Field Definitions: PR ACA 1095C Employee Form

The following is a list of field descriptions for the PR ACA 1095C Employee form. Many of the descriptions include links to other topics that provide additional information about or related to the topic.

Last Name

Last Name field on the PR ACA 1095-C Employee form, Covered Individuals tab

Necessary only if the Enrolled in Employer Provided Self-Insurance check box on the Info tab is selected.

If the Enrolled in Employer Provided Self-Insurance check box on the Info tab is selected, defaults the employee's last name in the last record.

For a new dependent record, enter a last name, up to 30 characters.

First Name

First Name field on the PR ACA 1095-C Employee form, Covered Individuals tab

Necessary only if the Enrolled in Employer Provided Self-Insurance check box on the Info tab is selected.

If the Enrolled in Employer Provided Self-Insurance check box on the Info tab is selected, defaults the employee's first name in the first record.

For a new dependent record, enter a first name, up to 30 characters.

Middle Init

Middle Init field on the PR ACA 1095-C Employee form, Info tab.

When this record is created, this field defaults the employee's middle initial from the Middle field in PR Employees. If a full middle name is entered in PR Employees, this field defaults the first letter of the middle name.

Accept the default, or enter the employee's middle initial.

Editing this field does not update the corresponding field in PR Employees.

SSN

SSN field on the PR ACA 1095-C Employee form, Covered Individuals tab

Necessary only if the Enrolled in Employer Provided Self-Insurance check box on the Info tab is selected.

If the Enrolled in Employer Provided Self-Insurance check box on the Info tab is selected, defaults the employee's SSN in the first record.

For a new dependent record, enter an SSN.

Is Full Time

Is Full Time check box on the PR ACA 1095-C Employee form

Select this check box to indicate that the employee is a full-time employee.

Note: A full-time employee is not the same as a full-time equivalent (FTE) employee. An FTE is not treated as a full-time employee because he or she is not employed on average at least 30 hours of service per week. However, an FTE is counted as the equivalent of a full-time employee for purposes of determining whether the employer is an Applicable Large Employer (ALE) member.
Note: For more information, visit the Internal Revenue Service website at www.irs.gov and search for "Instructions for Forms 1094-C and 1095-C".

Enrolled in Employer Provided Self-Insurance

Enrolled in Employer Provided Self-Insurance check box on the PR ACA 1095-C Employee form

Select this check box to indicate that self-insurance coverage was provided to the employee. Self-insurance coverage is coverage provided by the employer through a self-insured plan.

Leave this check box unselected if the employers subscribes to a conventional insurance plan.

Note: When you select this check box, the individual will be added to the Covered Individual tab. Once the individual is added, if the check box is later unselected, the covered individual must be manually deleted from the tab.

1095 Email Consent

(United States only) The 1095 Email Consent check box on the PR ACA 1095-C Employees form, Info tab.

This field defaults based on how you set the 1095 Email Consent check box in PR Employees.

Select this check box if this employee has consented to receive 1095s electronically (via email) for this tax year. If selected, the employee must have an email address defined in PR Employees (Info tab).

Leave this check box unselected if the employee has not consented to receive 1095s electronically for this tax year. Instead, the employee will receive printed 1095s.

When you launch Aatrix via the PR ACA Process form (Tasks > Launch Aatrix Print and eFile), the setting defined here is sent to Aatrix and determines how Aatrix will handle delivery of 1095s for the employee.

Offered Coverage in All 12 Months

Offered Coverage in All 12 Months field on the PR ACA 1095-C Employee form

Select the type of offered coverage for the employee.

Make a selection in this field only if the employee was offered coverage for all 12 months of the tax year. Leave this field blank if the employee was offered coverage in fewer than 12 months of the tax year.

Employee Share All 12 Months

Employee Share All 12 Months field on the PR ACA 1095-C Employee form

Required only when the Offered all 12 Months field value is set to 1B-Employee only, 1C-Employee/dependents, 1D-Employee/spouse, or 1E-Employee/dependents/spouse.

Enter the dollar value for the employee’s share of the lowest-cost monthly premium for self-only minimum essential coverage providing minimum value that is offered to the employee. If the employee is not required to contribute any amount towards the premium, enter 0.00.

Enter a value in this field only if the employee was offered coverage for all 12 months of the tax year. Do not use this field if the employee was offered coverage in only some months of the tax year.

