1095-C : Employer-Provided Health Insurance Offer and Coverage

FDX

#	Id	Type	Description
1	employeeName	IndividualName	Box 1, Employee name
2	tin	string	Box 2, Social security number (SSN)
3	employeeAddress	Address	Boxes 3-6, Employee address
4	employerNameAddress	NameAddressPhone	Boxes 7, 9-13, Employer name, address and phone
5	employerTin	string	Box 8, Employer identification number (EIN)
6	selfInsuredCoverage	boolean	Self Insured Coverage
7	offersOfCoverage	Array of OfferOfHealthInsuranceCoverage	Boxes 14-16, Employee Offer of Coverage
8	employeeAge	integer	Employee's Age on January 1
9	planStartMonth	integer	Plan Start Month
10	coveredIndividuals	Array of HealthInsuranceCoveredIndividual	Boxes 17+, Covered Individuals

This form is not reported in the IRS FIRE system.

The TXF standard does not support this form.