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Department of the Treasury
Internal Revenue Service
2024

Instructions for Forms

1094-B and 1095-B

Section references are to the Internal Revenue Code unless Who Must File
otherwise noted. Every person that provides minimum essential coverage to an
individual during a calendar year must file an information return
Future Developments reporting the coverage. Filers will use Form 1094-B (transmittal)
For the latest information about developments relating to Forms to submit Forms 1095-B (returns).
1094-B, Transmittal of Health Coverage Information Returns, and
1095-B, Health Coverage, and their instructions, such as Employers (including government employers) subject to the
legislation enacted after they were published, go to IRS.gov/ employer shared responsibility provisions sponsoring
Form1094B and IRS.gov/Form1095B. self-insured group health plans, including individual coverage
health reimbursement arrangements (HRAs), will generally
Additional Information report information about the coverage in Part III of Form 1095-C
For information relating to the Affordable Care Act, visit IRS.gov/ instead of on Form 1095-B. However, employers that offer
ACA. employer-sponsored self-insured health coverage to
nonemployees who enroll in the coverage may use Form
For the final regulations relating to Form 1095-B reporting, 1095-B, rather than Form 1095-C, Part III, to report coverage for
see T.D. 9660, 2014-13 I.R.B., at IRS.gov/IRB/2014-13_IRB/ those individuals and other family members. In general,
AR08.html and T.D. 9970, 2023-02 I.R.B. 311, at IRS.gov/irb/ employers with 50 or more full-time employees (including
2023-02_IRB. full-time equivalent employees) during the prior calendar year
are subject to the employer shared responsibility provisions. See
For additional guidance and proposed regulatory changes the Instructions for Forms 1094-C and 1095-C for more
relating to Form 1095-B reporting, including the requirement to information about who must file Forms 1094-C and 1095-C and
solicit the taxpayer identification number (TIN) of each covered for more information about reporting coverage for
individual for purposes of the reporting of health coverage nonemployees. Small employers that aren't subject to the
information, see Proposed Regulations section 1.6055-1(h) and employer shared responsibility provisions sponsoring
Regulations section 301.6724-1. self-insured group health plans will use Forms 1094-B and
1095-B to report information about covered individuals.
For additional information relating to reporting by providers of
minimum essential coverage, go to IRS.gov/Affordable-Care-Act/ Insured coverage. Health insurance issuers and carriers must
Employers/Information-Reporting-by-Providers-of-Minimum- file Form 1095-B for most health insurance coverage, including
Essential-Coverage. individual market coverage and insured coverage sponsored by
employers. However, health insurance issuers and carriers don't
For information relating to filing Forms 1094-B and 1095-B report coverage under the Children’s Health Insurance Program
electronically, visit IRS.gov/For-Tax-Pros/Software-Developers/ (CHIP), Medicaid, Medicare (including Medicare Advantage), or
Information-Returns/Affordable-Care-Act-Information-Return-Air- the Basic Health Program provided through health insurance
Program. companies. These types of coverage are reported by the
government sponsors of those programs.
In addition, health insurance issuers and carriers aren't
General Instructions for Forms required to file Form 1095-B to report coverage in individual
1094-B and 1095-B market qualified health plans that individuals enroll in through
Health Insurance Marketplaces. This coverage is generally
Purpose of Form reported by Marketplaces on Form 1095-A. However, health
insurance issuers are required to file Form 1095-B to report on
Form 1095-B is used to report certain information to the IRS and coverage for employees obtained through the Small Business
to taxpayers about individuals who are covered by minimum Health Options Program (SHOP). For coverage in 2024 (filing in
essential coverage. Eligibility for certain types of minimum 2025), health insurance issuers and carriers are encouraged
essential coverage can affect a taxpayer's eligibility for the (but not required) to report coverage in catastrophic health plans
premium tax credit. enrolled in through the Marketplace.

