Instructions For Forms 1094-B And 1095-B - 2017 Page 5


Void Box
1095-B reporting that Tim was covered only for January
through October 2017. If Ace filed the Form 1095-B with
Don't use this box on Form 1095-B.
the IRS, it must file a corrected Form 1095-B with the IRS
reporting coverage only for January through October
Corrected Form 1095-B
For information about filing corrections for electronically
filed forms, see section 7.1 of Pub. 5165. A corrected
Example 2. Sharon is enrolled in Medicaid for January
return should be filed as soon as possible after an error is
through September 2017. The Medicaid agency files a
discovered. File corrected returns as follows.
Form 1095-B and furnishes a statement to Sharon
Form 1095-B: Fully complete Form 1095-B and enter
reporting coverage for January through September 2017.
an “X” in the CORRECTED checkbox. File a Form
In April 2018, Sharon is approved for Medicaid coverage
1094-B Transmittal with the corrected Forms 1095-B.
beginning on November 1, 2017. The Medicaid agency
(Do not file a corrected Form 1094-B.)
must file a corrected Form 1095-B with the IRS and
Recipient's statement: A copy of the corrected Form
furnish Sharon a corrected statement reporting coverage
1095-B must be furnished to the individual who
for January through September and November through
received the original Form 1095-B.
December 2017.
Note. Enter an “X” in the CORRECTED checkbox only
Statements Furnished to Individuals
when correcting a Form 1095-B previously filed with the
Filers of Form 1095-B must furnish a copy by January 31,
IRS. If you are correcting a Form 1095-B that was
2018, to the person identified as the “responsible
previously furnished to a recipient, but not filed with the
individual” on the form for coverage in 2017.
IRS, write, print, or type CORRECTED on the new Form
1095-B furnished to the recipient.
The “responsible individual” is the person who, based
on a relationship to the covered individuals, the primary
See the next chart for examples of errors and
name on the coverage, or some other circumstances,
step-by-step instructions for filing corrected
should receive the statement. Generally, the statement
recipient should be the taxpayer (tax filer) who would be
liable for the individual shared responsibility payment for
the covered individuals, if that person is known. A
Original Form 1095-B Filed With the IRS and Furnished to the
statement recipient may be a parent if only minor children
are covered individuals, a primary subscriber for insured
IF any of the following are
THEN ...
coverage, an employee or former employee in the case of
incorrect ...
employer-sponsored coverage, a uniformed services
Name of responsible individual
1. Fully complete a new Form
sponsor for TRICARE, or another individual who should
(Part I)
1095-B and enter an “X” in the
receive the statement. Filers may, but aren't required to,
CORRECTED checkbox
furnish a statement to more than one recipient.
2. File a Form 1094-B Transmittal
with the corrected Form 1095-B
Copies of Form 1095-B furnished to recipients may
Origin of the Health Coverage
3. Furnish a copy of the corrected
include a truncated SSN or other TIN, if applicable, of the
(Part I)
Form 1095-B to the person
statement recipient and covered individuals by showing
identified as the responsible
only the last four digits of the SSN or other TIN and
replacing the first five digits with asterisks (*) or Xs.
Social security number (SSN) or
Copies of Form 1095-B furnished to recipients also may
taxpayer identification number
truncate the EIN of an employer reported in Part II, if any.
(TIN) (Part I)
The filer’s EIN may not be truncated on the statement
furnished to recipients. Truncation of TINs, including EINs,
Information About Certain
is not allowed on returns filed with the IRS.
Employer-Sponsored Coverage
(Part II)
In general, statements must be furnished on paper by
mail (or hand delivered), unless the recipient affirmatively
Issuer or Other Coverage
consents to receive the statement in an electronic format.
Provider (Part III)
If mailed, the statement must be sent to the recipient’s last
Covered Individuals (Part IV)
known permanent address, or, if no permanent address is
known, to the recipient’s temporary address.
Consent to furnish statement electronically. Except
You must file a corrected return to report
as provided below, a filer is required to obtain affirmative
retroactive changes in coverage.
consent to furnish a statement electronically. The
requirement to obtain affirmative consent to furnish a
Example 1. Tim enrolls in health insurance with Ace
statement electronically ensures that statements are sent
Insurance Company in January 2017. Tim fails to pay his
electronically only to individuals who are able to access
premiums for November and December 2017 and
them. The consent must relate specifically to receiving
January 2018. Ace sends Tim a Form 1095-B on January
Form 1095-B electronically. A recipient may consent on
31, 2018, reporting coverage for every month in 2017. On
paper or electronically, such as by email. If consent is on
February 1, 2018, Ace cancels Tim’s coverage effective
paper, the recipient must confirm the consent
November 1, 2017. Ace must send Tim a corrected Form
electronically. A statement may be furnished electronically
Instructions for Forms 1094-B and 1095-B (2017)


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