Form 1095-C health insurance information for federal tax return

The county has mailed you a document called Form 1095-C. This is in addition to your W-2 form. This form is proof of your health insurance coverage through the county in 2016.

Keep the form for your records; you do not attach it to your 2016 tax return.

Form 1095-C contains information that identifies:

  • Your employer, which is Hennepin County
  • You, the employee
  • The months during the previous year (2016) that you were eligible for/were enrolled in coverage
  • The lowest monthly single premium you could have paid ($13.72 for Advantage – HCMC/NorthPoint)
  • The names and social security numbers of each person covered. Read instructions on how to add SSN of each covered person into APEX (PDF).
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View Form 1095-C

How do I consent to receive my Form 1095-C online?

  1. Go to My Pay and Benefits > Benefits Information > Form 1095-C
  2. Read the consent statement and click the box giving your consent
  3. Click the Submit button
  4. Enter your Network password, then click Continue
  5. Click OK on the Submit Confirmation page
  6. On the 1095-C Consent Form page, Your Current Status will show “Consent received”

Note: to withdraw your consent to receive electronic 1095-C forms, go to the 1095-C Consent Form page and select the check box withdrawing your consent.

How do I view my online Form 1095-C?

  1. Go to My Pay and Benefits > Benefits Information > Form 1095-C
  2. Select the Year End Form link to view the form
  3. Select Filing Instructions for information about how to use your 1095-C information to file your taxes

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How do I view past 1095-C forms?

Select View a Different Tax Year to view forms back to 2015 when the form was implemented.

What you need to do

  1. Review the information in Form 1095-C. If you notice errors, email hr.servicecenter@hennepin.us by April 15 and include your name, employee ID, phone number, and explain what information is incorrect.
  2. Keep Form 1095-C for your records.

Note: If you were offered health insurance coverage by the county but did not enroll, you and your eligible dependents will not be eligible for a premium tax credit through MNsure.

What do the codes mean?

Line 14

  • Shows if the coverage offered by the county met the minimum essential coverage and minimum value required by the Affordable Care Act (ACA).
  • Most employees will see code 1E, which means the county offered.

Line 15

  • The dollar amount in line 15 on Form 1095-C does not match what you actually pay for the 2016 coverage.
  • Is the employee’s share of lowest cost single coverage (with the full employer contribution) offered by the county - this is the premium for Advantage – HCMC/NorthPoint.
  • This amount is not intended to match the amounts of actual deductions displayed on your pay stub or what you actually pay.

Line 16

  • Shows if you were enrolled in the county coverage.
  • Most employees will see code 2C, which means they were enrolled in one of the county’s health insurance plans.

View the full IRS form (PDF).

If you did not receive Form 1095-C or need a copy

You will not receive Form 1095-C if you were not eligible for health insurance coverage by Hennepin County during 2016.

If you believe you should have received it, email hr.servicecenter@hennepin.us. Include your name, employee ID, phone number, and explain why you should receive a document.

Also, be sure to verify your address in APEX, especially if you have a new address or are not sure it is correct. This ensures all documents will be mailed to you.

  1. Sign into APEX.
  2. Click on the My HR tab
  3. Scroll down to My Personal Information
  4. Select Home and Mailing Address
  5. If address is incorrect, select Edit to make your change

If you need help, email hr.servicecenter@hennepin.us.

Get a copy

After Form 1095-C is mailed to you, it will be available in APEX Self Service.

If your child is covered under your health plan and files their own taxes, they will not receive a copy of Form 1095-C from the county. You can print a copy for them from APEX Self Service.

Why you need to do this

The Affordable Care Act (ACA) requires large employers like the county to report to the IRS about health coverage offered to our eligible employees.

Form 1095-C provides both you and the IRS with information about the 2016 health insurance offered to you and, if applicable, your family by the county. It is not for dental or vision coverage.

The IRS will receive a copy of this document and will use the information to determine whether you may have to pay a fine for failing to have health care coverage. The IRS will cross-check the information you provide on your tax return against the information the county submits.

For more information about Form 1095-C and filing your taxes in 2017, go to www.irs.gov.

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