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دستورالعمل های فرم های 1094-B و 1095-B

دستورالعمل های فرم های 1094-B و 1095-B

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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  
otherwise noted.  
Minimum essential coverage doesn't include coverage  
consisting solely of excepted benefits. Excepted benefits  
include vision and dental coverage not part of a  
TIP  
Future Developments  
comprehensive health insurance plan, workers’ compensation  
coverage, and coverage limited to a specified disease or illness.  
For the latest information about developments relating to Forms  
1094-B, Transmittal of Health Coverage Information Returns, and  
1095-B, Health Coverage, and their instructions, such as  
legislation enacted after they were published, go to IRS.gov/  
Who Must File  
Every person that provides minimum essential coverage to an  
individual during a calendar year must file an information return  
reporting the coverage. Filers will use Form 1094-B (transmittal)  
to submit Forms 1095-B (returns).  
What’s New  
The electronic filing threshold for information returns required to  
be filed on or after January 1, 2024, has been decreased to 10 or  
more returns. See Electronic Filing, later.  
Employers (including government employers) subject to the  
employer shared responsibility provisions sponsoring  
self-insured group health plans, including individual coverage  
health reimbursement arrangements (HRAs), will generally  
report information about the coverage in Part III of Form 1095-C  
instead of on Form 1095-B. However, employers that offer  
employer-sponsored self-insured health coverage to  
Additional Information  
For information relating to the Affordable Care Act, visit IRS.gov/  
ACA.  
For the final regulations relating to Form 1095-B reporting,  
see T.D. 9660, 2014-13 I.R.B., at IRS.gov/IRB/2014-13_IRB/  
AR08.html and T.D. 9970, 2023-02 I.R.B. 311, at IRS.gov/irb/  
nonemployees who enroll in the coverage may use Form  
1095-B, rather than Form 1095-C, Part III, to report coverage for  
those individuals and other family members. In general,  
employers with 50 or more full-time employees (including  
full-time equivalent employees) during the prior calendar year  
are subject to the employer shared responsibility provisions. See  
the Instructions for Forms 1094-C and 1095-C for more  
information about who must file Forms 1094-C and 1095-C and  
for more information about reporting coverage for  
For additional guidance and proposed regulatory changes  
relating to Form 1095-B reporting, including the requirement to  
solicit the taxpayer identification number (TIN) of each covered  
individual for purposes of the reporting of health coverage  
information, see Proposed Regulations section 1.6055-1(h) and  
Regulations section 301.6724-1.  
nonemployees. Small employers that aren't subject to the  
employer shared responsibility provisions sponsoring  
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  
file Form 1095-B for most health insurance coverage, including  
individual market coverage and insured coverage sponsored by  
employers. However, health insurance issuers and carriers don't  
report coverage under the Children’s Health Insurance 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  
government sponsors of those programs.  
In addition, health insurance issuers and carriers aren't  
required to file Form 1095-B to report coverage in individual  
market qualified health plans that individuals enroll in through  
Health Insurance Marketplaces. This coverage is generally  
reported by Marketplaces on Form 1095-A. However, health  
insurance issuers are required to file Form 1095-B to report on  
coverage for employees obtained through the Small Business  
Health Options Program (SHOP). For coverage in 2023 (filing in  
2024), health insurance issuers and carriers are encouraged  
(but not required) to report coverage in catastrophic health plans  
enrolled in through the Marketplace.  
For information relating to filing Forms 1094-B and 1095-B  
General Instructions for Forms  
1094-B and 1095-B  
Purpose of Form  
Form 1095-B is used to report certain information to the IRS and  
to taxpayers about individuals who are covered by minimum  
essential coverage. Eligibility for certain types of minimum  
essential coverage can affect a taxpayer's eligibility for the  
premium tax credit.  
Minimum essential coverage includes government-sponsored  
programs, eligible employer-sponsored plans, individual market  
plans, and other coverage the Department of Health and Human  
Services designates as minimum essential coverage. Minimum  
essential coverage is described in more detail under Who Must  
File, later.  
