Self-Insured Plans: Form 1095-C Preparation

All providers of health coverage, including employers that provide self-insured plans, must file their annual returns with the IRS to report information about the coverage and each covered individual.

Self-Insured Plans: Required Information

For self-insured plans, the following information must be reported to the IRS:

  • The name, address, and employer identification number (EIN) of the provider.
  • The statement recipient’s name, address, and taxpayer identification number (TIN). A date of birth may be used if you cannot obtain the recipient’s TIN.
  • The name and TIN of each individual covered (employees and their dependents) under the policy or program and the months for which the individual was enrolled in coverage and entitled to receive benefits. A date of birth may be used if a TIN cannot be obtained.

Self-insured coverage is defined as coverage where the employer assumes the financial risk for providing health care benefits to its employees. It is rare for small businesses to offer this form of coverage due to its costliness.

Lines 17-22 of Form 1095-C must be completed by employers offering self-insured health coverage for any individual who was an employee for one or more calendar months of the year, whether full-time or non-full-time, and enrolled in the coverage.

The IRS instructs that all employee dependents that are covered through the employee’s enrollment must be included on the same Form 1095-C as the employee.

If an employee is married to or a dependent of another employee and covered under their enrollment (such as with family coverage), the enrollment information should be reflected only on the Form 1095-C for the employee enrolled in the coverage. However, you would still report the employed spouse or dependent as a covered individual.


For more information regarding the instructions for Lines 17-22 for self-insured plans, please refer to the IRS instructions for Form 1095-C.

It is a good idea to gather this information as early as possible. It can be difficult to gather all of the necessary information from your employees in a timely manner. Check the deadlines today and get started!

BoomTax, The Boom Post, and its affiliates do not provide tax, legal or accounting advice. This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, tax, legal or accounting advice. You should consult your own tax, legal and accounting advisors prior to engaging in any transaction.

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