Minimum essential coverage includes government-sponsored Eligible Employer-Sponsored Plans
programs, eligible employer-sponsored plans, individual market
plans, and other coverage the Department of Health and Human Eligible employer-sponsored plans are minimum essential
Services designates as minimum essential coverage. Minimum coverage and include the following.
essential coverage is described in more detail under Who Must 1. Group health insurance coverage for employees under the
File, later. following.
Minimum essential coverage doesn't include coverage a. A governmental plan, such as the Federal Employees
TIP consisting solely of excepted benefits. Excepted benefits Health Benefits program.
include vision and dental coverage not part of a
comprehensive health insurance plan, workers’ compensation b. An insured plan or coverage offered in the small or large
coverage, and coverage limited to a specified disease or illness. group market within a state.
c. A grandfathered health plan offered in a group market.

Aug 6, 2024 Cat. No. 63017B

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2. A self-insured group health plan for employees. Generally, b. CHAMPVA, or
an HRA, including an individual coverage HRA, is a
self-insured group health plan. c. Comprehensive health care for children suffering from
spina bifida who are the children of Vietnam veterans
As noted earlier, minimum essential coverage doesn't include and veterans of covered service in Korea.
coverage consisting solely of excepted benefits. Excepted 6. Coverage for Peace Corps volunteers.
benefits include vision and dental coverage not part of a
comprehensive health insurance plan, workers’ compensation 7. The Nonappropriated Fund Health Benefits Program of the
coverage, and coverage limited to a specified disease or illness. Department of Defense.
Health insurance issuers or carriers will file Form 1095-B for In general, the government agency sponsoring the program
all insured employer coverage. Plan sponsors are responsible for will file Form 1095-B. The state agency that administers a
reporting self-insured employer coverage. Plan sponsors that are Medicaid or CHIP program will file Form 1095-B for coverage
employers subject to the employer shared responsibility under those programs. However, Medicaid and CHIP agencies
provisions must generally report the coverage on Form 1095-C in U.S. possessions or territories (American Samoa, the
and other plan sponsors (such as employers not subject to the Commonwealth of the Northern Mariana Islands, Guam, Puerto
employer shared responsibility provisions and sponsors of Rico, and the U.S. Virgin Islands) aren’t required to report
multiemployer plans) report the coverage on Form 1095-B. Medicaid or CHIP coverage on Form 1095-B.
Plan sponsors of self-insured employer coverage include: When coverage under the Nonappropriated Fund Health
• Each participating employer (for its own covered individuals) Benefits Program of the Department of Defense or TRICARE is
in a plan or arrangement established or maintained by more reported on Form 1095-B, Part I, line 8, filers should use code C
than one employer; (government-sponsored program).
• The association, committee, joint board of trustees, or
similar group of representatives who establish or maintain a Coverage designated as minimum essential coverage. The
multiemployer plan; Department of Health and Human Services has designated the
• The employee organization for a plan or arrangement following health benefit plans or arrangements as minimum
maintained solely by an employee organization; and essential coverage.
• Each participating employer (for its own employees) for a 1. Medicare Part C (Medicare Advantage).
plan or arrangement maintained by a Multiple Employer
Welfare Arrangement. 2. Refugee Medical Assistance.
A government employer may designate another government 3. Coverage provided to a business owner under a plan that is
entity to report coverage of its employees. Generally, a eligible employer-sponsored coverage with respect to at
designated government entity will file Form 1095-B on behalf of a least one employee.
government employer that sponsors or maintains a self-insured 4. Coverage under a group health plan provided through
group health plan for its employees only if that government insurance regulated by a foreign government if:
employer isn't subject to the employer shared responsibility
provisions, which would require reporting on Form 1095-C. The a. A covered individual is physically absent from the
Instructions for Forms 1094-C and 1095-C contain further United States for at least 1 day during the month, or
information on reporting options for government entities. b. A covered individual is physically present in the United
States for a full month and the coverage provides health
Government-Sponsored Programs benefits within the United States while the individual is
The following government-sponsored programs are minimum outside the United States.
essential coverage.
5. The Basic Health Program.
1. Medicare Part A.
6. Coverage of pregnancy-related services that consists of full
2. Medicaid, except for the following programs. Medicaid benefits.
a. Optional coverage of family planning services. 7. Coverage under a section 1115 demonstration waiver
program.
b. Optional coverage of tuberculosis-related services.
8. Specific programs listed at CMS.gov/CCIIO/Programs-and-
c. Coverage of pregnancy-related services.
Initiatives/Health-Insurance-Market-Reforms/Minimum-
d. Coverage of medical emergency services. Essential-Coverage.html (click on the link for “Approved
Plans”).
e. Coverage of medically needy individuals.
Providers of these and later designated programs will file
f. Coverage of COVID-19 testing and diagnostic services.
Form 1095-B. The sponsor for the Basic Health Program is the
3. The Children’s Health Insurance Program (CHIP). state government agency administering the program.

