See which Series 1 code applies to a specific employee for Form 1095-C.

1. “WHICH CODE APPLIES TO THIS EMPLOYEE?”
ACA Reporting
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EMPLOYEE TYPE
NO
FORM
NO
FORM
CURRENT YEAR
PRIOR YEAR
EMPLOYEE
TERMED IN
PLAN OFFERED MET
STANDARDS OF MINIMUM
ESSENTIAL COVERAGE
OFFERED AT
MINIMUM
VALUE?
2015 TRANSITION RELIEF
NO COVERAGE
EMPLOYEE’S MONTHLY
CONTRIBUTION TOWARDS
SELF-ONLY COVERAGE -
IN RELATION TO THE FEDERAL
POVERTY LINE:
> 9.5% ($93.18)
≤ 9.5% ($93.18)
ANY CODES A-E
DETERMINED BY THE COBRA
COVERAGE ELECTED
WHO WAS
OFFERED
COVERAGE?
EMPLOYEE
ELECTED
COBRA?
NO
YES
WAS EMPLOYEE
ELIGIBLE FOR
COVERAGE?
More info on Series 1 Codes at bit.ly/how-to-1095-c