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Form 1095-C

In 2016, the IRS Form 1095-C debuted to accompany the W-2 form you use to file your taxes. The Affordable Care Act (ACA) requires large employers, such as VUMC, with 50 or more full-time employees to offer health insurance to their workers. Form 1095-C allows the Internal Revenue Service (IRS) to confirm VUMC’s compliance with the coverage and affordability provisions of the ACA and assist Vanderbilt employees in preparing for 2016 tax return filing.

VUMC will provide Form 1095-C (employee statement) to employees and file copies with the IRS.

 There are three parts to Form 1095-C:

  • Employee and Employer Information reports information about you and your employer,
  • Employee Offer and Coverage reports information about the coverage offered to you by your employer, the affordability of the coverage offered, and the reason why you were or were not offered coverage by your employer, and
  • Covered Individuals reports information about the dependents covered under your self-insured health plan.

Form 1095-C 1

Form 1095-C 2


If you have not done so already, please provide the social security number of all of your dependents enrolled in the VUMC Health Plan in My VUMC Benefits. The IRS requires this information to confirm the dependents enrolled in our health care plan.

If you were hired at Vanderbilt University Medical Center after May 1, 2016:

  • You will receive one 1095-C form from Vanderbilt University Medical Center to your home address.

If you were previously a Vanderbilt University employee and transferred to Vanderbilt University Medical Center after legal separation on April 29, 2016:

  • You will receive two separate 1095-C forms, one from Vanderbilt University and one from Vanderbilt University Medical Center to your home address.  


VUMC employees should receive Form 1095-C in March each year.

See the IRS website for more information about the 1095-C form and how it affects your taxes. Go to and then look for the section titled "Report Minimum Essential Coverage."