4. The TRICARE program, except for the following options. Coverage in More Than One Minimum Essential
a. Coverage on a space-available basis in a military Coverage Plan or Program
treatment facility for individuals who aren't eligible for If, for any month, an individual is covered by more than one
TRICARE coverage for private sector care. minimum essential coverage plan or program that is provided by
b. Coverage for a line-of-duty-related injury, illness, or the same provider, the provider is required to report only one of
disease for individuals who have left active duty. the plans or programs for that month. For example, if an
individual is covered by a self-insured major medical plan and an
5. Coverage administered by the Department of Veterans HRA provided by the same employer for a month, the employer
Affairs that is: is the provider of both types of coverage and is therefore
a. Coverage consisting of the medical benefits package for required to report the coverage of the individual under only one
eligible veterans, of the arrangements for that month.

2 Instructions for Forms 1094-B and 1095-B (2024)

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Generally, reporting is also not required for an individual’s your Form 8809. You can also submit the extension request
minimum essential coverage for a month if that minimum online through the FIRE System. You are encouraged to submit
essential coverage is offered only to individuals who are also requests using the online fill-in form. See Pub. 1220 for more
covered by other minimum essential coverage for which information on filing online or electronically. See the instructions
reporting is required. For example, an insurance company for Form 8809 for more information.
offering a Medicare or TRICARE supplement for which only
individuals enrolled in Medicare or TRICARE are eligible is not Where To File
required to report coverage under the Medicare or TRICARE Send all information returns filed on paper to the following.
supplement.
Under this rule, a state Medicaid agency is not required to If your principal business,
report Medicaid coverage for which only individuals enrolled in office or agency, or legal
Use the following address:
other minimum essential coverage, such as employer-sponsored residence in the case of an
coverage or a qualified health plan, are eligible. individual, is located in:
This second rule applies to eligible employer-sponsored ▼ ▼
coverage only if both types of coverage (the supplemental
coverage and the eligible employer-sponsored coverage for Alabama, Arizona, Arkansas,
which section 6055 reporting is required) are offered by the Connecticut, Delaware, Florida,
same employer. For example, if an employer offers both an Georgia, Kentucky, Louisiana,
insured group health plan and an HRA that an employee is Maine, Massachusetts, Department of the Treasury
eligible for if the employee enrolls in the insured group health Mississippi, New Hampshire, Internal Revenue Service
plan, and an employee enrolls in both, the employer is not New Jersey, New Mexico, New Center
required to report the employee’s coverage under the HRA for York, North Carolina, Ohio, Austin, TX 73301
the months in which the employee is enrolled in both plans. If, Pennsylvania, Rhode Island,
however, an individual is covered by an HRA sponsored by one Texas, Vermont, Virginia,
employer, including an individual coverage HRA, and a non-HRA West Virginia
group health plan sponsored by another employer (such as
spousal coverage) or an individual is covered by an individual Alaska, California, Colorado,
