What is Form 1095-B?

Form 1095-B is a health coverage form used to report certain types of health insurance coverage to the Internal Revenue Service (IRS) and to individuals. Its primary function is to provide proof of minimum essential coverage, which is a requirement under the ACA. This form reports various types of health insurance coverage, including individual market coverage, employer-sponsored coverage, and government health care plans.

It’s important to distinguish Form 1095-B from Form 1095-C, which is used by larger employers (those with 50 or more full-time employees) to report their offer of health coverage to employees. Form 1095-B, on the other hand, is typically used by smaller self-insured employers and health insurance issuers.

Who Must File Form 1095-B?

Not everyone needs to file Form 1095-B. The entities required to file this form include:

• Health insurance issuers: These are companies that provide health insurance policies directly to individuals.

• Carriers: These are entities that provide health coverage through various plans.

• Smaller self-insured employers: Employers with fewer than 50 full-time employees who offer self-insured health plans must also file Form 1095-B.

Specific scenarios where Form 1095-B is used instead of Form 1095-C include situations where an employer has fewer than 50 full-time employees or when an individual purchases health insurance directly from an issuer.

Information Reported on Form 1095-B

Form 1095-B is divided into several sections, each containing specific information:

Part I: Responsible Individual Information

• This section includes the name, Social Security Number (SSN), and address of the policy holder.

• It also includes codes indicating the origin of the health coverage.

Part II: Information about Certain Employer-Sponsored Coverage

• If applicable, this section includes the employer’s name, Employer Identification Number (EIN), and address.

Part III: Issuer or Other Coverage Provider

• Here you’ll find the name, EIN, and contact information of the issuer or other coverage provider.

Part IV: Covered Individuals

• This section lists the names, SSNs or dates of birth (DOBs), and months of coverage for each individual covered under the policy.

Purpose and Use of Form 1095-B

The primary purpose of Form 1095-B is to verify that individuals have minimum essential coverage as required by the ACA. Here’s how it’s used:

• Verification of Health Coverage: The form serves as proof that an individual had qualifying health coverage for a given year.

• Eligibility for Premium Tax Credit: It helps determine whether an individual is eligible for the premium tax credit when purchasing health insurance through a marketplace.

• Calculation of Penalties: Historically, it was used to calculate any penalties for lack of coverage under the ACA’s individual mandate. Although the penalty has been set to zero since 2019, understanding this aspect remains important for historical context.

Filing and Reporting Requirements

Filing Form 1095-B involves several key steps:

• Deadlines for Filing and Furnishing Forms: The IRS requires that these forms be furnished to individuals by January 31st of each year and filed with the IRS by February 28th (or March 31st if filing electronically).

• Procedure for Submitting Corrected Forms: If there are errors on the original form, corrected forms must be submitted promptly.

• Importance of Keeping Records: It’s crucial to keep accurate records as they may be needed for future reference or audits.

Frequently Asked Questions

Here are some common questions about Form 1095-B:

What to Do If the Form Is Lost?

If you lose your Form 1095-B, contact your health insurance provider or employer to request a replacement copy.

Handling Multiple 1095-B Forms?

If you receive multiple forms (e.g., from different employers or issuers), you should review each form carefully to ensure all your coverage periods are accurately reported.

Attachment Requirements for Tax Returns?

You do not need to attach Form 1095-B to your tax return; however, you should keep it with your tax records in case it’s needed later.