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Department of the Treasury
Internal Revenue Service
2023

Instructions for Forms

1094-B and 1095-B

Section references are to the Internal Revenue Code unless Minimum essential coverage doesn't include coverage
otherwise noted. TIP consisting solely of excepted benefits. Excepted benefits
include vision and dental coverage not part of a
Future Developments comprehensive health insurance plan, workers’ compensation
For the latest information about developments relating to Forms coverage, and coverage limited to a specified disease or illness.
1094-B, Transmittal of Health Coverage Information Returns, and
1095-B, Health Coverage, and their instructions, such as Who Must File
legislation enacted after they were published, go to IRS.gov/ Every person that provides minimum essential coverage to an
Form1094B and IRS.gov/Form1095B. individual during a calendar year must file an information return
reporting the coverage. Filers will use Form 1094-B (transmittal)
What’s New to submit Forms 1095-B (returns).
The electronic filing threshold for information returns required to
be filed on or after January 1, 2024, has been decreased to 10 or Employers (including government employers) subject to the
more returns. See Electronic Filing, later. employer shared responsibility provisions sponsoring
self-insured group health plans, including individual coverage
Additional Information health reimbursement arrangements (HRAs), will generally
For information relating to the Affordable Care Act, visit IRS.gov/ report information about the coverage in Part III of Form 1095-C
ACA. instead of on Form 1095-B. However, employers that offer
employer-sponsored self-insured health coverage to
For the final regulations relating to Form 1095-B reporting, nonemployees who enroll in the coverage may use Form
see T.D. 9660, 2014-13 I.R.B., at IRS.gov/IRB/2014-13_IRB/ 1095-B, rather than Form 1095-C, Part III, to report coverage for
AR08.html and T.D. 9970, 2023-02 I.R.B. 311, at IRS.gov/irb/ those individuals and other family members. In general,
2023–02_IRB. employers with 50 or more full-time employees (including
For additional guidance and proposed regulatory changes full-time equivalent employees) during the prior calendar year
relating to Form 1095-B reporting, including the requirement to are subject to the employer shared responsibility provisions. See
solicit the taxpayer identification number (TIN) of each covered the Instructions for Forms 1094-C and 1095-C for more
individual for purposes of the reporting of health coverage information about who must file Forms 1094-C and 1095-C and
information, see Proposed Regulations section 1.6055-1(h) and for more information about reporting coverage for
Regulations section 301.6724-1. nonemployees. Small employers that aren't subject to the
employer shared responsibility provisions sponsoring
For additional information relating to reporting by providers of self-insured group health plans will use Forms 1094-B and
minimum essential coverage, go to IRS.gov/Affordable-Care-Act/ 1095-B to report information about covered individuals.
Employers/Information-Reporting-by-Providers-of-Minimum-
Essential-Coverage. Insured coverage. Health insurance issuers and carriers must
file Form 1095-B for most health insurance coverage, including
For information relating to filing Forms 1094-B and 1095-B individual market coverage and insured coverage sponsored by
electronically, visit IRS.gov/For-Tax-Pros/Software-Developers/ employers. However, health insurance issuers and carriers don't
Information-Returns/Affordable-Care-Act-Information-Return-Air- report coverage under the Children’s Health Insurance Program
Program. (CHIP), Medicaid, Medicare (including Medicare Advantage), or
the Basic Health Program provided through health insurance
companies. These types of coverage are reported by the
General Instructions for Forms government sponsors of those programs.
1094-B and 1095-B In addition, health insurance issuers and carriers aren't
required to file Form 1095-B to report coverage in individual
Purpose of Form market qualified health plans that individuals enroll in through
Form 1095-B is used to report certain information to the IRS and Health Insurance Marketplaces. This coverage is generally
to taxpayers about individuals who are covered by minimum reported by Marketplaces on Form 1095-A. However, health
essential coverage. Eligibility for certain types of minimum insurance issuers are required to file Form 1095-B to report on
essential coverage can affect a taxpayer's eligibility for the coverage for employees obtained through the Small Business
premium tax credit. Health Options Program (SHOP). For coverage in 2023 (filing in
2024), health insurance issuers and carriers are encouraged
Minimum essential coverage includes government-sponsored (but not required) to report coverage in catastrophic health plans
programs, eligible employer-sponsored plans, individual market enrolled in through the Marketplace.
plans, and other coverage the Department of Health and Human
Services designates as minimum essential coverage. Minimum Eligible Employer-Sponsored Plans
essential coverage is described in more detail under Who Must Eligible employer-sponsored plans are minimum essential
File, later. coverage and include the following.
1. Group health insurance coverage for employees under the
following.

