skip navigation
Search Help
Navigation Help

Tax Map Index
ABCDEFGHI
JKLMNOPQR
STUVWXYZ#

International
Tax Topic Index

Affordable Care Act
Tax Topic Index

FAQs
Forms
Publications
Tax Topics

Comments
About Tax Map

IRS.gov Website
Instructions for Forms 1094-B and 1095-B
taxmap/instr2/i109495b-006.htm#en_us_publink100012143

taxmap/instr2/i109495b-006.htm#TXMP2ae10b2d
Specific Instructions for Form 1095-B(p3)

rule
taxmap/instr2/i109495b-006.htm#en_us_publink100012144

taxmap/instr2/i109495b-006.htm#TXMP2120b7cd
Part I—Responsible Individual (Policy Holder)(p3)

rule
taxmap/instr2/i109495b-006.htm#en_us_publink100013959
taxmap/instr2/i109495b-006.htm#TXMP232c50c3
Line 1. (p3)
rule
Enter the name of the responsible individual. A responsible individual may be a primary insured employee, former employee, parent, uniformed services sponsor, or other person enrolling individuals in coverage. Do not enter the name of a business or business owner that is the policy holder for its employees.
taxmap/instr2/i109495b-006.htm#en_us_publink100013960
taxmap/instr2/i109495b-006.htm#TXMP62941582
Line 2.(p3)
rule
Enter the nine-digit social security number (SSN) of the responsible individual (111-11-1111). Enter a taxpayer identification number (TIN), rather than an SSN, if the responsible individual does not have an SSN. No SSN or other TIN is required if the responsible individual is not a covered individual identified in Part IV. See Statements Furnished to Individuals, earlier, for information on truncating the SSN or other TIN.
taxmap/instr2/i109495b-006.htm#en_us_publink100013961
taxmap/instr2/i109495b-006.htm#TXMP7cc89e42
Line 3. (p4)
rule
Enter the responsible individual’s date of birth (MM/DD/YYYY) only if Line 2 is blank.
taxmap/instr2/i109495b-006.htm#en_us_publink100013962
taxmap/instr2/i109495b-006.htm#TXMP4761d6e8
Line 4-7.(p4)
rule
Enter the complete mailing address of the responsible individual. If mail is not delivered to the street address and the responsible individual has a P.O. Box, enter the box number instead of the street address.
taxmap/instr2/i109495b-006.htm#en_us_publink100013963
taxmap/instr2/i109495b-006.htm#TXMP60c3b877
Line 8.(p4)
rule
Enter the letter identifying the origin of the policy.
A. Small Business Health Options Program (SHOP).
B. Employer-sponsored coverage.
C. Government-sponsored program.
D. Individual market insurance.
E. Multiemployer plan.
F. Miscellaneous minimum essential coverage.
taxmap/instr2/i109495b-006.htm#en_us_publink100013964
taxmap/instr2/i109495b-006.htm#TXMP24cd8b43
Line 9. (p4)
rule
For 2014, leave this line blank.
taxmap/instr2/i109495b-006.htm#en_us_publink100012148

taxmap/instr2/i109495b-006.htm#TXMP7d3a11ec
Part II—Employer Sponsored Coverage(p4)

rule
This part is completed only by issuers or carriers of insured group health plans, including coverage purchased through the SHOP.
taxtip
Insurance companies entering codes A or B on line 8 will complete Part II. Employers reporting self-insured group health plan coverage on Form 1095-B enter code B on line 8, but do not complete Part II. If you entered code B for self-insured coverage, skip Part II and go to Part III.
taxmap/instr2/i109495b-006.htm#en_us_publink100013966
taxmap/instr2/i109495b-006.htm#TXMP455fb186
Lines 10–15.(p4)
rule
Enter the name, EIN, and complete mailing address for the employer sponsoring the coverage. If mail is not delivered to the street address and the employer has a P.O. Box, enter the box number instead of the street address.
taxmap/instr2/i109495b-006.htm#en_us_publink100012153

taxmap/instr2/i109495b-006.htm#TXMP068584ce
Part III—Issuer or Other Coverage Provider(p4)

rule
taxmap/instr2/i109495b-006.htm#en_us_publink100013967
taxmap/instr2/i109495b-006.htm#TXMP4f28f4e4
Lines 16-22.(p4)
rule
Enter the name, EIN, and complete mailing address of the provider of the coverage. The provider of the coverage is the issuer or carrier of insured coverage, sponsor of a self-insured employer plan, government agency providing government-sponsored coverage, or other entity. Enter on line 18 the telephone number the individual seeking additional information may call to speak to a person.
taxmap/instr2/i109495b-006.htm#en_us_publink100013901

taxmap/instr2/i109495b-006.htm#TXMP7b0da042
Part IV—Covered Individuals(p4)

rule
taxmap/instr2/i109495b-006.htm#en_us_publink100013903
taxmap/instr2/i109495b-006.htm#TXMP10efddc2
Column (a).(p4)
rule
Enter the name of each covered individual.
taxmap/instr2/i109495b-006.htm#en_us_publink100013968
taxmap/instr2/i109495b-006.htm#TXMP12a96399
Column (b).(p4)
rule
Enter the nine-digit SSN for each covered individual (111-11-1111). Enter a TIN, rather than an SSN, if the covered individual does not have an SSN. See Statements Furnished to Individuals, earlier, for information on truncating the SSN or other TIN.
taxmap/instr2/i109495b-006.htm#en_us_publink100013969
taxmap/instr2/i109495b-006.htm#TXMP136b09b0
Column (c).(p4)
rule
Enter a date of birth (MM/DD/YYYY) for the covered individual only if column (b) is blank.
taxmap/instr2/i109495b-006.htm#en_us_publink100013970
taxmap/instr2/i109495b-006.htm#TXMP16241f2b
Column (d).(p4)
rule
Check this box if the individual was covered for at least one day per month for all 12 months of the calendar year.
taxmap/instr2/i109495b-006.htm#en_us_publink100013971
taxmap/instr2/i109495b-006.htm#TXMP17e6751e
Column (e).(p4)
rule
If the individual was not covered for all months check the applicable box(es) for the months in which the individual was covered for at least one day. If there are more than six covered individuals, complete one or more additional Forms 1095-B, Part I lines 1 through 7 and Part IV. Do not include these additional Forms 1095-B in the count of forms submitted with Form 1094-B.