1095-C Self-Funded Plans - How do I complete the covered individuals' section of the spreadsheet?

The covered individuals section of our ACA spreadsheet templates has green headers. 


Important: This section should only be completed if the ALE Member offers employer-sponsored self-insured health coverage in which the employee or other covered individual enrolled. If this is the case, please list all individuals (employee, spouse, and/or dependents) who were covered for at least one day.


Covered individuals (including the employee) need to be listed starting on the employee line of the spreadsheet, then each other covered individual (CI) should be listed below. 

There are 2 options for how to complete the spreadsheet when listing CIs.


Option 1:

You can add blank rows to ensure that you aren't listing the CIs on the wrong employee line. Please see image below for reference are hidden in the screenshot):

option-1.jpg
Covered Individuals - Option 1

Looking at employee, Michael Foster (Line 2): this employee is listed as the first CI, then he has 2 other CIs listed below him. The employee data sections (column A-BQ) are left blank for the other CIs, as they are dependents of Michael.


Option 2:

You can duplicate the employee data to ensure that you aren't listing the CIs on the wrong employee line. Please see image below for reference are hidden in the screenshot):

option-2.jpg
Covered Individuals - Option 2

Looking at employee, Michael Foster (Line 2): this employee is listed as the first CI, then he has 2 other CIs listed below him. The employee data sections are completed with Michael's data for the other CIs, as they are his dependents.

Both options listed above are correct and will import without issue, so please use whichever you prefer and is easier for you!

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