Sep 27, 2023 Cat. No. 63017B

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

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HRA provided by the same employer for a month, the employer            30-day extension. See Form 8809 and its instructions for more 
is the provider of both types of coverage and is therefore             information about extensions of time to file.
required to report the coverage of the individual under only one 
                                                                       How to apply. File Form 8809 as soon as you know that a 
of the arrangements for that month.
                                                                       30-day extension of time to file is needed. Follow the instructions 
Generally, reporting is also not required for an individual’s          on Form 8809, which provide information on where to fax or mail 
minimum essential coverage for a month if that minimum                 your Form 8809. You can also submit the extension request 
essential coverage is offered only to individuals who are also         online through the FIRE System. You are encouraged to submit 
covered by other minimum essential coverage for which                  requests using the online fill-in form. See Pub. 1220 for more 
reporting is required. For example, an insurance company               information on filing online or electronically. See the instructions 
offering a Medicare or TRICARE supplement for which only               for Form 8809 for more information.
individuals enrolled in Medicare or TRICARE are eligible is not 
required to report coverage under the Medicare or TRICARE              Where To File
supplement.                                                            Send all information returns filed on paper to the following.
Under this rule, a state Medicaid agency is not required to 
report Medicaid coverage for which only individuals enrolled in        If your principal business, 
other minimum essential coverage, such as employer-sponsored           office or agency, or legal 
                                                                                                       Use the following address:
coverage or a qualified health plan, are eligible.                     residence in the case of an 
                                                                       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 
For more information on the reporting of supplemental                  Minnesota, Missouri, Montana, 
                                                                                                                    Center
coverage, including the rule on when different entities are treated    Nebraska, Nevada, North 
                                                                                                          P.O. Box 219256
as a single employer for purposes of the second rule, see              Dakota, Oklahoma, Oregon, 
                                                                                                       Kansas City, MO 64121-9256
Proposed Regulations section 1.6055-1(d)(2) and (3).                   South Carolina, South Dakota, 
                                                                       Tennessee, Utah, Washington, 
When To File                                                           Wisconsin, Wyoming
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 2024 reporting coverage provided in                 Shipping and mailing.     If you're filing on paper, send the forms 
calendar year 2023, 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, 2024, or April 1, 2024, 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 
certain hardship conditions, you may apply for an additional 
Instructions for Forms 1094-B and 1095-B (2023)                     -3-