Eligible Employer-Sponsored Plans  
Eligible employer-sponsored plans are minimum essential  
coverage and include the following.  
1. Group health insurance coverage for employees under the  
following.  
Sep 27, 2023  
Cat. No. 63017B  
 
a. A governmental plan, such as the Federal Employees  
Health Benefits program.  
5. Coverage administered by the Department of Veterans  
Affairs that is:  
b. An insured plan or coverage offered in the small or large  
group market within a state.  
a. Coverage consisting of the medical benefits package for  
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,  
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  
and veterans of covered service in Korea.  
6. Coverage for Peace Corps volunteers.  
As noted earlier, minimum essential coverage doesn't include  
coverage consisting solely of excepted benefits. Excepted  
benefits include vision and dental coverage not part of a  
comprehensive health insurance plan, workers’ compensation  
coverage, and coverage limited to a specified disease or illness.  
Health insurance issuers or carriers will file Form 1095-B for  
all insured employer coverage. Plan sponsors are responsible for  
reporting self-insured employer coverage. Plan sponsors that are  
employers subject to the employer shared responsibility  
provisions must generally report the coverage on Form 1095-C  
and other plan sponsors (such as employers not subject to the  
employer shared responsibility provisions and sponsors of  
multiemployer plans) report the coverage on Form 1095-B.  
7. The Nonappropriated Fund Health Benefits Program of the  
Department of Defense.  
In general, the government agency sponsoring the program  
will file Form 1095-B. The state agency that administers a  
Medicaid or CHIP program will file Form 1095-B for coverage  
under those programs. However, Medicaid and CHIP agencies  
in U.S. possessions or territories (American Samoa, the  
Commonwealth of the Northern Mariana Islands, Guam, Puerto  
Rico, and the U.S. Virgin Islands) aren’t required to report  
Medicaid or CHIP coverage on Form 1095-B.  
When coverage under the Nonappropriated Fund Health  
Benefits Program of the Department of Defense or TRICARE is  
reported on Form 1095-B, Part I, line 8, filers should use code C  
(government-sponsored program).  
Plan sponsors of self-insured employer coverage include:  
Each participating employer (for its own covered individuals)  
in a plan or arrangement established or maintained by more  
than one employer;  
Coverage designated as minimum essential coverage. The  
Department of Health and Human Services has designated the  
following health benefit plans or arrangements as minimum  
essential coverage.  
The association, committee, joint board of trustees, or  
similar group of representatives who establish or maintain a  
multiemployer plan;  
The employee organization for a plan or arrangement  
maintained solely by an employee organization; and  
Each participating employer (for its own employees) for a  
plan or arrangement maintained by a Multiple Employer  
Welfare Arrangement.  
1. Medicare Part C (Medicare Advantage).  
2. Refugee Medical Assistance.  
3. Coverage provided to a business owner under a plan that is  
eligible employer-sponsored coverage with respect to at  
least one employee.  
A government employer may designate another government  
entity to report coverage of its employees. Generally, a  
designated government entity will file Form 1095-B on behalf of a  
government employer that sponsors or maintains a self-insured  
group health plan for its employees only if that government  
employer isn't subject to the employer shared responsibility  
provisions, which would require reporting on Form 1095-C. The  
Instructions for Forms 1094-C and 1095-C contain further  
information on reporting options for government entities.  
4. Coverage under a group health plan provided through  
insurance regulated by a foreign government if:  
a. A covered individual is physically absent from the  
United States for at least 1 day during the month, or  
b. A covered individual is physically present in the United  
States for a full month and the coverage provides health  
benefits within the United States while the individual is  
outside the United States.  
Government-Sponsored Programs  
The following government-sponsored programs are minimum  
5. The Basic Health Program.  
essential coverage.  
6. Coverage of pregnancy-related services that consists of full  
Medicaid benefits.  
