Mastering Form 1095-B: The Essential Guide

Form 1095-B, Health Coverage, is used to report information regarding individuals who are covered by minimum essential coverage (MEC) to the IRS. Eligibility for certain types of coverage can affect a taxpayer’s eligibility for the premium tax credit.

This type of filing is typically completed by insurance companies and other coverage providers, such as small employers.

Image of Form 1095-b
Image of Form 1095-B, Health Coverage

What information is reported on Form 1095-B?

Form 1095-B, Health Coverage is broken up into 4 parts: Responsible Individual Information, Information about Certain Employer-Sponsored Coverage, Issuer or Other Coverage Provider Information, and Covered Individuals Information.

Part I – Responsible Individual Information

The Responsible Individual is typically the person who is the primary name on the coverage. This section has the following boxes to report information:

  • Box 1-3 – Responsible individual name, SSN, and DOB
  • Box 4-7 – Responsible individual address
  • Box 8 – Enter letter identifying Origin of Health Coverage. These codes can be found in the IRS instructions and are listed below:
    • A. Small Business Health Options Program (SHOP)
    • B. Employer-sponsored coverage, except for an individual coverage HRA
    • C. Government-sponsored program
    • D. Individual market insurance
    • E. Multiemployer plan
    • F. Other designated minimum essential coverage
    • G. Employer-sponsored coverage that is an individual coverage HRA
  • Box 9 – Reserved

Part II – Information about Certain Employer-Sponsored Coverage

This section should only be completed by issuers or carriers of group health plans, including coverage purchased through SHOP.

Insurance companies that use code A or B on line 8 will complete this section. Employers reporting self-funded coverage, except for ICHRA, will enter code B on Line 8, but will not complete this section.

This section has the following boxes to report information:

  • Box 10 – Employer name
  • Box 11 – EIN
  • Boxes 12-15 – Employer address

Part III – Issuer or Other Coverage Provider

This section typically provides information regarding the issuer or carrier of the coverage. This section has the following boxes to report information:

  • Box 16 – Name
  • Box 17 – EIN
  • Box 18 – Contact phone number
  • Boxes 19-22 – Address

Part IV – Covered Individuals

A covered individual is any person that is covered under the Responsible Individual’s plan. This includes the Responsible Individual, spouse, and any other dependents, if applicable.

This section is made up of a grid. It includes 6 lines (Lines 23-28) for covered individuals’ information. If there were more than 6 covered individuals in the tax year, then the Part IV, Covered Individuals – Continuation Sheet can be used (Lines 29-40).

Part IV reports the name, SSN (or DOB for covered individuals other than the Responsible Individual), and coverage information for each individual that was covered under the health plan (including the responsible individual).

These 6 rows are split into 5 main columns of information:

  • (a) – Name of covered individual(s): first name, middle initial, last name
  • (b) – SSN or other TIN
  • (c) – DOB (if SSN or other TIN is not available)
  • (d) – Covered all 12 months*
  • (e) – Months of Coverage: Jan – Dec*
    *Please note: Either (d) or (e) should be completed for each covered individual.

How are Forms 1095-A and 1095-C different from 1095-B?

Each of the different form types are distributed by different entities and received by different groups of people.

1095-A is generally provided by the Marketplace to those who are enrolled (or have dependents that are enrolled) in health coverage through the Marketplace. The Marketplace, which is short for the Health Insurance Marketplace, is a shopping and enrollment service for healthcare that was created by the Affordable Care Act in 2010. In most states, it is run by the federal government. Only those who are enrolled in Marketplace coverage should receive Form 1095-A, not Form 1095-B.

Form 1095-C is generally provided by ALE Members, or employers with 50 or more full-time and full-time equivalent employees, whom are subject to employer shared responsibility provisions (ESRP). Employers subject to ESRP that sponsor self-insured health plans, including ICHRA plans, will typically use Part III of Form 1095-C instead of using Form 1095-B. Learn more about this form type using our Essential Guide:  Mastering Form 1095-C.

How are Forms 1095-A and 1095-C similar to 1095-B?

All forms provide individuals with information regarding health coverage during the prior year. They also provide the IRS with specific coverage information, such as if an individual was enrolled in coverage and for which months.

Who needs to file Forms 1095-B with the IRS?

Every entity that provides MEC to an individual during a calendar year must file an information return reporting the coverage. Filers must submit both transmittal Form 1094-B and Forms 1095-B. If you have any questions regarding the transmittal form, please review our Essential Guide: Mastering Form 1094-B.