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Electronic Filing be filed as soon as possible after an error is discovered. File
corrected returns as follows.
If you're required to file 10 or more • Form 1095-B: Fully complete Form 1095-B and enter an “X”
information returns, you must file in the CORRECTED checkbox. File a Form 1094-B
electronically. The 10-or-more requirement Transmittal with the corrected Forms 1095-B. (Do not file a
applies in the aggregate to certain information returns that are corrected Form 1094-B.)
original or corrected returns. Accordingly, a filer may be required • Recipient's statement: A copy of the corrected Form 1095-B
to file fewer than 10 Forms 1094-B and 1095-B, but still have an must be furnished to the individual who received the original
electronic filing obligation based on other kinds of information Form 1095-B.
returns filed. The electronic filing requirement does not apply if
you request and receive a hardship waiver. The IRS encourages Note. Enter an “X” in the CORRECTED checkbox only when
you to file electronically even if you’re filing fewer than 10 returns. correcting a Form 1095-B previously filed with the IRS. If you are
correcting a Form 1095-B that was previously furnished to a
Waiver. To receive a waiver from the required filing of recipient, but not filed with the IRS, write, print, or type
information returns electronically, submit Form 8508. You are “CORRECTED” on the new Form 1095-B furnished to the
encouraged to file Form 8508 at least 45 days before the due recipient.
date of the return but no later than the due date of the return. The
IRS doesn’t process waiver requests until January 1 of the See the next chart for examples of errors and
calendar year the returns are due. You can't apply for a waiver for TIP step-by-step instructions for filing corrected returns.
more than 1 tax year at a time. If you need a waiver for more than
1 tax year, you must reapply at the appropriate time each year.
An approved waiver for original returns will cover corrections only Original Form 1095-B Filed With the IRS and Furnished to the
for the same type of return. If you receive an approved waiver, Recipient
don't send a copy of it to the Service Center where you file your IF any of the following are THEN ...
paper returns. Keep the waiver for your records only. incorrect ...
If you are required to file electronically but fail to do so, and Name of responsible individual 1. Fully complete a new Form
you don't have an approved waiver, you may be subject to a (Part I) 1095-B and enter an “X” in the
penalty of up to $310 per return unless you establish reasonable CORRECTED checkbox.
cause. However, you can file up to 10 returns on paper; those 2. File a Form 1094-B Transmittal
returns will not be subject to a penalty for failure to file with the corrected Form 1095-B.
electronically. The penalty applies separately to original returns Origin of the Health Coverage 3. Furnish a copy of the corrected
and corrected returns. (Part I) Form 1095-B to the person
Pub. 5165, Guide for Electronically Filing Affordable Care Act identified as the responsible
(ACA) Information Returns for Software Developers and individual.
Transmitters, specifies the communication procedures,
transmission formats, business rules, and validation procedures, Social security number (SSN) or
and explains when a return will be accepted, accepted with taxpayer identification number
errors, or rejected for returns filed electronically for calendar year (TIN) (Part I)
2023 through the ACA Information Return (AIR) system. To
develop software for use with the AIR system, software Information About Certain
developers, transmitters, and issuers, including employers filing Employer-Sponsored Coverage
their own Forms 1094-B and 1095-B, should use the guidelines (Part II)
provided in Pub. 5165, along with the Extensible Markup Issuer or Other Coverage
Language (XML) Schemas published on IRS.gov. Provider (Part III)
Reminder. The formatting directions in these instructions are for
the preparation of paper returns. When filing forms electronically, Covered Individuals (Part IV)
the formatting set forth in the XML Schemas and Business Rules
published on IRS.gov must be followed rather than the formatting
directions in these instructions. For more information regarding You must file a corrected return to report retroactive
electronic filing, see Pubs. 5164 and 5165. ! changes in coverage.
CAUTION
Substitute Returns Filed With the IRS
See Pub. 5223, General Rules and Specifications for Affordable Example 1. Tim enrolls in health insurance with Ace
Care Act Substitute Forms 1095-A, 1094-B, 1095-B, 1094-C, Insurance Company in January 2023. Tim fails to pay the
and 1095-C, for specifications for private printing of substitute premiums for November and December 2023 and January 2024.
information returns. You may not request special consideration. Ace sends Tim a Form 1095-B on January 31, 2024, reporting
Only forms that conform to the official form and the specifications coverage for every month in 2023. On February 1, 2024, Ace
in Pub. 5223 are acceptable for filing with the IRS. Substitute cancels Tim’s coverage effective November 1, 2023. Ace must
returns filed with the IRS must be printed in landscape format. send Tim a corrected Form 1095-B reporting that Tim was
covered only for January through October 2023. If Ace filed the
Void Box Form 1095-B with the IRS, it must file a corrected Form 1095-B
with the IRS reporting coverage only for January through
Don't use this box on Form 1095-B. October 2023.
Corrected Form 1095-B Example 2. Sharon is enrolled in Medicaid for January
For information about filing corrections for electronically filed through September 2023. The Medicaid agency files a Form
forms, see section 7.1 of Pub. 5165. A corrected return should 1095-B and furnishes a statement to Sharon reporting coverage
for January through September 2023. In April 2024, Sharon is
approved for Medicaid coverage beginning on November 1,
2023. The Medicaid agency must file a corrected Form 1095-B