1. Medicare Part A.  
2. Medicaid, except for the following programs.  
a. Optional coverage of family planning services.  
b. Optional coverage of tuberculosis-related services.  
c. Coverage of pregnancy-related services.  
d. Coverage of medical emergency services.  
e. Coverage of medically needy individuals.  
f. Coverage of COVID-19 testing and diagnostic services.  
3. The Children’s Health Insurance Program (CHIP).  
4. The TRICARE program, except for the following options.  
7. Coverage under a section 1115 demonstration waiver  
program.  
8. Specific programs listed at CMS.gov/CCIIO/Programs-and-  
Essential-Coverage.html (click on the link for “Approved  
Plans”).  
Providers of these and later designated programs will file  
Form 1095-B. The sponsor for the Basic Health Program is the  
state government agency administering the program.  
Coverage in More Than One Minimum Essential  
Coverage Plan or Program  
a. Coverage on a space-available basis in a military  
treatment facility for individuals who aren't eligible for  
TRICARE coverage for private sector care.  
If, for any month, an individual is covered by more than one  
minimum essential coverage plan or program that is provided by  
the same provider, the provider is required to report only one of  
the plans or programs for that month. For example, if an  
b. Coverage for a line-of-duty-related injury, illness, or  
disease for individuals who have left active duty.  
individual is covered by a self-insured major medical plan and an  
-2-  
Instructions for Forms 1094-B and 1095-B (2023)  
HRA provided by the same employer for a month, the employer  
is the provider of both types of coverage and is therefore  
required to report the coverage of the individual under only one  
of the arrangements for that month.  
30-day extension. See Form 8809 and its instructions for more  
information about extensions of time to file.  
How to apply. File Form 8809 as soon as you know that a  
30-day extension of time to file is needed. Follow the instructions  
on Form 8809, which provide information on where to fax or mail  
your Form 8809. You can also submit the extension request  
online through the FIRE System. You are encouraged to submit  
requests using the online fill-in form. See Pub. 1220 for more  
information on filing online or electronically. See the instructions  
for Form 8809 for more information.  
Generally, reporting is also not required for an individual’s  
minimum essential coverage for a month if that minimum  
essential coverage is offered only to individuals who are also  
covered by other minimum essential coverage for which  
reporting is required. For example, an insurance company  
offering a Medicare or TRICARE supplement for which only  
individuals enrolled in Medicare or TRICARE are eligible is not  
required to report coverage under the Medicare or TRICARE  
supplement.  
Where To File  
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  
other minimum essential coverage, such as employer-sponsored  
coverage or a qualified health plan, are eligible.  
If your principal business,  
office or agency, or legal  
Use the following address:  
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  
which section 6055 reporting is required) are offered by the  
same employer. For example, if an employer offers both an  
insured group health plan and an HRA that an employee is  
eligible for if the employee enrolls in the insured group health  
plan, and an employee enrolls in both, the employer is not  
required to report the employee’s coverage under the HRA for  
the months in which the employee is enrolled in both plans. If,  
however, an individual is covered by an HRA sponsored by one  
employer, including an individual coverage HRA, and a non-HRA  
group health plan sponsored by another employer (such as  
spousal coverage) or an individual is covered by an individual  
coverage HRA, each employer (or the health insurance issuer or  
carrier, if the plan is insured) must report the coverage the  
employer (or issuer or carrier) provides.  
Alabama, Arizona, Arkansas,  
Connecticut, Delaware, Florida,  
Georgia, Kentucky, Louisiana,  
Maine, Massachusetts,  
Mississippi, New Hampshire,  
New Jersey, New Mexico, New  
York, North Carolina, Ohio,  
Pennsylvania, Rhode Island,  
Texas, Vermont, Virginia,  
West Virginia  
Department of the Treasury  
Internal Revenue Service  
Center  
Austin, TX 73301  
Alaska, California, Colorado,  
District of Columbia, Hawaii,  
Idaho, Illinois, Indiana, Iowa,  
Kansas, Maryland, Michigan,  
Minnesota, Missouri, Montana,  
Nebraska, Nevada, North  
Dakota, Oklahoma, Oregon,  
South Carolina, South Dakota,  
Tennessee, Utah, Washington,  
Wisconsin, Wyoming  
Department of the Treasury  
Internal Revenue Service  
Center  
For more information on the reporting of supplemental  
coverage, including the rule on when different entities are treated  
as a single employer for purposes of the second rule, see  
Proposed Regulations section 1.6055-1(d)(2) and (3).  
