Updated October 17, 2026. Quick answer: Part III of Form 1095-C lists the people covered under your employer’s plan, but only when the plan is self-insured. Line 17, in Part II, shows a ZIP code only when the employer offered an individual coverage HRA. If your employer’s plan is insured, Part III is not completed and coverage information may come on a different form.
What Part III reports
The recipient instructions describe it this way: “Part III reports the name, SSN (or TIN for covered individuals other than the employee listed in Part I), and coverage information about each individual” They add who is included: “(including any full-time employee and non-full-time employee, and any employee’s family members) covered under the employer’s health plan, if the plan is “self-insured.”” The form’s lines for these people are 18 to 30, and the section is headed “Covered Individuals”. The overview of the form is Form 1095 explained.
Only for self-insured coverage
The filer’s instructions put the limit first: “Complete Part III ONLY if the ALE Member offers employer-sponsored, self-insured health coverage, including an individual coverage HRA, in which the employee or other individual enrolled.” Then the exclusions: “For this purpose, employer-sponsored, self-insured health coverage does not include coverage under a multiemployer plan.” “Do not complete Part III if the ALE Member offers coverage only under an insured group health plan.” And a mixed case: “If an ALE Member offers both insured and self-insured coverage, complete Part III only for employees who enroll in the self-insured coverage.”
The recipient instructions explain where information on other coverage may arrive: “If your employer provided you or a family member health coverage through an insured health plan or in another manner, you may receive information about the coverage separately on Form 1095-B, Health Coverage.” That form is described on the Form 1095-B page. For Marketplace plans, the statement is a different form again: “the Health Insurance Marketplace will report information about that coverage on Form 1095-A, Health Insurance Marketplace Statement.” See Form 1095-A.
Who is listed, and on which form
The employee goes first. The filer’s instructions say: “The employee (if enrolled in self-insured coverage) should be listed on line 18; any other family members who enrolled in coverage offered to the employee should be listed on subsequent lines.”
A tip says family members stay together on one form: “All employee family members that are covered individuals through the employee’s enrollment (for example, because the employee elected family coverage) must be included on the same form as the employee”. That means if you enrolled with family coverage, the people covered with you appear on your Form 1095-C. The recipient instructions add: “Employers are required to furnish Form 1095-C only to the employee.” Then: “As the recipient of this Form 1095-C, you should provide a copy to any family members covered under a self-insured employer-sponsored plan listed in Part III if they request it for their records.”
The columns
Part III is a small table. The filer’s instructions describe the columns in order. Column (a): “Enter the name of each covered individual (first name, middle initial, last name)”. Column (b): “Enter the nine-digit SSN for each covered individual”. Column (c): “Enter a date of birth (YYYY-MM-DD) for the covered individual only if column (b) is blank.”
For months of coverage, column (d): “Check this box if the individual was covered for at least 1 day per month for all 12 months of the calendar year.” Column (e): “If the individual was not covered for all 12 months of the calendar year, check the applicable box(es) for the month(s) in which the individual was covered for at least 1 day in the month.” The recipient instructions note the paper form limit: “If there are more than 13 covered individuals, additional copies of page 3 may be used.”
Spouses who both work for the employer
A rule covers two employees in one family: “the enrollment information should be reflected only on Form 1095-C for the employee who enrolled in the coverage.” The same passage adds “(However, it would report the other employee family members as covered individuals.)” If you and your spouse each received a Form 1095-C from the same employer, the Part III listing may therefore show up on only one of them.
Line 17: the individual coverage HRA ZIP code
Line 17 is in Part II, next to the offer information. The recipient instructions say: “This line reports the applicable ZIP code your employer used for determining affordability if you were offered an individual coverage HRA.” Which ZIP code it is depends on the line 14 code: “If code 1L, 1M, 1N, or 1T was used on line 14, this will be your primary residence location.” “If code 1O, 1P, 1Q, or 1U was used on line 14, this will be your primary employment site.”
The filer’s instruction is: “enter the appropriate ZIP code used for identifying the lowest cost silver plan used to calculate the Employee Required Contribution in line 15.” That ties line 17 to the dollar amount on line 15, covered on the line 15 page, and to the codes on the line 14 codes 1L to 1U page.
The location safe harbor
The filer’s instructions describe the work-location option: “For purposes of section 4980H(b), an employer may use the cost of self-only coverage for the lowest cost silver plan for the employee for self-only coverage offered through the Exchange where the employee’s primary site of employment is located for determining whether an offer of an individual coverage HRA to a full-time employee is affordable.” If your line 17 ZIP code is that of your workplace and not your home, that is the option this sentence describes.
Using the form
Part III is a record of who had coverage in which months. If you need to confirm coverage for yourself or a family member, it is the section to read. For the income and credit side of coverage questions, see the ACA subsidy calculator page and HSA after leaving your employer, and for health account reporting see Form 8889. The return itself is Form 1040.
Edition and tax year
The 2025 Form 1095-C and the 2025 Instructions for Forms 1094-C and 1095-C were the ones read for this page. They were the current files on irs.gov on 2026-10-17. Check the tax year printed on the form you received.
Common mistakes
- Expecting Part III on every Form 1095-C. The instructions say “Do not complete Part III if the ALE Member offers coverage only under an insured group health plan.”
- Looking for a covered family member on a separate form. The instructions say covered family members “must be included on the same form as the employee”.
- Assuming the ZIP code on line 17 is always your home ZIP. The recipient instructions say it is your primary residence location for codes 1L, 1M, 1N and 1T and “your primary employment site” for codes 1O, 1P, 1Q and 1U.
Related: ACA subsidy calculator, HSA after leaving your employer, Form 8889, and Form 1040.
Sources
- Form 1095-C (2025), Employer-Provided Health Insurance Offer and Coverage: https://www.irs.gov/pub/irs-pdf/f1095c.pdf
- 2025 Instructions for Forms 1094-C and 1095-C: https://www.irs.gov/pub/irs-pdf/i109495c.pdf
Read from the IRS documents linked above on October 17, 2026. General information, not tax advice. Your own facts decide the outcome, and a preparer, the account provider or the IRS is the right place to confirm anything consequential.