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with the IRS and furnish Sharon a corrected statement reporting secondary page that includes a statement—in capital
coverage for January through September and November through letters, “IMPORTANT HEALTH COVERAGE TAX
December 2023. DOCUMENTS”; (2) explains how responsible individuals
may request a copy of Form 1095-B, Health Coverage (or,
Statements Furnished to Individuals for an applicable large employer member that sponsors a
Filers of Form 1095-B must furnish a copy by March 1, 2024, to self-insured group health plan and makes a return in
the person identified as the "responsible individual" on the form accordance with Regulations section 1.6055-1(f)(2)(i),
for coverage in 2023. However, a provider of minimum essential explains how non-full-time employees and nonemployees
coverage will be treated as timely furnishing Form 1095-B to who are enrolled in the plan may request a copy of Form
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 1,
relationship to the covered individuals, the primary name on the 2024, and retain the notice in the same location on its
coverage, or some other circumstances, should receive the website through October 15, 2024.
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, 2024, to March 1, 2024. 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 2023 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 $310 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 $3,783,000.
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 $310 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 $3,783,000.
terms and with letters of a font size large enough, including • Special rules apply that increase the per-return and
any visual clues or graphical figures, to call to a viewer’s per-statement and total penalties with no maximum
attention that the information pertains to tax statements limitations if there is intentional disregard of the requirement
reporting that individuals had health coverage. For example, to file the returns and furnish recipient statements.
a provider’s website provides a clear and conspicuous
notice if it (1) includes a statement on the main page—or a
link on the main page, reading “Tax Information,” to a
Instructions for Forms 1094-B and 1095-B (2023) -5-

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Waiver of Penalties Part II—Information About Certain
Employer-Sponsored Coverage
The penalties may be waived if the failure was due to reasonable
cause and not willful neglect. See section 6724, Regulations This part is completed only by issuers or carriers of insured
section 301.6724-1, and Regulations section 1.6055-1(h). For group health plans, including coverage purchased through the
additional information, see Pub. 1586. SHOP.
Insurance companies entering code A or B on line 8 will
TIP complete Part II. Employers reporting self-insured group
Specific Instructions for Form 1094-B 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
complete Part II. If you entered code B for self-insured coverage,
Line 2. Enter the filer’s nine-digit employer identification number skip Part II and go to Part III.
(EIN). If you don't have an EIN, you may apply for one online at
IRS.gov/EIN. You may also apply by faxing or mailing Form SS-4, Lines 10–15. Enter the name, EIN, and complete mailing
Application for Employer Identification Number, to the IRS. See address for the employer sponsoring the coverage. If mail isn't
the Instructions for Form SS-4 and Pub. 1635 for more delivered to the street address and the employer has a P.O. box,
information. 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
coverage is provided through an association or a Multiple
Lines 5–8. Enter the filer’s complete address where all Employer Welfare Arrangement, enter information for the
correspondence will be sent. If mail is delivered to a P.O. box and participating employer of the covered employee. Don't complete
not a street address, enter the box number instead of the street Part II if the coverage is provided through a multiemployer plan.
address.
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
on this form is Internal Revenue Code section 6055 and its
Line 9. For 2023, leave this line blank. regulations. Providing false or fraudulent information may subject
you to penalties. We may disclose this information to the
Department of Justice for civil or criminal investigation, and to
cities, states, and the District of Columbia for use in
administering their tax laws. We may also disclose this

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The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

information to other countries under a tax treaty, to federal and Form 1094-B . . . . . . . . . . . . . . . 10 min.
state agencies to enforce federal nontax criminal laws, or to
federal law enforcement and intelligence agencies to combat Form 1095-B . . . . . . . . . . . . . . . 1 min.
terrorism.
You aren't required to provide the information requested on a
form that is subject to the Paperwork Reduction Act unless the If you have comments concerning the accuracy of these time
form displays a valid OMB control number. Books or records estimates or suggestions for making this form simpler, we would
relating to a form or its instructions must be retained as long as be happy to hear from you. You can send us comments from
their contents may become material in the administration of any IRS.gov/FormComments. Or you can write to the Internal
Internal Revenue law. Generally, tax returns and return Revenue Service, Tax Forms and Publications Division, 1111
information are confidential, as required by section 6103. Constitution Ave. NW, IR-6526, Washington, DC 20224. Don't
The time needed to complete the following forms will vary send the form to this office.
depending on individual circumstances. The estimated average
time is:

Instructions for Forms 1094-B and 1095-B (2023) -7-

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