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1095-C, Employer-Provided Health Insurance, Employer/Employee Copy

Item 92636.5096, 1095-C, Employer-Provided Health Insurance, Employer/Employee Copy

Order by Recipients to See Price

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Used by large employers with more than 50 full-time employees to report Affordable Care Act (ACA) information to employees/recipients and to the IRS as proof of healthcare coverage.  For laser or inkjet printers.

  • This form is used for the Recipient copy and as the Employer copy, so with 100 Recipients you would typically order 200 forms
  • For employees with more than 6 dependents, order 92636.5096C Continuation form, which can be found in Compatible Products (see below)
  • The form used to file with the IRS is 92636.5095L, which can be found in Compatible Products (see below)
  • One recipient per sheet
  • 8 1/2" x 11" sheet, horizontal perforation at 5 1/2", on 20 lb. paper stock
  • Filing Deadlines: to Recipients by January 31 - to IRS by February 28
  • Compatible with Laser Link Tax Preparation Software (Product 95412)
Please contact us if you need quantities other than those listed.  We'd be happy to give you a very competitive quote.  And please also give us the opportunity to meet or beat any other legitimate quotes.

You may also want to review our FAQs for frequently-asked questions about tax forms.

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