coverage HRA, each employer (or the health insurance issuer or District of Columbia, Hawaii,
carrier, if the plan is insured) must report the coverage the Idaho, Illinois, Indiana, Iowa,
Department of the Treasury
employer (or issuer or carrier) provides. Kansas, Maryland, Michigan,
Internal Revenue Service
Minnesota, Missouri, Montana,
Center
For more information on the reporting of supplemental Nebraska, Nevada, North
P.O. Box 219256
coverage, including the rule on when different entities are treated Dakota, Oklahoma, Oregon,
Kansas City, MO 64121-9256
as a single employer for purposes of the second rule, see South Carolina, South Dakota,
Proposed Regulations section 1.6055-1(d)(2) and (3). Tennessee, Utah, Washington,
Wisconsin, Wyoming
When To File
Generally, the return and transmittal form must be filed with the
IRS on or before February 28 if filing on paper (March 31 if filing
electronically) of the year following the calendar year of If your legal residence or principal place of business or
coverage. principal office or agency is outside the United States, file with
the Department of the Treasury, Internal Revenue Service
You will meet the requirement to file if the form is properly Center, Austin, TX 73301.
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 How To File
next business day. A business day is any day that isn't a
Saturday, Sunday, or legal holiday. Filing Paper Returns With the IRS
For forms filed in 2025 reporting coverage provided in Shipping and mailing. If you're filing on paper, send the forms
calendar year 2024, Forms 1094-B and 1095-B are required to to the IRS in a flat mailing (not folded) and don’t staple or
be filed by February 28, 2025, or March 31, 2025, if filing paperclip the forms together. If you're sending many forms, you
electronically. may send them in conveniently sized packages. On each
See Statements Furnished to Individuals, later, for information package, write your name, and number the packages
on when Form 1095-B must be furnished. consecutively. Place Form 1094-B in package number one and a
copy of Form 1094-B in each additional package. Postal
Extension of Time To File regulations require forms and packages to be sent by first-class
mail. Returns filed with the IRS must be printed in landscape
You can get an automatic 30-day extension of time to file by format.
completing Form 8809 and filing it with the IRS on or before the
due date for the Forms 1094-B and 1095-B. Form 8809 may be Keeping copies. Generally, keep copies of information returns
submitted on paper or through the FIRE System either as a fill-in you filed with the IRS or maintain the ability to reconstruct the
form or an electronic file. No signature or explanation is required data for at least 3 years, from the due date of the returns.
for the extension. However, you must file Form 8809 by the due
date of the returns in order to get the 30-day extension. Under Electronic Filing
certain hardship conditions, you may apply for an additional
If you're required to file 10 or more
30-day extension. See Form 8809 and its instructions for more
information returns, you must file
information about extensions of time to file.
electronically. The 10-or-more requirement
How to apply. File Form 8809 as soon as you know that a applies in the aggregate to certain information returns.
30-day extension of time to file is needed. Follow the instructions Accordingly, a filer may be required to file fewer than 10 Forms
on Form 8809, which provide information on where to fax or mail 1094-B and 1095-B, but still have an electronic filing obligation
Instructions for Forms 1094-B and 1095-B (2024) 3

