Personnel Support Services - Benefits

For general inquiries and assistance email:
Phone: (858) 521-2800 ext. 2897, FAX: 858-485-1355

Carin Freitas, Insurance Benefits Specialist, email:
Christine Gold, Insurance Benefits Technician, email:
Shannon Wolff, Insurance Benefits Technician, email:


Form 1095-C Information

Employees who measured 30 or more hours during the measurement period should receive a Form 1095-C on or prior to March 4, 2019.

What is a Form 1095-C?

Health Care Reform legislation requires that health plan sponsors (employers) and insurers provide a statement each year to eligible employees describing the medical coverage available to them.  The 1095-C is the form created for employers by the IRS for this purpose. Everyone who measured 30 or more hours during the measurement period and had health coverage with Poway Unified School District will receive a form, even if coverage is waived.

What will this form be used for?

If you receive your Form 1095-C prior to filing your taxes in 2020, you may use the information on the Form to file your Federal income tax return for 2019. If not, then your Form 1095-C will be used as proof that you indeed had coverage in 2019 if you are audited by the Internal Revenue Service in the future.  In either situation, the 1095-C Form will be used to substantiate that you had minimum essential coverage for each month of the year. If you did not have coverage, you may qualify for an exemption.
In addition, the IRS will also use this Form to ensure that Poway Unified School District has complied with the Employer Shared Responsibility rules and will be used to determine whether or not individuals who applied for Marketplace coverage were actually eligible for premium tax credits.

Who will receive a Form 1095-C?

Employees who were full-time as defined by the IRS (employees who worked 30 or more hours during a measurement period) for one or more months during 2018 will receive a Form 1095-C. Part-time employees may also receive a Form 1095-C if they averaged a total of 30 or more hours during the measurement period.  This form provides information about the medical coverage offered to you by Poway Unified School District.
If you were enrolled in either Kaiser or Aetna, you should also receive a Form 1095-B. If you were enrolled in coverage from the Exchange or Marketplace, you should receive a Form 1095-A.

What information is on the Form?

  • Part I, Employee and Employer Information - includes your specific information, as well as details about Poway Unified School District.
  • Part II, Employee Offer and Coverage - includes information about the coverage offered to you.
  • Part III ** Please Note** Does not apply to PUSD. This section if for self-funded plans only

Will each person on my plan receive a Form?

No. Poway Unified School District is only required to send the Form to employees.

Where can I find additional information concerning Form 1095-C?


The Poway Unified School District (PUSD) is an equal opportunity employer/program and is committed to an active Nondiscrimination Program. PUSD prohibits discrimination, harassment, intimidation, and bullying based on actual or perceived race, color, ancestry, national origin, nationality, immigration status, ethnicity, ethnic group identification, age, religion, marital or parental status, physical or mental ability, sex, sexual orientation, gender, gender identity, or gender expression or association with a person or a group with one or more of these actual or perceived characteristics. For more information, please contact: Title IX/Equity Compliance Officer, James Jimenez, Associate Superintendent of Personnel Support Services, Poway Unified School District, 15250 Avenue of Science, San Diego, CA 92128, 1-858-521-2800, extension 2761,

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POWAY UNIFIED SCHOOL DISTRICT | 15250 Avenue of Science, San Diego, CA 92128 | (858) 521-2800