P.O. Box 219256  
Kansas City, MO 64121-9256  
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  
coverage.  
If your legal residence or principal place of business or  
principal office or agency is outside the United States, file with  
the Department of the Treasury, Internal Revenue Service  
Center, Austin, TX 73301.  
You will meet the requirement to file if the form is properly  
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  
next business day. A business day is any day that isn't a  
Saturday, Sunday, or legal holiday.  
How To File  
Filing Paper Returns With the IRS  
For forms filed in 2024 reporting coverage provided in  
calendar year 2023, Forms 1094-B and 1095-B are required to  
be filed by February 28, 2024, or April 1, 2024, if filing  
electronically.  
Shipping and mailing. If you're filing on paper, send the forms  
to the IRS in a flat mailing (not folded) and don’t staple or  
paperclip the forms together. If you're sending many forms, you  
may send them in conveniently sized packages. On each  
package, write your name, and number the packages  
consecutively. Place Form 1094-B in package number one and a  
copy of Form 1094-B in each additional package. Postal  
regulations require forms and packages to be sent by first-class  
mail. Returns filed with the IRS must be printed in landscape  
format.  
See Statements Furnished to Individuals, later, for information  
on when Form 1095-B must be furnished.  
Extension of Time To File  
You can get an automatic 30-day extension of time to file by  
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  
submitted on paper or through the FIRE System either as a fill-in  
form or an electronic file. No signature or explanation is required  
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  
Keeping copies. Generally, keep copies of information returns  
you filed with the IRS or maintain the ability to reconstruct the  
data for at least 3 years, from the due date of the returns.  
-3-  
Instructions for Forms 1094-B and 1095-B (2023)  
be filed as soon as possible after an error is discovered. File  
corrected returns as follows.  
Electronic Filing  
If you're required to file 10 or more  
Form 1095-B: Fully complete Form 1095-B and enter an “X”  
in the CORRECTED checkbox. File a Form 1094-B  
Transmittal with the corrected Forms 1095-B. (Do not file a  
corrected Form 1094-B.)  
information returns, you must file  
electronically. The 10-or-more requirement  
applies in the aggregate to certain information returns that are  
original or corrected returns. Accordingly, a filer may be required  
to file fewer than 10 Forms 1094-B and 1095-B, but still have an  
electronic filing obligation based on other kinds of information  
returns filed. The electronic filing requirement does not apply if  
you request and receive a hardship waiver. The IRS encourages  
you to file electronically even if you’re filing fewer than 10 returns.  
Recipient's statement: A copy of the corrected Form 1095-B  
must be furnished to the individual who received the original  
Form 1095-B.  
Note. Enter an “X” in the CORRECTED checkbox only when  
correcting a Form 1095-B previously filed with the IRS. If you are  
correcting a Form 1095-B that was previously furnished to a  
recipient, but not filed with the IRS, write, print, or type  
“CORRECTED” on the new Form 1095-B furnished to the  
recipient.  
Waiver. To receive a waiver from the required filing of  
information returns electronically, submit Form 8508. You are  
encouraged to file Form 8508 at least 45 days before the due  
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  
calendar year the returns are due. You can't apply for a waiver for  
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  
for the same type of return. If you receive an approved waiver,  
don't send a copy of it to the Service Center where you file your  
paper returns. Keep the waiver for your records only.  
See the next chart for examples of errors and  
step-by-step instructions for filing corrected returns.  
TIP  
Original Form 1095-B Filed With the IRS and Furnished to the  
Recipient  
IF any of the following are  
incorrect ...  
THEN ...  