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based on other kinds of information returns filed. The electronic Note. Enter an “X” in the CORRECTED checkbox only when
filing requirement does not apply if you request and receive a correcting a Form 1095-B previously filed with the IRS. If you are
hardship waiver. The IRS encourages you to file electronically correcting a Form 1095-B that was previously furnished to a
even if you’re filing fewer than 10 returns. recipient, but not filed with the IRS, write, print, or type
“CORRECTED” on the new Form 1095-B furnished to the
Waiver. To receive a waiver from the required filing of recipient.
information returns electronically, submit Form 8508. You are
encouraged to file Form 8508 at least 45 days before the due See the next chart for examples of errors and
date of the return but no later than the due date of the return. The TIP step-by-step instructions for filing corrected returns.
IRS doesn’t process waiver requests until January 1 of the
calendar year the returns are due. You can't apply for a waiver for Original Form 1095-B Filed With the IRS and Furnished to the
more than 1 tax year at a time. If you need a waiver for more than Recipient
1 tax year, you must reapply at the appropriate time each year.
An approved waiver for original returns will cover corrections only IF any of the following are THEN ...
for the same type of return. If you receive an approved waiver, incorrect ...
don't send a copy of it to the Service Center where you file your Name of responsible individual 1. Fully complete a new Form
paper returns. Keep the waiver for your records only. (Part I) 1095-B and enter an “X” in the
If you are required to file electronically but fail to do so, and CORRECTED checkbox.
you don't have an approved waiver, you may be subject to a 2. File a Form 1094-B Transmittal
penalty of up to $330 per return unless you establish reasonable with the corrected Form 1095-B.
cause. However, you can file up to 10 returns on paper; those Origin of the Health Coverage 3. Furnish a copy of the corrected
returns will not be subject to a penalty for failure to file (Part I) Form 1095-B to the person
electronically. The penalty applies separately to original returns identified as the responsible
and corrected returns. individual.
Pub. 5165, Guide for Electronically Filing Affordable Care Act
(ACA) Information Returns for Software Developers and Social security number (SSN) or
Transmitters, specifies the communication procedures, taxpayer identification number
transmission formats, business rules, and validation procedures, (TIN) (Part I)
and explains when a return will be accepted, accepted with
Information About Certain
errors, or rejected for returns filed electronically for calendar year Employer-Sponsored Coverage
2024 through the ACA Information Return (AIR) system. To (Part II)
develop software for use with the AIR system, software
developers, transmitters, and issuers, including employers filing Issuer or Other Coverage
their own Forms 1094-B and 1095-B, should use the guidelines Provider (Part III)
provided in Pub. 5165, along with the Extensible Markup
Language (XML) Schemas published on IRS.gov. Covered Individuals (Part IV)
Reminder. The formatting directions in these instructions are for
the preparation of paper returns. When filing forms electronically,
the formatting set forth in the XML Schemas and Business Rules You must file a corrected return to report retroactive
published on IRS.gov must be followed rather than the formatting ! changes in coverage.
directions in these instructions. For more information regarding CAUTION
electronic filing, see Pubs. 5164 and 5165.
Example 1. Tim enrolls in health insurance with Ace
Substitute Returns Filed With the IRS Insurance Company in January 2024. Tim fails to pay the
See Pub. 5223, General Rules and Specifications for Affordable premiums for November and December 2024 and January 2025.
Care Act Substitute Forms 1095-A, 1094-B, 1095-B, 1094-C, Ace sends Tim a Form 1095-B on January 31, 2025, reporting
and 1095-C, for specifications for private printing of substitute coverage for every month in 2024. On February 1, 2025, Ace
information returns. You may not request special consideration. cancels Tim’s coverage effective November 1, 2024. Ace must
Only forms that conform to the official form and the specifications send Tim a corrected Form 1095-B reporting that Tim was
in Pub. 5223 are acceptable for filing with the IRS. Substitute covered only for January through October 2024. If Ace filed the
returns filed with the IRS must be printed in landscape format. Form 1095-B with the IRS, it must file a corrected Form 1095-B
with the IRS reporting coverage only for January through
Void Box October 2024.
Don't use this box on Form 1095-B. Example 2. Sharon is enrolled in Medicaid for January
through September 2024. The Medicaid agency files a Form
Corrected Form 1095-B 1095-B and furnishes a statement to Sharon reporting coverage
For information about filing corrections for electronically filed for January through September 2024. In April 2025, Sharon is
forms, see section 7.1 of Pub. 5165. A corrected return should approved for Medicaid coverage beginning on November 1,
be filed as soon as possible after an error is discovered. File 2024. The Medicaid agency must file a corrected Form 1095-B
corrected returns as follows. with the IRS and furnish Sharon a corrected statement reporting
• Form 1095-B: Fully complete Form 1095-B and enter an “X” coverage for January through September and November through
in the CORRECTED checkbox. File a Form 1094-B December 2024.
Transmittal with the corrected Forms 1095-B. (Do not file a
corrected Form 1094-B.) Statements Furnished to Individuals
• Recipient's statement: A copy of the corrected Form 1095-B Filers of Form 1095-B must furnish a copy by March 3, 2025, to
must be furnished to the individual who received the original the person identified as the "responsible individual" on the form
Form 1095-B. for coverage in 2024. However, a provider of minimum essential
coverage will be treated as timely furnishing Form 1095-B to

