Part II — Publication 5258 — Guide for Affordable Care

Plan Start Month

Employee’s Age

14 Offer of Coverage

Employee Required 15 Contribution

Contact telephone number, including area code, of the person to contact who is responsible for answering any questions.

‘PlanStartMonth’ with PlanStartMonth efile type of string, length 2. Pattern

This is the Employee’s age on Jan1. <xsd:minInclusive value=”1”/> <xsd:maxInclusive value=”120”>

The applicable code from Code Series 1, either for “All 12 Months” if the same code applies for all 12 calendar months, or the applicable code for each month (see form instructions for Code Series 1 values). 1A 1B 1C 1D 1E 1F 1G 1H 1J 1K 1L 1M 1N 10 1P 1Q 1R 1S 1T 1U 1V 1W 1X 1Y 1Z

The amount of the Employee Required Contribution (only if 1B, 1C, 1D, 1E, 1J, 1K, 1L, 1M, 1N, 1O, 1P, 1Q, 1T or 1U is entered on line 14)

Guide for Electronically Filing ACA Information Returns for Software Developers and Transmitters 103

Data Mapping for ISS-UI Services/ISS-A2A Web Services

Form Line Num	1095-C Data Element	Definition	XML Element Name
16	Applicable Section 4980H Safe Harbor	The applicable code from Series 2, either for “All 12 Months” if the same code applies for all 12 calendar months, or the applicable code for each month (see form instructions for Code Series 2 values). 2A 2B 2C 2D 2E 2F 2G 2H	EmployeeOfferAndCoverageGrp Choice between AnnualSafeHarborCd MonthlySafeHarborGrp JanSafeHarborCd - DecSafeHarborCd
17	Zip Code	The applicable ZIP Code used for determining affordability if employee was offered an individual coverage HRA.	Choice between AnnualICHRAZipCd or MonthlyICHRAZipCdGrp