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1095-C Employee Copy:
1095-C Employee Copy
Item #: TF5096
Form to submit information about individuals who enroll in a qualified health plan through the Health Insurance Marketplace.

QuantityPriceSavings
100$26.25-
200$33.0037%
300$39.0050%
400$44.2558%
500$52.5060%
600$59.2562%
700$64.5065%
800$71.2566%
900$78.0067%
1000$86.2567%


Product Details
  • 2 sided, black/black
  • Issued by: employers with 50 oir more full-time employees (Applicable Large Employers) both insured and self-insured employers with fewer than 50 Fulltime employees, that provide health plans
  • Used for reporting whether or not the employer offered health coverage to employees.



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