skip navigation
Search Help
Navigation Help

Tax Map Index

Tax Topic Index

Affordable Care Act
Tax Topic Index

Tax Topics

About Tax Map Website
Instructions for Forms 1094-B and 1095-B

General Instructions for Forms 1094-B and 1095-B(p1)


Purpose of Form(p1)

Form 1095-B is used to report certain information to the IRS and to taxpayers about individuals who are covered by minimum essential coverage and therefore are not liable for the individual shared responsibility payment.
Minimum essential coverage includes government-sponsored programs, eligible employer-sponsored plans, individual market plans, and miscellaneous coverage designated by the Department of Health and Human Services. Minimum essential coverage is described in more detail under Who Must File, later.
Minimum essential coverage does not include coverage consisting solely of excepted benefits. Excepted benefits include vision and dental coverage not part of a comprehensive health insurance plan, workers’ compensation coverage, and coverage limited to a specified disease or illness.

Who Must File(p1)

Every person that provides minimum essential coverage to an individual during a calendar year must file an information return and a transmittal. Most filers will use Forms 1094-B (transmittal) and 1095-B (return). However, employers (including government employers) subject to the employer shared responsibility provisions sponsoring self-insured group health plans will report information about the coverage in Part III of Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, instead of on Form 1095-B. In general, an employer with 50 or more full-time employees (including full-time equivalent employees) during the prior calendar year is subject to the employer shared responsibility provisions. See the Instructions for Forms 1094-C and 1095-C for more information about who must file Forms 1094-C and 1095-C. Small employers that are not subject to the employer shared responsibility provisions sponsoring self-insured group health plans will use Forms 1094-B and 1095-B to report information about covered individuals.
Insured coverage.(p1)
Health insurance issuers or carriers must file Form 1095-B for most health insurance coverage, including individual market coverage and insured coverage sponsored by employers. However, insurance issuers or carriers will not file Form 1095-B to report coverage under the Childrens’ Health Insurance Program (CHIP), Medicaid, and Medicare (including Medicare Advantage) provided through health insurance companies, which will be reported by the government sponsors of those programs.
In addition, insurance issuers or carriers will not file Form 1095-B to report coverage in individual market qualified health plans that individuals enroll in through Health Insurance Marketplaces, which will be reported by Marketplaces on Form 1095-A. Health insurance issuers will file Form 1095-B to report on coverage for employees of small employers obtained through the Small Business Health Options Program (SHOP).

Eligible Employer-Sponsored Plans(p1)

Eligible employer-sponsored plans include:
  1. Group health insurance coverage for employees under:
    1. A governmental plan, such as the Federal Employees Health Benefit program.
    2. An insured plan or coverage offered in the small or large group market within a state.
    3. A grandfathered health plan offered in a group market.
  2. A self-insured group health plan for employees.
Health insurance issuers or carriers will file Form 1095-B for all insured employer coverage. Plan sponsors are responsible for reporting self-insured employer coverage. Plan sponsors that are employers subject to the employer shared responsibility provisions must report the coverage on Form 1095-C and other plan sponsors (such as sponsors of multiemployer plans) report the coverage on Form 1095-B.
Plan sponsors of self-insured employer coverage include:
A government employer may designate another government entity to report coverage of its employees. Generally, a designated government entity will file Form 1095-B on behalf of a government employer that sponsors or maintains a self-insured group health plan for its employees only if that government employer is not subject to the employer shared responsibility provisions, which would require reporting on Form 1095-C. The 2014 Instructions for Forms 1094-C and 1095-C contain further information on reporting options for self-insured government entities.

Government-Sponsored Programs(p2)

Government-sponsored programs that are minimum essential coverage are:
  1. Medicare Part A.
  2. Medicaid, except for the following programs:
    1. Optional coverage of family planning services.
    2. Optional coverage of tuberculosis-related services.
    3. Coverage of pregnancy-related services in states that do not provide full Medicaid benefits on the basis of pregnancy.
    4. Coverage of medical emergency services.
    5. Coverage of medically-needy individuals.
    6. Coverage under a section 1115 demonstration waiver program.
    • The Children’s Health Insurance Program (CHIP).
    • Coverage under the TRICARE program, except for the following programs:
      1. Coverage on a space-available basis in a military treatment facility for individuals who are not eligible for TRICARE coverage for private sector care.
      2. Coverage for a line of duty related injury, illness, or disease for individuals who have left active duty.
    • Coverage administered by the Department of Veterans Affairs that is:
      1. Coverage consisting of the medical benefits package for eligible veterans.
      2. CHAMPVA.
      3. Comprehensive health care for children suffering from spina bifida who are the children of Vietnam veterans and veterans of covered service in Korea.
      • Coverage for Peace Corps volunteers.
      • The Nonappropriated Fund Health Benefits Program of the Department of Defense.
      In general, the government agency sponsoring the program will file Form 1095-B. The State agency that administers a Medicaid or CHIP program will file Form 1095-B for coverage under those programs.
      Miscellaneous minimum essential coverage.(p2)
      The Department of Health and Human Services has designated the following health benefit plans or arrangements as minimum essential coverage:
      1. Self-insured student health plans (for 2014 only).
      2. State high risk pools (for 2014 only).
      3. Coverage under Medicare Part C (Medicare Advantage).
      4. Refugee Medical Assistance.
      5. Coverage provided to business owners who are not employees.
      6. Coverage under a group health plan provided through insurance regulated by a foreign government if:
        1. A covered individual is physically absent from the U.S. for at least 1 day during the month; or
        2. A covered individual is physically present in the U.S. for a full month and the coverage provides health benefits within the U.S. while the individual is outside the U.S.
      Sponsors of these and later designated programs will file Form 1095-B.

      When To File(p2)

      The return and transmittal form must be filed with the IRS on or before February 28 (March 31 if filed electronically) of the year following the calendar year of coverage.
      You will meet the requirement to file if the form is properly addressed and mailed on or before the due date. If the regular due date falls on a Saturday, Sunday, or legal holiday, file by the next business day. A business day is any day that is not a Saturday, Sunday, or legal holiday.
      The due date applies to forms filed in 2016 reporting coverage provided in calendar year 2015.


      Where To File(p3)

      Send all information returns filed on paper to the following:
      If your principal business, office or agency, or legal residence in the case of an individual, is located in:Use the following address:
      Alabama, Arizona, Arkansas, Connecticut, Delaware, Florida, Georgia, Kentucky, Louisiana, Maine, Massachusetts, Mississippi, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Texas, Vermont, Virginia,
      West Virginia
      Department of the Treasury
      Internal Revenue Service Center
      Austin, TX 73301
      Alaska, California, Colorado, District of Columbia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Maryland, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, North Dakota, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Utah, Washington, Wisconsin, Wyoming Department of the Treasury
      Internal Revenue Service Center
      Kansas City, MO 64999
      If your legal residence or principal place of business or principal office or agency is outside the United States, file with the Department of the Treasury, Internal Revenue Service Center, Austin, TX 73301.