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    IMPORTANT INFORMATION

    Under the IRS-Affordable Care Act, Denton ISD is required by law to send Form 1095-C to all employees, regardless of the employee accepting or declining coverage. This form includes important information and reflects the employee's decision about the health insurance coverage offered to you or your family by Denton ISD.  

    Form 1095-C Breakdown 

    https://www.irs.gov/pub/irs-pdf/f1095c.pdf

    Part I

    Employee - This information contains the employee information that must match what appears on the employee’s social security card.

    Employer - This information contains the employer's information that must match the employer identification number (EIN).

    Part II

    Employee Offer of Coverage - This section contains three parts (line 14, 15 & 16)

    Line 14 - Coding will indicate a 1 followed by a letter from A to K. Depending on the letter is an indicator for the IRS as to the type of coverage your employer offered: Qualifying offer, minimum essential coverage, an offer of coverage, or no offer of coverage.

    Line 15 - This amount has two reasons 1) Employee accepted coverage and this is the amount the employee would pay for the minimum value coverage. 2) The employee declined coverage and this is the amount the employee would have paid for the minimum value coverage.

    Line 16 - Coding will indicate a 2 followed by a letter from A - H. Depending on the letter is an indicator for the IRS the type of Safe Harbor Codes and Other Relief for Employers. 

    Part III

    Coverage Individuals - If Employer-provided self-insured coverage, check the box and enter the information for each individual enrolled in coverage, including the employee. An "X" will appear in the box only if you accepted coverage for yourself and/or member (s) of your family.

    Lines 17-22 - Each line will only contain the person (s) that coverage was accepted for along with their social security number (only last four will appear), and an "X" in each month of coverage. Should the person (s) have coverage all 12 months then an "X" will appear in the box marked "under the Covered all 12 months."   

     

    Questions regarding Form 1095-C can be directed back to Kim Smith 940-369-0025 or email KSmith4@dentonisd.org