1095B Health Ins Offer & Coverage Employee Copy MDTF5095

  • Model: MDTF5095

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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; packaged in quantities of 100.
  • Typically used by payroll companies and smaller companies with self-funded insurance plans.


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