If you are required to file electronically but fail to do so, and  
you don't have an approved waiver, you may be subject to a  
penalty of up to $310 per return unless you establish reasonable  
cause. However, you can file up to 10 returns on paper; those  
returns will not be subject to a penalty for failure to file  
electronically. The penalty applies separately to original returns  
and corrected returns.  
Pub. 5165, Guide for Electronically Filing Affordable Care Act  
(ACA) Information Returns for Software Developers and  
Transmitters, specifies the communication procedures,  
transmission formats, business rules, and validation procedures,  
and explains when a return will be accepted, accepted with  
errors, or rejected for returns filed electronically for calendar year  
2023 through the ACA Information Return (AIR) system. To  
develop software for use with the AIR system, software  
developers, transmitters, and issuers, including employers filing  
their own Forms 1094-B and 1095-B, should use the guidelines  
provided in Pub. 5165, along with the Extensible Markup  
Language (XML) Schemas published on IRS.gov.  
Name of responsible individual  
(Part I)  
1. Fully complete a new Form  
1095-B and enter an “X” in the  
CORRECTED checkbox.  
2. File a Form 1094-B Transmittal  
with the corrected Form 1095-B.  
3. Furnish a copy of the corrected  
Form 1095-B to the person  
identified as the responsible  
individual.  
Origin of the Health Coverage  
(Part I)  
Social security number (SSN) or  
taxpayer identification number  
(TIN) (Part I)  
Information About Certain  
Employer-Sponsored Coverage  
(Part II)  
Issuer or Other Coverage  
Provider (Part III)  
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  
published on IRS.gov must be followed rather than the formatting  
directions in these instructions. For more information regarding  
electronic filing, see Pubs. 5164 and 5165.  
Covered Individuals (Part IV)  
You must file a corrected return to report retroactive  
changes in coverage.  
!
CAUTION  
Substitute Returns Filed With the IRS  
Example 1. Tim enrolls in health insurance with Ace  
Insurance Company in January 2023. Tim fails to pay the  
premiums for November and December 2023 and January 2024.  
Ace sends Tim a Form 1095-B on January 31, 2024, reporting  
coverage for every month in 2023. On February 1, 2024, Ace  
cancels Tim’s coverage effective November 1, 2023. Ace must  
send Tim a corrected Form 1095-B reporting that Tim was  
covered only for January through October 2023. If Ace filed the  
Form 1095-B with the IRS, it must file a corrected Form 1095-B  
with the IRS reporting coverage only for January through  
October 2023.  
See Pub. 5223, General Rules and Specifications for Affordable  
Care Act Substitute Forms 1095-A, 1094-B, 1095-B, 1094-C,  
and 1095-C, for specifications for private printing of substitute  
information returns. You may not request special consideration.  
Only forms that conform to the official form and the specifications  
in Pub. 5223 are acceptable for filing with the IRS. Substitute  
returns filed with the IRS must be printed in landscape format.  
Void Box  
Don't use this box on Form 1095-B.  
Example 2. Sharon is enrolled in Medicaid for January  
through September 2023. The Medicaid agency files a Form  
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  
Corrected Form 1095-B  
For information about filing corrections for electronically filed  
forms, see section 7.1 of Pub. 5165. A corrected return should  
-4-  
Instructions for Forms 1094-B and 1095-B (2023)  
 
with the IRS and furnish Sharon a corrected statement reporting  
coverage for January through September and November through  
December 2023.  
secondary page that includes a statement—in capital  
letters, “IMPORTANT HEALTH COVERAGE TAX  
DOCUMENTS”; (2) explains how responsible individuals  
may request a copy of Form 1095-B, Health Coverage (or,  
for an applicable large employer member that sponsors a  
self-insured group health plan and makes a return in  
accordance with Regulations section 1.6055-1(f)(2)(i),  
explains how non-full-time employees and nonemployees  
who are enrolled in the plan may request a copy of Form  
1095-C, Employer-Provided Health Insurance Offer and  
Coverage); and (3) includes the provider’s email address,  
mailing address, and telephone number.  
