1095-C Census Instructions

1095-C Census Instructions

Below are guidelines to successfully complete the 1095-C census upload sheet:



NOTE: You will first need to configure your 1095-C subgroups to access the "List" tab, where you will be able to download the 1095-B census upload sheet.

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  1. First Name (Column A)
    1. Maximum of 20 characters
      1. If the first name is longer than 20 characters, enter the first 20 characters, including spaces
    2. Leading space, trailing space, adjacent spaces, and any other symbols are not allowed
  2. Last Name (Column B)
    1. Maximum of 20 characters
      1. If the last name is longer than 20 characters, enter the first 20 characters, including spaces
    2. Leading space, trailing space, adjacent spaces, and any other symbols are not allowed
  3. Street Address (Column C)
    1. Maximum of 35 characters
    2. Hyphen, slash, and single spaces are allowed
    3. Leading space, trailing space, adjacent spaces, and any other symbols are not allowed
  4. City (Column D)
    1. Maximum of 22 characters
      1. If the city is longer than 22 characters, enter the first 22 characters, including spaces
  5. State (Abbreviation) (Column E)
  6. ZIP (Column F)
    1. 5-digits only
  7. Social security number (Column G)
  8. Plan start month (2 digit number) (Column H)
  9. 1094-C ALE subgroup reference code (Column I)
    1. Found in the “Subgroups” area in BerniePortal
  10. Line 14 codes (Columns J-U)
    1. Must be one of the following: 1A, 1B, 1C, 1D, 1E, 1F, 1G, 1H, 1I, 1J, 1K
    2. No month can be left blank
    3. Specific information about the codes can be found here
  11. Line 15 codes (Columns V-AG)
    1. Must be filled in with a value if Line 14 code is one of the following: 1B, 1C, 1D, 1E, 1J, 1K
  12. Line 16 codes (Columns AH-AS)
    1. Must be one of the following: 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H
    2. No month can be left blank
    3. Specific information about the codes can be found here
  13. Self Insured (Yes/No) (Column AT)
    1. If NO, then nothing beyond this cell needs to be filled out
      1. All other cells from AU on are related to self-insured employees and dependents
  14. Employee Self-Insured Information (Columns AU-BI)
    1. First Name (Column AU)
      1. Only fill this out if the employer is self-insured and the employee had medical coverage for at least one month out of the year
    2. Last Name (Column AV)
      1. Only fill this out if the employer is self-insured and the employee had medical coverage for at least one month out of the year
    3. SSN (Column AW)
      1. Only fill this out if the employer is self-insured and the employee had medical coverage for at least one month out of the year
    4. Coverage (Yes/No) (Columns AX-BI)
      1. Only fill this out if the employer is self-insured and the employee had medical coverage for at least one month out of the year
        1. If all 12 boxes are NO, then you should not be entering in this information for the employee
  15. Dependents 1-10 Self-Insured Information
    1. First Name
      1. Only fill this out if the employer is self-insured and the dependent had medical coverage for at least one month out of the year
    2. Last Name
      1. Only fill this out if the employer is self-insured and the dependent had medical coverage for at least one month out of the year
    3. SSN
      1. Only fill this out if the employer is self-insured and the dependent had medical coverage for at least one month out of the year
      2. If you do not have the SSN of the dependent, you can leave it blank and fill in the date of birth in the next cell
    4. DOB (YYYY-MM-DD)
      1. If you do not have the SSN of the dependent, you can include the date of birth and exclude the SSN for the dependent
  16. Coverage (Yes/No)
    1. Only fill this out if the employer is self-insured and the dependent had medical coverage for at least one month out of the year
      1. If all 12 boxes are NO, then you should not be entering in this information for the dependent
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