I have offered ICHRA LCSP based on the work location zip code to one of my employees named John, 30 years old, who recently joined my organization on April 1, 2020, for an annual salary of $28,000. He was in a waiting period of 2 months and John was enrolled in the ICHRA plan from June 1, 2020. The Safe Harbor we used to determine affordability is the W-2 Wages. Now how do I fill Lines 14 through 17 in Form 1095-C for John?
800 views |Last modified 1/21/2023 3:46:45 AM EST | Added by TaxBandits Team

Here's what you need to fill out on Lines 14 through 17 of Form 1095-C for John.

• Line 14: Enter Code 1H from Jan - May, indicating that John was not offered coverage.  Use Code 1O from Jun-Dec stating that John was offered and enrolled in your ICHRA plan.
• Line 15- Need to enter only the employees’ monthly share of the Lowest Cost Silver Plan for the month’s John was eligible for coverage.
• Line 16- Use Code 2A for the months (Jan - Mar) the employee was not employed.  Enter Code 2D for the month (Apr-May) that the waiting period applied. Code 2C is used for the months that the employee was enrolled in ICHRA coverage.
• Line 17- Enter the zip code (employee's work location Zipcode) that is used to determine the Affordability.

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