555 S Howes St, Second Floor
Fort Collins, CO 80523-6004
(970) 491-MyHR (6947)

1095 Tax Form

Colorado State University provides employees with the 1095-C tax form as required by the Affordable Care Act (ACA). This form will be sent to your home address in late January.

The 1095-C contains important information about the healthcare coverage offered or provided to you by CSU. You will need the form to finalize your tax return and while it's not necessary to send your 1095 to the IRS, you should keep a copy for your personal tax file.


A Form 1095-C is provided to employees who were:

  • Enrolled in medical coverage through CSU, or

  • Considered full-time (those who work an average of 30 or more hours per week) even if those employees declined to participate in the medical plans.


Faculty, Admin Pro, Non-Classified, and ACA-Eligible employees will receive one 1095-C from CSU.

State Classified employees will receive more than one form. CSU will provide a 1095-C while the State of Colorado or your insurance provider will give you a 1095-B form.



Understanding IRS Form 1095-C




Part I: Employee and Applicable Large Employer Member


This section will include your employee demographic information as well as CSU's tax ID number and mailing address.


Part II: Employee Offer of Coverage


Line 14 indicates if coverage was offered to an employee. The most common codes you'll see are:

  • 1E - coverage offered to employee and dependents

  • 1H - employee wasn't eligible for insurance (ie, they were not employed during the month)

  • 1G - employee was not full-time but enrolled in self-insured employer-sponsored coverage

Line 15 shows the employee's share of the lowest cost monthly premium for plans offered by your employer (regardless of the plan you enrolled in).

  • $0.00 for Faculty, Admin Pro, Non-Classified, and ACA-Eligible employees

  • $18.92 (Jan-Jun) and $25.18 (Jul-Dec) for State Classified employees

Line 16 is used to denote Affordability Safe Harbors used and enrollment in Minimum Essential Coverage plans. These codes provide the IRS information to administer employer shared responsibility provisions.


Part III: Covered Individuals


Part III reports the employee and dependent(s) that were covered for any day of a month under a self-insured medical plan.

Why is Part III of my 1095-C blank?

  • No one was enrolled in coverage for any month of the year 

  • The coverage is through a fully-insured plan (you'll receive a 1095-B)

  • The coverage is through COBRA

For State Classified employees, the 1095-C form that you receive from CSU will not include dependent information.




State Classified

  • United Healthcare: 1-800-719-3434

  • Kaiser Permanente: 1-800-632-9700

Faculty, Admin Pro, Non-Classified, and ACA-Eligible

  •  970-491-6947