1095B Health Ins Offer & Coverage Continuation Employ MDTF5095C

  • Model: MDTF5095C

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Benefits and Features


Meet your reporting requirements under the Affordable Care Act (ACA) by using this form to report employees covered by your health plan.

  • Compatible with laser or inkjet printers.
  • Paper filing due date: to IRS by February 28 / to recipient by January 31.
  • 1 filing per sheet; shrinkwrapped in packs of 25.
  • Continuation form is used in addition to 1095B when an employee has more than 6 dependents.


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