Who needs to file Forms 1095-B with the state?

Along with the federal filing and recipient furnishing requirements, some states have individual requirements.

California, the District of Columbia, Massachusetts, New Jersey, Rhode Island, and Vermont have Individual Mandates in place that require employers to report ACA data on the state level as well as the federal. Learn more about these state requirements in our ACA State Requirements Guide.

What are the deadlines for Form 1095-B?

Traditionally, the filing deadlines for Forms 1094-B & 1095-B are as follows:

  • Submit a Paper Filing – February 28th
  • Furnish Recipient Copies – March 2nd
  • Submit an Electronic Filing – March 31st

If these deadlines fall on a weekend or legal holiday, then the due date is typically the following business day. Check out our annually updated deadlines article for the most up-to-date information.

Can I submit a paper filing?

Employers may choose to paper file their Form 1095-B filing to the IRS if their total form count is less than the 250-form threshold. E-filing is encouraged by the IRS, but if you have less than 250 forms to file, then paper filing is an option.

When filing on paper, you must send the forms to the IRS in a flat mailing without staples or paperclips. These forms can be printed on regular paper in landscape format, and special forms do not need to be ordered.

If you have many forms to send, then you can send them in conveniently sized packages. Each package must be labeled with your name and should be numbered consecutively. The transmittal Form 1094-B should be placed in the first package along with Forms 1095-B. Additional Forms 1095-B can be included in the other packages, if applicable. If you have any questions about completing Form 1094-B, check out our Essential Guide: Mastering Form 1094-B.

Please note that postal regulations require that packages with official IRS forms must be sent via first-class mail.

Determining where to send your filing is dependent upon the filer’s address, specifically the state. Locate your state in the graphic below to find the correct IRS mailing address for your filing.

1095-B IRS Addresses
IRS Addresses by State

Can I download Form 1095-B?

Yes, you can download a PDF version of this form from the IRS website. This copy can be completed virtually and printed out in landscape format with black ink to distribute to recipients and/or send to the IRS.

Can I submit an electronic filing?

Yes, of course! E-filing is encouraged by the IRS and offers many benefits. These benefits include immediate submission, quick turnaround time, status updates, and more.

E-filing can be a requirement for some filers. If filing more than 250 Forms 1095-B, then you must submit your filing electronically.

If choosing to submit your filing electronically, be sure to find an authorized ACA software provider to make e-filing quick and easy!

What are the penalties for not filing or filing late?

If you are required to file these information returns and fail to file or fail to furnish forms by the due date, then you may be subject to the following penalties:

  • Failure to file correct forms – $280 per form
  • Failure to furnish recipient forms – $280 per form
  • Failure to file electronically, when required to do so – $280 per form

Special rules apply that increase the per-return and per-statement and total penalties with no maximum limitations if there is intentional disregard of the requirement to file the returns and furnish recipient statements

2021 Instructions for Forms 1094-B and 1095-B

Check out the graphic below to see how quickly fines can accumulate based on a small sample size of only 10 forms the business should have filed.

Form 1095-B Penalties
IRS Potential Fine Amounts

How do I make a correction?

It is important that you take the time to review the information you are reporting on your Forms 1095-B for accuracy before distributing and filing. This will minimize the risk of common errors which can result in your business incurring penalties and fines.

Even with careful reviewing, mistakes can happen! If your filing has errors, you can easily make corrections to your Forms 1095-B.

  • If you submitted your original filing electronically, then you should edit your filing accordingly with the original vendor.
  • If you submitted your original filing via mail, then you should complete a new form and include the updated information.
  • Once this has been completed, simply check the “Corrected” box at the top of the form. Always include a new transmittal Form 1094-B when mailing in corrections to the IRS.

Before you can consider your correction complete, an updated copy of the form must be provided to the recipient as well. This ensures that all parties have updated information.

Conclusion

Once you have submitted these forms to the IRS, either electronically or via mail, and have received your “Accepted” status, then you have met all of the IRS requirements for these forms.

If you’re looking for a broken-down Understanding Form 1095-B guide in a downloadable format, make sure to download our PDF guide.

BoomTax, The Boom Post, and its affiliates do not provide tax, legal or accounting advice. This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, tax, legal or accounting advice. You should consult your own tax, legal and accounting advisors prior to engaging in any transaction.

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