Section 4980H Safe Harbor All 12 Months

Section 4980H Safe Harbor All 12 Months field on the PR ACA 1095-C Employee form

Select an option relating to 12-month coverage offered:

  • 2A - Not employed

  • 2B - Not full-time

  • 2C - Enrolled

  • 2D - Non-Assessment

  • 2E - Multi-employer

  • 2F - W-2 Safe Harbor

  • 2G - Fed Poverty Safe Harbor

  • 2H - Rate of Pay Safe Harbor

  • 2I - Non-calendar year transition

Make a selection in this field only if the employee was offered coverage for all 12 months of the tax year. Do not use this field if the employee was offered coverage in only some months of the tax year.

ZIP Code (Line 17)

ZIP Code (Line 17) field on the PR ACA 1095-C Employee form, Info tab and Monthly Offer of Coverage tab

Enter the zip code used to determine affordability for an ICHRA, if one was offered to the employee.

The correct entry depends on the Series One Offer Code applicable to this employee.
Note: Certain Series One codes dictate using the zip code of the employee's primary residence, while others dictate using the zip code of the employee's primary work location.

Plan Start Month

Plan Start Month on the PR ACA 1095-C Employee form, Info and Grid tabs.

If you initialized employees (via PR ACA Process > Tasks > Initialize ACA), this field defaults the Plan Start Month selected in PR ACA Initialize. May be overridden as needed for each employee.

From the drop-down menu, select the calendar month (01- January thru 12 - December) in which the plan year begins. If more than one plan year could apply (e.g. the ALE Member changes the plan year during the year), select the earliest applicable month.

If no health plan coverage was offered to the employee, select 00 - No Health Plan Offered.

Note: This field is not required for Tax Year 2016; however, it will be required beginning Tax Year 2017. If you enter a value here, it will be included in the XML file and will print on the Form 1095-C.

Age on Jan 1

Age on Jan 1 field on the PR ACA 1095-C Employee form, Info tab.

When this record is created, this field defaults the employee's middle initial from the Middle field in PR Employees. If a full middle name is entered in PR Employees, this field defaults the first letter of the middle name.

Accept the default, or enter the employee's middle initial.

The employee's age on January 1st of the tax year.

Type

The Type field on the PR ACA 1095-C Employee form.

Note: Beginning December 2021, Aatrix is required for ACA reporting. Amended and replacement 1095s/1094s must be handled directly in Aatrix (using the History button in PR Aatrix - ACA Print & eFile). Therefore, this field is no longer used and is disabled. However, to preserve historical data, this field remains visible. New records automatically default as "Original" and are not updated by Aatrix.

Display only, indicating the submission type for 1095-C printed or e-file transmissions.

  • O-Original - Indicates this record was included in original or replacement 1095-C forms.

  • C-Corrected - Indicates this record was included in corrected 1095-C forms.

Transmission ID

The Transmission ID field on the PR ACA 1095-C Employee form, Info and Grid tabs.

Note: Beginning December 2021, Aatrix is required for ACA reporting. Amended and replacement 1095s/1094s must be handled directly in Aatrix (using the History button in PR Aatrix - ACA Print & eFile). Aatrix does not send data back to Vista; therefore, this field is no longer used. However, to preserve historical data, this field remains visible.

Display only, the 1095-C transmission ID, populated when the e-file transmission was written with the current, numeric transmission ID in the 1095-C record.

Record ID

The Record ID field on the PR ACA 1095-C Employee form, Info and Grid tabs.

Note: Beginning December 2021, Aatrix is required for ACA reporting. Amended and replacement 1095s/1094s must be handled directly in Aatrix (using the History button in PR Aatrix - ACA Print & eFile). Aatrix does not send data back to Vista; therefore, this field is no longer used. However, to preserve historical data, this field remains visible.

Display only, the numeric value written into the 1095-C record as a part of the e-file generation process.

Original Rec ID

The Original Rec ID field on the PR ACA 1095-C Employee form, Info and Grid tabs.

Note: Beginning December 2021, Aatrix is required for ACA reporting. Amended and replacement 1095s/1094s must be handled directly in Aatrix (using the History button in PR Aatrix - ACA Print & eFile). Aatrix does not send data back to Vista; therefore, this field is no longer used. However, to preserve historical data, this field remains visible.

