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Office of State Uniform Payroll

Notice: 2019 1095-C forms will be mailed by January 31, 2020


Affordable Care Act (ACA) Information for LaGov HCM Paid State Employees and Retirees

Beginning in 2016, the federal Affordable Care Act (ACA) requires that applicable large employers must report certain health insurance information via Form 1095-C.  Large employers are required to provide this form to ACA full time employees, retirees, and certain other covered individuals (COBRA, surviving spouse/dependent) and to file this informational form with the Internal Revenue Service (IRS).  The form identifies ACA full time employees and other individuals who were offered health insurance and/or were covered by an OGB-sponsored health plan during the previous calendar year.

If you meet the criteria of having been an ACA full time employee and/or had OGB sponsored health insurance during 2019, you will receive this form by January 31, 2020.  Employees, retirees, and other covered individuals (COBRA, surviving spouse/dependent) who are members of a self-insured plan (Blue Cross/Blue Shield or LSU Health) will receive Form 1095-C from the Office of State Uniform Payroll (OSUP); employees who are members of a fully-insured plan (Vantage) will receive two forms, Form 1095-C from OSUP reporting the offer of health insurance and Form 1095-B directly from the insurance carrier reporting insurance coverage information.

If you are a retiree who retired from an agency paid through the State Payroll System (UPS, ISIS HR, LaGov HCM) and had Blue Cross / Blue Shield or LSU Health coverage in 2019, then you will receive Form 1095-C from OSUP.

Under the individual shared responsibility provision of ACA, individuals must have qualifying health insurance for themselves and their dependents or be subject to penalties.  The information on Forms 1095-B (if applicable) and 1095-C will assist you and the IRS in establishing that you have satisfied this obligation; therefore you will not be subject to a penalty.  Refer to the IRS website ( for more information about the individual shared responsibility provision.

Once you receive the form(s), be sure to review the form(s) and instructions.  You should use the form when preparing your 2019 tax return.  This form is for your records and should be kept with other important tax documents.  Do not return the form to OSUP.

Requesting a Duplicate Form 1095-C

As required by the Affordable Care Act (ACA), OSUP provides IRS Form 1095-C to ACA full-time employees, retirees, and certain other covered individuals (COBRA, surviving spouse/dependent) who are members of a self-insured plan (Blue Cross/Blue Shield or LSU Health).  These forms are not available in LEO.  Form OSUP/F037 should be used to request a duplicate copy of Form 1095-C issued by OSUP.  Requests will be accepted beginning approximately 2 weeks after mailing (see mailing date at the top of this page).

Active Employees and Non-Retirees

Duplicate Forms 1095-C for prior calendar years are available for active employees and non-retirees to request by contacting their HR/EA office and completing Form OSUP/F037.  Duplicate forms will be printed and mailed directly to the employee's mailing address that is in LaGov HCM (payroll system).  This form cannot be emailed.

Retirees and Other Covered Individuals (Surviving Spouse/Dependent)

OSUP will accept requests directly from retirees and other covered individuals.  Please complete Form OSUP/F037 and fax it to (225) 342-1650.

Note: Retired employees should contact the Office of Group Benefits at (800) 272-8451 and select option 6 for address changes.