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

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Form 1095-B (2014)

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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

TIP

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.

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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.

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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

CAUTION

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.

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

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