Display only, the numeric-ID that was assigned to the 1095-C record when the Transmission ID was generated.

Offer of Coverage

Offer of Coverage field on the PR ACA 1095-C Employee form, Monthly Offer of Coverage tab

Note: You should not select a value here if values have been entered in any of the fields in the "Part 2-Employee Offer and Coverage all 12 months" section of the Info tab.

Select an option relating to monthly coverage offered for the employee.

Make a selection in this field only if the employee was offered coverage in fewer than 12 months of the tax year. Leave this field blank if the employee was offered coverage in all 12 months of the tax year.

Employee Share

Employee Share field on the PR ACA 1095-C Employee form, Monthly Offer of Coverage tab

Required only when the Offer of Coverage field value is set to 1B-Employee only, 1C-Employee/dependents, 1D-Employee/spouse, or 1E-Employee/dependents/spouse.

Note: You should not enter a value here if values have been entered in any of the fields in the "Part 2-Employee Offer and Coverage all 12 months" section of the Info tab.

For each month, enter the monthly dollar value for the employee’s share of the lowest-cost monthly premium for self-only minimum essential coverage providing minimum value that is offered to the employee. If the employee is not required to contribute any amount towards the premium in a month, enter 0.00.

Enter a value in this field only if the employee was offered coverage for only some months of the tax year. Do not use this field if the employee was offered coverage in all 12 months of the tax year.

Section 4980H Safe Harbor

Section 4980H Safe Harbor field on the PR ACA 1095-C Employee form, Monthly Offer of Coverage tab

Note: You should not select a value here if values have been entered in any of the fields in the "Part 2-Employee Offer and Coverage all 12 months" section of the Info tab.

Select an option relating to monthly coverage offered:

  • 2A - Not employed

  • 2B - Not full-time

  • 2C - Enrolled

  • 2D - Non-Assessment

  • 2E - Multi-employer

  • 2F - W-2 Safe Harbor

  • 2G - Fed Poverty Safe Harbor

  • 2H - Rate of Pay Safe Harbor

  • 2I - Non-calendar year transition

Make a selection in this field only if the employee was offered coverage for only some months of the tax year. Do not use this field if the employee was offered coverage in all 12 months of the tax year.

ZIP Code (Line 17)

ZIP Code (Line 17) field on the PR ACA 1095-C Employee form, Info tab and Monthly Offer of Coverage tab

Enter the zip code used to determine affordability for an ICHRA, if one was offered to the employee.

The correct entry depends on the Series One Offer Code applicable to this employee.
Note: Certain Series One codes dictate using the zip code of the employee's primary residence, while others dictate using the zip code of the employee's primary work location.

Seq

Seq field on the PR ACA 1095-C Employee form, Covered Individuals tab

Necessary only if the Enrolled in Employer Provided Self-Insurance check box on the Info tab is selected.

If the Enrolled in Employer Provided Self-Insurance check box on the Info tab is selected, the first sequence defaults to the employee.

Enter N, New, or + to add a new sequence number for a dependent. The system will automatically assign the next available sequential number.

MidInitial

MidInitial field on the PR ACA 1095-C Employee form, Covered Individuals tab.

Only used if the Enrolled in Employer Provided Self-Insurance check box on the Info tab is selected.

Note: Once you select the Enrolled in Employer Provided Self-Insurance check box, the system defaults the employee as the first record. The employee's middle intial will default as recorded on the Info tab.

If you initialized from HR and selected the Include Dependents check box, this field will default from HR Resource Dependents. You may edit this field as necessary.

For a new dependent record, enter a middle initial.

DOB

DOB field on the PR ACA 1095-C Employee form, Covered Individuals tab

Necessary only if the Enrolled in Employer Provided Self-Insurance check box on the Info tab is selected.

If the Enrolled in Employer Provided Self-Insurance check box on the Info tab is selected, defaults the employee's date of birth in the first record.

For a new dependent record, enter a date of birth.

Covered All 12 Months / Individual Months

Covered All 12 Months check box and the individual months' check boxes on the PR ACA 1095-C Employee form, Covered Individuals tab

Necessary only if the Enrolled in Employer Provided Self-Insurance check box on the Info tab is selected.

Select the Covered All 12 Months check box to indicate full-year coverage, or select the appropriate individual month(s) that the individual was covered under employer self-insurance plan.