Chamber Insider Blog

Get the 411 on 1095 Forms

-Written by Bill Schmidt, SBIS

You may have read or seen articles about a new tax form called a 1095 form.  So, what exactly is this form and do you need to be concerned about it?

The answer is YES, you do need to be concerned!  The 1095 form is a tax document that proves that you had insurance during the 2015 year.  Think back to 2010 when the Healthcare Reform bill was passed.  You may remember that a key component of the bill was the mandate that everyone must have health insurance coverage.  If individuals did not obtain coverage and keep it for more than 9 months, they would be fined or taxed – depending on how you look at things. 

During the first year, the fine was minimal – only $95.  However, it has gone up each successive year.  For the 2015 tax year, the fine was the greater of 2% of household income or $325 per adult and $162.50 per child.  If you did not have coverage in 2015, you can expect to pay the greater of those fines on your tax return.  Going into 2016, the fine will increase up to 2.5% of household income or $695 for each adult and $347.50 for each child; whichever is greater.  The 1095 form will give you the proof of coverage to avoid the fine.  I have included a sample what the 1095 form looks like below.

So, how do you get the 1095 form?

If you are individually insured, or if you are insured on a small employer (2-50) plan that is not self-insured, this form will come to you from your insurance company.  The original date that the insurance companies had to have this out to you was January 31, 2016.   However, there was an extension given by the IRS to accommodate the first year of implementation.  Now, the insurance companies have until March 31, 2016 to send the required form.

If you work for an employer that has more than 50 employees, or your employer has a self-insured plan, the employer is responsible for providing the form – NOT the insurance companies.  They, too, have until March 31, 2016 to distribute.  This is quite the undertaking for a lot of employers as they have to go back and track all of their employees for 2015 and moving forward.  The backtracking is a significant amount of work, but the alternative is a fine to the employer of up to $500 per return (or, per employee).  That can be a hefty fee of up to $50,000 if you have 100 full-time employees.

All individuals should make sure they receive their forms by March 31, 2016.  If you do not receive it and you were insured, you will need to reach out to your insurance company or employer – depending on which situation you fall in. Employers with over 50 full-time employees need to pay special attention to this.  If you have done nothing, you need to consult with a company that can handle this reporting for you.

If you’d like more information or have additional questions, I invite you to contact me.


-Written by Bill Schmidt, SBIS

About SBIS

Bill Schmidt is the President and Founder of SBIS.  He has more than 20 years of insurance industry experience.  Since 1998, SBIS has provided benefits and insurance solutions to +300 small businesses and commercial cilents throughout Virginia, Maryland, and D.C.  We bring decades of insurance experience to the table – both on the carrier and agent side of the business.  We take great pride on both our expertise in the insurance industry and our understanding of the small business market.


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