable Section 408H Safe Harbor.... | 2A / 2B / 2C / 2D / 2E / 2F / 2G / 2H / (All12Months or Jan - Dec) | |
| Jun Safe Harbor Code | 2 | Code | Box 16: Applicable Section 408H Safe Harbor.... | 2A / 2B / 2C / 2D / 2E / 2F / 2G / 2H / (All12Months or Jan - Dec) | |
| Jul Safe Harbor Code | 2 | Code | Box 16: Applicable Section 408H Safe Harbor.... | 2A / 2B / 2C / 2D / 2E / 2F / 2G / 2H / (All12Months or Jan - Dec) | |
| Aug Safe Harbor Code | 2 | Code | Box 16: Applicable Section 408H Safe Harbor.... | 2A / 2B / 2C / 2D / 2E / 2F / 2G / 2H / (All12Months or Jan - Dec) | |
| Sep Safe Harbor Code | 2 | Code | Box 16: Applicable Section 408H Safe Harbor.... | 2A / 2B / 2C / 2D / 2E / 2F / 2G / 2H / (All12Months or Jan - Dec) | |
| Oct Safe Harbor Code | 2 | Code | Box 16: Applicable Section 408H Safe Harbor.... | 2A / 2B / 2C / 2D / 2E / 2F / 2G / 2H / (All12Months or Jan - Dec) | |
| Nov Safe Harbor Code | 2 | Code | Box 16: Applicable Section 408H Safe Harbor.... | 2A / 2B / 2C / 2D / 2E / 2F / 2G / 2H / (All12Months or Jan - Dec) | |
| Dec Safe Harbor Code | 2 | Code | Box 16: Applicable Section 408H Safe Harbor.... | 2A / 2B / 2C / 2D / 2E / 2F / 2G / 2H / (All12Months or Jan - Dec) | |
| All Months Zip Code | 5 | Code | Box 17: Zip Code | Used by employers to determine affordability | Part II |
| Jan Zip Code | 5 | Code | Box 17: Zip Code | Used by employers to determine affordability | |
| Feb Zip Code | 5 | Code | Box 17: Zip Code | Used by employers to determine affordability | |
| Mar Zip Code | 5 | Code | Box 17: Zip Code | Used by employers to determine affordability | |
| Apr Zip Code | 5 | Code | Box 17: Zip Code | Used by employers to determine affordability | |
| May Zip Code | 5 | Code | Box 17: Zip Code | Used by employers to determine affordability | |
| Jun Zip Code | 5 | Code | Box 17: Zip Code | Used by employers to determine affordability | |
| Jul Zip Code | 5 | Code | Box 17: Zip Code | Used by employers to determine affordability | |
| Aug Zip Code | 5 | Code | Box 17: Zip Code | Used by employers to determine affordability | |
| Sep Zip Code | 5 | Code | Box 17: Zip Code | Used by employers to determine affordability | |
| Oct Zip Code | 5 | Code | Box 17: Zip Code | Used by employers to determine affordability | |
| Nov Zip Code | 5 | Code | Box 17: Zip Code | Used by employers to determine affordability | |
| Dec Zip Code | 5 | Code | Box 17: Zip Code | Used by employers to determine affordability | |
| Box 17- 34 Covered Individuals | Character | Covered Individuals | Employee Dependents | Part III | |
| Emp Self Insured Chk | 1 | Character | Employee Self Insured Checkbox | X / Y / T / 1 = Checked | |
| Last Name/Company | 40 | Character | Covered Individual last name | Part III | |
| First Name | 40 | Character | Covered Individual first name | Part III | |
| RCP TIN | 11 | TIN | Covered Individual SSN | Part III | |
| RCP Date of Birth | 10 | Date | Covered Individual DOB (if SSN is not available) | MM/DD/YYYY or M/D/YYYY | Part III |
| Ind All Coverage Chk | 1 | Checkbox | Covered Individual covered all 12 months | X / Y / T / 1 = Checked | Part III |
Ind Jan Coverage Chk | 1 | Checkbox | January Coverage | X / Y / T / 1 = Checked | Part III |
| Ind Feb Coverage Chk | 1 | Checkbox | February Coverage | X / Y / T / 1 = Checked | Part III |
| Ind Mar Coverage Chk | 1 | Checkbox | March Coverage | X / Y / T / 1 = Checked | Part III |
| Ind Apr Coverage Chk | 1 | Checkbox | April Coverage | X / Y / T / 1 = Checked | Part III |
| Ind May Coverage Chk | 1 | Checkbox | May Coverage | X / Y / T / 1 = Checked | Part III |
| Ind Jun Coverage Chk | 1 | Checkbox | June Coverage | X / Y / T / 1 = Checked | Part III |
| Ind Jul Coverage Chk | 1 | Checkbox | July Coverage | X / Y / T / 1 = Checked | Part III |
| Ind Aug Coverage Chk | 1 | Checkbox | August Coverage | X / Y / T / 1 = Checked | Part III |
| Ind Sep Coverage Chk | 1 | Checkbox | September Coverage | X / Y / T / 1 = Checked | Part III |
| Ind Oct Coverage Chk | 1 | Checkbox | October Coverage | X / Y / T / 1 = Checked | Part III |
| Ind Nov Coverage Chk | 1 | Checkbox | November Coverage | X / Y / T / 1 = Checked | Part III |
| Ind Dec Coverage Chk | 1 | Checkbox | December Coverage | X / Y / T / 1 = Checked | Part III |
| See Form Common Fields | Form fields common to all form types. |
1095-C Form:
IRS 1095-C Form: 1095-C Form
IRS 1095-C Instructions: 1095-C Instructions
Overview
Content Tools