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Mapping item | Additional info | Additional info 2 | Required? |
---|---|---|---|
Employee ID | N/A | N/A | Either Employee ID or Last Name and SSN must be mapped. |
First Name | N/A | N/A | N/A |
Middle Name | N/A | N/A | N/A |
Last Name | N/A | N/A | Either Employee ID or Last Name and SSN must be mapped. |
Suffix | N/A | N/A | N/A |
SSN/EIN | N/A | N/A | Either Employee ID or Last Name and SSN must be mapped. |
Part II: Employee Offer and Coverage | Box 14: Offer of Coverage Code | <Month> or All 12 Months | N/A |
Part II: Employee Offer and Coverage | Box 15: Employee Share of Lowest Cost Monthly Premium | <Month> or All 12 Months | N/A |
Part II: Employee Offer and Coverage | Box 16: Applicable Section 4980H Safe Harbor Code | <Month> or All 12 Months | N/A |
Part III: Covered Individuals | Covered Individual First Name | N/A | N/A |
Part III: Covered Individuals | Covered Individual Last Name | N/A | N/A |
Part III: Covered Individuals | Covered Individual Suffix | N/A | N/A |
Part III: Covered Individuals | Covered Individual SSN | N/A | N/A |
Part III: Covered Individuals | Covered Individual DOB | N/A | N/A |
Part III: Covered Individuals | Employer Provided Self Insured Coverage Indicator | N/A | N/A |
Part III: Covered Individuals | Covered Individual Months | <Month> or All 12 Months | N/A |