Instructions For Recipient, Instructions For Forms 1094-B And 1095-B - 2014


Form 1095-B (2014)
Instructions for Recipient
Line 8. This is the code for the type of coverage in which you or other
covered individuals were enrolled. Only one letter will be entered on this line.
This Form 1095-B provides information needed to report on your income tax
A. Small Business Health Options Program (SHOP)
return that you, your spouse, and individuals you claim as dependents had
B. Employer-sponsored coverage
qualifying health coverage (referred to as “minimum essential coverage”) for
C. Government-sponsored program
some or all months during the year. Individuals who do not have minimum
D. Individual market insurance
essential coverage and do not qualify for an exemption may be liable for the
E . Multiemployer plan
individual shared responsibility payment.
F . Miscellaneous minimum essential coverage
Minimum essential coverage includes government-sponsored programs,
eligible employer-sponsored plans, individual market plans, and
If you or another family member received health insurance
miscellaneous coverage designated by the Department of Health and
coverage through a Health Insurance Marketplace (also known as
Human Services. For more information on minimum essential coverage, see
an Exchange) that coverage will be reported on a Form 1095-A
Pub. 974, Premium Tax Credit (PTC).
rather than a Form 1095-B.
Providers of minimum essential coverage are required to furnish
Line 9. This line will be blank for 2014.
only one Form 1095-B for all individuals whose coverage is
Part II. Employer-Sponsored Coverage, lines 10–15. This part will be
reported on that form. As the recipient of this Form 1095-B, you
completed by the insurance company if an insurance company provides your
should provide a copy to individuals covered under the policy if they request
employer-sponsored health coverage. It provides information about the
it for their records.
employer sponsoring the coverage. If your coverage is not insured employer
Part I. Responsible Individual, lines 1–9. Part I reports information about
coverage, this part will be blank.
you and the coverage.
Part III. Issuer or Other Coverage Provider, lines 16–22. This part reports
Lines 2 and 3. Line 2 reports your social security number (SSN) or other
information about the coverage provider (insurance company, employer
taxpayer identification number (TIN), if applicable. For your protection, this
providing self-insured coverage, government agency sponsoring coverage
form may show only the last four digits. However, the coverage provider is
under a government program such as Medicaid or Medicare, or other
required to report your complete SSN or other TIN, if applicable to the IRS.
coverage sponsor). Line 18 reports a telephone number for the coverage
Your date of birth will be entered on line 3 only if line 2 is blank.
provider that you can call if you have questions about the information
reported on the form.
If you don't provide your SSN and the SSNs of all covered individuals
Part IV. Covered Individuals, lines 23–28. This part reports the name, SSN,
to the sponsor of the coverage, the IRS may not be able to match the
and coverage information for each covered individual. A date of birth will be
Form 1095-B with the individuals to determine that they have
entered in column (c) only if an SSN is not entered in column (b). Column (d)
complied with the individual shared responsibility provision.
will be checked if the individual was covered for at least one day in every
month of the year. For individuals who were covered for some but not all
months, information will be entered in column (e) indicating the months for
which these individuals were covered. If there are more than six covered
individuals, you will receive one or more additional Forms 1095-B that
continue Part IV.


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