What is Form 1095-B?

Guide To Filling Out Form 1095-B

Only small businesses that self-fund their employee health coverage need to complete this form. And, while filling out Form 1095-B may not be complex, it can take up valuable time for small business owners.

We recommend working with an experienced tax preparer to help you navigate IRS requirements and make tax compliance easier.

Here are high-level instructions on how to fill out Form 1095-B.

Step 1: Responsible Individual

To complete Part I of Form 1095-B, you’ll need to provide personal information about the responsible individual or employee. This section includes nine specific lines to fill out:

• Line 1: Name – Enter the full name (first, middle, last) of the responsible individual.
• Line 2: Social Security Number (SSN) or other Tax Identification Number (TIN) – Enter the individual’s 9-digit SSN or, if not available, another TIN.
• Line 3: Date of Birth – Only complete this line if SSN/TIN is unavailable.
• Line 4: Street Address – Enter the street address, including apartment number. Use a P.O. box number if mail is not delivered to the street.
• Line 5: City or Town – Provide the city or town of the individual.
• Line 6: State or Province – Enter the state or province.
• Line 7: Country and ZIP or Postal Code – Provide the country and ZIP or postal code.
• Line 8: Health Coverage Origin Code – Enter the relevant letter for the coverage source:
  • A: Small Business Health Options Program (SHOP)
  • B: Employer-sponsored coverage
  • C: Government-sponsored program
  • D: Individual market insurance
  • E: Multiemployer plan
  • F: Other designated minimum essential coverage
  • G: Individual coverage health reimbursement arrangement (HRA)
• Line 9: Reserved for future use – Leave blank for 2024.

Step 2: Information About Certain Employer-Sponsored Coverage

Part II of Form 1095-B is used to provide details about employer-sponsored health coverage, completed specifically by issuers or carriers of insured group health plans, including those purchased through the Small Business Health Options Program (SHOP). This section requires entering essential employer information for the coverage provider.

• Line 10: Employer Name – Enter the full name of the employer sponsoring the coverage.
• Line 11: Employer Identification Number (EIN) – Provide the employer’s EIN.
• Line 12: Street Address – Enter the full street address, including room or suite number. Use a P.O. box if mail is not delivered to the street address.
• Line 13: City or Town – Input the city or town of the employer’s address.
• Line 14: State or Province – Specify the state or province where the employer is located.
• Line 15: Country and ZIP or Postal Code – Enter the country and ZIP or postal code for the employer.

This information helps ensure accurate identification of employer-sponsored health coverage, especially for group health plans provided through SHOP or other employer-based arrangements.

Step 3: Issuer or Other Coverage Provider

Part III of Form 1095-B captures information about the issuer or coverage provider, which may be the insurer, government agency, self-insured employer plan sponsor, or another coverage sponsor. This section allows individuals to identify and contact the provider if they need additional information.

• Line 16: Name – Enter the full name of the coverage provider.
• Line 17: Employer Identification Number (EIN) – Provide the EIN of the provider.
• Line 18: Contact Telephone Number – List a contact number for individuals seeking more information.
• Line 19: Street Address – Enter the provider’s full street address, including room or suite number.
• Line 20: City or Town – Enter the city or town of the provider’s location.
• Line 21: State or Province – Specify the state or province of the provider.
• Line 22: Country and ZIP or Postal Code – Enter the provider’s country and ZIP or foreign postal code.

Step 4: Covered Individuals

Part IV of Form 1095-B records information about each individual covered under the policy, including the primary insured person and any dependents. If there are more than six covered individuals, Continuation Sheets can be added without counting as separate Forms 1095-B.

• Column (a): Name of Covered Individual(s) – Enter each covered individual’s full name, including first name, middle initial, and last name.
• Column (b): SSN or Other TIN – Provide the Social Security Number (SSN) or other Tax Identification Number (TIN) for each covered individual. Leave blank if the individual does not have a TIN.
• Column (c): Date of Birth – Enter the date of birth (YYYY/MM/DD) only if no SSN or TIN is available in Column (b).
• Column (d): Covered All 12 Months – Check this box if the individual had coverage for at least one day per month throughout the entire calendar year.
• Column (e): Months of Coverage – If the individual was not covered for all 12 months, check the box(es) for each specific month they were covered for at least one day.