4 Instructions for Forms 1094-B and 1095-B (2024)

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individuals if the form is made available through the provider’s 1095-C, Employer-Provided Health Insurance Offer and
website and certain conditions are met. See Alternative manner Coverage); and (3) includes the provider’s email address,
of furnishing statements, later. mailing address, and telephone number.
The “responsible individual” is the person who, based on a • The provider must post the notice on its website by March 3,
relationship to the covered individuals, the primary name on the 2025, and retain the notice in the same location on its
coverage, or some other circumstances, should receive the website through October 15, 2025.
statement. Generally, the statement recipient should be the • The provider must furnish the statement to a requesting
primary taxpayer, if that person is known. A statement recipient responsible individual within 30 days of the date the request
may be a parent if only minor children are covered individuals, a is received. To satisfy this requirement, the provider may
primary subscriber for insured coverage, an employee or former furnish the statement electronically if the recipient
employee in the case of employer-sponsored coverage, a affirmatively consents.
uniformed services sponsor for TRICARE, or another individual
who should receive the statement. Filers may, but aren't required Consent to furnish statement electronically. Except as
to, furnish a statement to more than one recipient. provided below, a filer is required to obtain affirmative consent to
furnish a statement electronically. The requirement to obtain
Copies of Form 1095-B furnished to recipients may include a affirmative consent to furnish a statement electronically ensures
truncated SSN or other TIN, if applicable, of the statement that statements are sent electronically only to individuals who
recipient and covered individuals by showing only the last four are able to access them. The consent must relate specifically to
digits of the SSN or other TIN and replacing the first five digits receiving Form 1095-B electronically. A recipient may consent on
with asterisks (*) or Xs. Copies of Form 1095-B furnished to paper or electronically, such as by email. If consent is on paper,
recipients may also truncate the employer identification number the recipient must confirm the consent electronically. A
(EIN) of an employer reported in Part II, if any. The filer’s EIN may statement may be furnished electronically by email or by
not be truncated on the statement furnished to recipients. informing the recipient how to access the statement on the filer’s
Truncation of TINs, including EINs, is not allowed on returns filed website. Statements reporting coverage under an expatriate
with the IRS. health plan, however, may be furnished electronically unless the
In general, statements must be furnished on paper by mail (or recipient has explicitly refused to consent to receive the
hand delivered), unless the recipient affirmatively consents to statement in an electronic format.
receive the statement in an electronic format. If mailed, the Extension of time to furnish statement to recipients. The
statement must be sent to the recipient’s last known permanent due date for furnishing Form 1095-B is automatically extended
address, or, if no permanent address is known, to the recipient’s from January 31, 2025, to March 3, 2025. Thus, no additional
temporary address. extensions will be granted.
Alternative manner of furnishing statements. A provider of
minimum essential coverage will be treated as timely furnishing Substitute Statements to Recipients
Form 1095-B to individuals if the provider uses the alternative If you aren't using the official IRS form to furnish statements to
manner of furnishing statements described in Regulations recipients, see Pub. 5223, which explains the requirements for
section 1.6055-1(g). If the provider is an applicable large format and content of substitute statements to recipients. You
employer (as defined under Regulations section 54.4980H-1(a) may develop them yourself or buy them from a private printer.
(4)) that offers employer-sponsored self-insured health
coverage, the employer may use the alternative manner of Information Reporting Penalties
furnishing for statements to non-full-time employees and A provider of minimum essential coverage that fails to comply
nonemployees who are enrolled in the self-insured health with the information reporting requirements may be subject to
coverage. See Who Must File, earlier. To use the alternative the general information reporting penalty provisions for failure to
manner of furnishing statements, the following conditions must file correct information returns and failure to furnish correct
be met. payee statements. For returns required to be made and
• The provider must provide clear and conspicuous notice, in statements required to be furnished for 2024 tax year returns, the
a location on its website that is reasonably accessible to all following apply.
responsible individuals, stating that responsible individuals • The penalty for failure to file a correct information return is
may receive a copy of their statement upon request. The $330 for each return for which the failure occurs, with the
notice must include an email address, a physical address to total penalty for a calendar year not to exceed $3,987,000.
which a request for a statement may be sent, and a • The penalty for failure to provide a correct payee statement
telephone number that responsible individuals may use to is $330 for each statement for which the failure occurs, with
contact the provider with any questions. A notice posted on the total penalty for a calendar year not to exceed
a provider’s website must be written in plain, non-technical $3,987,000.
terms and with letters of a font size large enough, including • There are lower annual maximums applicable to small
any visual clues or graphical figures, to call to a viewer’s businesses with average gross receipts of $5 million or less.
attention that the information pertains to tax statements • The penalty per return increases to $660 with no annual
reporting that individuals had health coverage. For example, maximum limitation if there is intentional disregard of the
a provider’s website provides a clear and conspicuous requirement to file the returns and furnish recipient
notice if it (1) includes a statement on the main page—or a statements.
link on the main page, reading “Tax Information,” to a
secondary page that includes a statement—in capital
letters, “IMPORTANT HEALTH COVERAGE TAX Waiver of Penalties
DOCUMENTS”; (2) explains how responsible individuals
may request a copy of Form 1095-B, Health Coverage (or, The penalties may be waived if the failure was due to reasonable
for an applicable large employer member that sponsors a cause and not willful neglect. See section 6724, Regulations
self-insured group health plan and makes a return in section 301.6724-1, and Regulations section 1.6055-1(h). For
accordance with Regulations section 1.6055-1(f)(2)(i), additional information, see Pub. 1586.
explains how non-full-time employees and nonemployees
who are enrolled in the plan may request a copy of Form
Instructions for Forms 1094-B and 1095-B (2024) 5

