1095B Health Ins Offer & Coverage Continuation IRS MDTF5095N

Benefits and Features


Meet your reporting requirements under the Affordable Care Act (ACA). Use to report employees who are covered under your health plan.

  • Compatible with laser or inkjet printers.
  • Paper Filing Due Date: To IRS, February 28 // To Recipient January 31
  • 1 Filing per sheet. Shrinkwrapped in packs of 25.
  • Report to IRS in mandated landscape format.
  • Continuation form is used in addition to 1095B, when an employee has more than 6 dependents.
  • Model: MDTF5095N

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