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IMPORTANT INFORMATION: 2016 Electronic Form 1095-C

Important information for the following employees only:

  • All benefited employees who have been offered NDPERS health insurance coverage
  • Non-benefited employees who have been offered health insurance coverage under the Affordable Care Act (ACA) for 2016

All other employees will not receive a Form 1095-C and can disregard this notice.

Form 1095-C Employer-Provided Health Insurance Offer and Coverage will be available to employees electronically for tax year 2016. To receive your 2016 Form 1095-C in electronic form only, you must give consent in Employee Self Service on or before February 10, 2017. You must have access to a computer with an internet browser and Adobe software. If you consented to electronic delivery of your Form 1095-C last year, you do not need to consent again.

If you do not give consent by February 10, 2017, a paper Form 1095-C will be sent to the mailing address currently on file for you. Paper Form 1095-C will be postmarked and mailed by March 2, 2017.


To give consent to receive your form 1095-C electronically, sign in to Employee Self Service at the following link: Navigate to Main Menu>Self Service>Benefits>1095-C Consent.

  • Click the check box to indicate your consent to receive Form 1095-C electronically
  • Click the Submit button
  • Submit Confirmation page shows a message that the Submit was successful
  • Click OK or log out of the system

A confirmation email will be sent to your preferred email address.

You will continue to receive Form 1095-C electronically until you withdraw your consent. To withdraw consent, access the same 1095-C Consent page, click the check box to withdraw your consent and click the submit button. The remaining steps are the same as written above.

If you have any problems logging into Employee Self Service, please contact the NDUS Helpdesk at: or call the Helpdesk at 866-457-6387.



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North Dakota State University
Phone: +1 (701) 231-8961 / Fax: (701) 231-9686
Campus address: SGC 102
Physical/delivery address: 1919 University Dr N, Fargo, ND 58102
Mailing address: NDSU Dept. 3140 / PO Box 6050 / Fargo, ND 58108-6050
Page manager: Human Resources/Payroll