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Insurance companies entering code A or B on line 8 will
Specific Instructions for Form 1094-B TIP complete Part II. Employers reporting self-insured group
health plan coverage on Form 1095-B, except for an
Line 1. Enter the filer’s complete name. individual coverage HRA, enter code B on line 8, but don't
Line 2. Enter the filer’s nine-digit employer identification number complete Part II. If you entered code B for self-insured coverage,
(EIN). If you don't have an EIN, you may apply for one online at skip Part II and go to Part III.
IRS.gov/EIN. You may also apply by faxing or mailing Form SS-4,
Application for Employer Identification Number, to the IRS. See Lines 10–15. Enter the name, EIN, and complete mailing
the Instructions for Form SS-4 and Pub. 1635 for more address for the employer sponsoring the coverage. If mail isn't
information. delivered to the street address and the employer has a P.O. box,
enter the box number instead of the street address. See
Lines 3 and 4. Enter the name and telephone number, Statements Furnished to Individuals, earlier, for information on
including area code, of the person to contact who is responsible truncating the employer's EIN. If the employer is a member of a
for answering any questions from the IRS regarding the filing of controlled group, enter information for the specific controlled
or information reported on Form 1094-B or 1095-B. group member that is the covered employee’s employer. If the
Lines 5–8. Enter the filer’s complete address where all coverage is provided through an association or a Multiple
correspondence will be sent. If mail is delivered to a P.O. box and Employer Welfare Arrangement, enter information for the
not a street address, enter the box number instead of the street participating employer of the covered employee. Don't complete
address. Part II if the coverage is provided through a multiemployer plan.

