1095B Health Ins Offer & Coverage Continuation Employ MDTF5095C

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.