Line 9. Enter the total number of Forms 1095-B that are Part III—Issuer or Other Coverage Provider
transmitted with Form 1094-B.
Lines 16–22. Enter your name, EIN, and complete mailing
address. The provider of the coverage is the issuer or carrier of
Specific Instructions for Form 1095-B insured coverage, sponsor of a self-insured employer plan,
government agency providing government-sponsored coverage,
Part I—Responsible Individual or other coverage sponsor. Enter on line 18 the telephone
number that an individual seeking additional information may call
Line 1. Enter the name of the responsible individual (statement to speak to a person.
recipient). See the description of who is a “responsible
individual” under Statements Furnished to Individuals, earlier. Part IV—Covered Individuals
Line 2. Enter the nine-digit social security number (SSN) of the Column (a). Enter the name of each covered individual.
responsible individual (111-11-1111). If the responsible
individual doesn't have an SSN, enter the responsible Column (b). Enter the nine-digit SSN or other TIN for each
individual’s other TIN. No SSN or other TIN is required if the covered individual (111-11-1111). The field may be left blank if
responsible individual isn't a covered individual identified in Part the covered individual doesn’t have a TIN. See Statements
IV. See Statements Furnished to Individuals, earlier, for Furnished to Individuals, earlier, for information on truncating the
information on truncating the SSN or other TIN. SSN or other TIN.
Line 3. Enter the responsible individual’s date of birth Column (c). Enter a date of birth (YYYY/MM/DD) for the
(YYYY/MM/DD) only if line 2 is blank. covered individual only if an SSN or other TIN isn't entered in
column (b).
Lines 4–7. Enter the complete mailing address of the
responsible individual. If mail isn't delivered to the street address Column (d). Check this box if the individual was covered for at
and the responsible individual has a P.O. box, enter the box least 1 day per month for all 12 months of the calendar year.
number instead of the street address. Column (e). If the individual wasn't covered for all 12 months,
Line 8. Enter the letter identifying the Origin of the Health check the applicable box(es) for the month(s) in which the
Coverage. See Who Must File, earlier, to determine which types individual was covered for at least 1 day.
of coverage fall under each category listed below. If there are more than six covered individuals, complete this
A. Small Business Health Options Program (SHOP). information for the additional covered individuals on Part IV,
B. Employer-sponsored coverage, except for an individual Continuation Sheet(s). Do not count the Continuation Sheet(s)
coverage HRA. as additional Forms 1095-B in the count of forms submitted with
C. Government-sponsored program. the accompanying Form 1094-B.
D. Individual market insurance.
E. Multiemployer plan. Privacy Act and Paperwork Reduction Act Notice. We ask
F. Other designated minimum essential coverage. for the information on these forms to carry out the Internal
G. Employer-sponsored coverage that is an individual coverage Revenue laws of the United States and the Patient Protection
HRA. and Affordable Care Act. Our legal right to ask for the information
Line 9. For 2024, leave this line blank. on this form is Internal Revenue Code section 6055 and its
regulations. Providing false or fraudulent information may subject
Part II—Information About Certain you to penalties. We may disclose this information to the
Department of Justice for civil or criminal investigation, and to
Employer-Sponsored Coverage cities, states, and the District of Columbia for use in
This part is completed only by issuers or carriers of insured administering their tax laws. We may also disclose this
group health plans, including coverage purchased through the information to other countries under a tax treaty, to federal and
SHOP. state agencies to enforce federal nontax criminal laws, or to
federal law enforcement and intelligence agencies to combat
terrorism.
You aren't required to provide the information requested on a
form that is subject to the Paperwork Reduction Act unless the

6 Instructions for Forms 1094-B and 1095-B (2024)

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form displays a valid OMB control number. Books or records         If you have comments concerning the accuracy of these time 
relating to a form or its instructions must be retained as long as estimates or suggestions for making this form simpler, we would 
their contents may become material in the administration of any    be happy to hear from you. You can send us comments from 
Internal Revenue law. Generally, tax returns and return            IRS.gov/FormComments. Or you can write to the Internal 
information are confidential, as required by section 6103.         Revenue Service, Tax Forms and Publications Division, 1111 
The time needed to complete the following forms will vary          Constitution Ave. NW, IR-6526, Washington, DC 20224. Don't 
depending on individual circumstances. The estimated average       send the form to this office.
time is:

Form 1094-B . . . . . . . . . . . . . . .               10 min.
Form 1095-B . . . . . . . . . . . . . . .                  1 min.

Instructions for Forms 1094-B and 1095-B (2024)                                                                               7

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