Statements Furnished to Individuals  
Filers of Form 1095-B must furnish a copy by March 1, 2024, to  
the person identified as the "responsible individual" on the form  
for coverage in 2023. However, a provider of minimum essential  
coverage will be treated as timely furnishing Form 1095-B to  
individuals if the form is made available through the provider’s  
website and certain conditions are met. See Alternative manner  
The provider must post the notice on its website by March 1,  
2024, and retain the notice in the same location on its  
website through October 15, 2024.  
The provider must furnish the statement to a requesting  
responsible individual within 30 days of the date the request  
is received. To satisfy this requirement, the provider may  
furnish the statement electronically if the recipient  
affirmatively consents.  
The “responsible individual” is the person who, based on a  
relationship to the covered individuals, the primary name on the  
coverage, or some other circumstances, should receive the  
statement. Generally, the statement recipient should be the  
primary taxpayer, if that person is known. A statement recipient  
may be a parent if only minor children are covered individuals, a  
primary subscriber for insured coverage, an employee or former  
employee in the case of employer-sponsored coverage, a  
uniformed services sponsor for TRICARE, or another individual  
who should receive the statement. Filers may, but aren't required  
to, furnish a statement to more than one recipient.  
Copies of Form 1095-B furnished to recipients may include a  
truncated SSN or other TIN, if applicable, of the statement  
recipient and covered individuals by showing only the last four  
digits of the SSN or other TIN and replacing the first five digits  
with asterisks (*) or Xs. Copies of Form 1095-B furnished to  
recipients may also truncate the employer identification number  
(EIN) of an employer reported in Part II, if any. The filer’s EIN may  
not be truncated on the statement furnished to recipients.  
Truncation of TINs, including EINs, is not allowed on returns filed  
with the IRS.  
Consent to furnish statement electronically. Except as  
provided below, a filer is required to obtain affirmative consent to  
furnish a statement electronically. The requirement to obtain  
affirmative consent to furnish a statement electronically ensures  
that statements are sent electronically only to individuals who  
are able to access them. The consent must relate specifically to  
receiving Form 1095-B electronically. A recipient may consent on  
paper or electronically, such as by email. If consent is on paper,  
the recipient must confirm the consent electronically. A  
statement may be furnished electronically by email or by  
informing the recipient how to access the statement on the filer’s  
website. Statements reporting coverage under an expatriate  
health plan, however, may be furnished electronically unless the  
recipient has explicitly refused to consent to receive the  
statement in an electronic format.  
In general, statements must be furnished on paper by mail (or  
hand delivered), unless the recipient affirmatively consents to  
receive the statement in an electronic format. If mailed, the  
statement must be sent to the recipient’s last known permanent  
address, or, if no permanent address is known, to the recipient’s  
temporary address.  
Extension of time to furnish statement to recipients. The  
due date for furnishing Form 1095-B is automatically extended  
from January 31, 2024, to March 1, 2024. Thus, no additional  
extensions will be granted.  
Alternative manner of furnishing statements. A provider of  
minimum essential coverage will be treated as timely furnishing  
Form 1095-B to individuals if the provider uses the alternative  
manner of furnishing statements described in Regulations  
section 1.6055-1(g). If the provider is an applicable large  
employer (as defined under Regulations section 54.4980H-1(a)  
(4)) that offers employer-sponsored self-insured health  
coverage, the employer may use the alternative manner of  
furnishing for statements to non-full-time employees and  
nonemployees who are enrolled in the self-insured health  
coverage. See Who Must File, earlier. To use the alternative  
manner of furnishing statements, the following conditions must  
be met.  
Substitute Statements to Recipients  
If you aren't using the official IRS form to furnish statements to  
recipients, see Pub. 5223, which explains the requirements for  
format and content of substitute statements to recipients. You  
may develop them yourself or buy them from a private printer.  
Information Reporting Penalties  
A provider of minimum essential coverage that fails to comply  
with the information reporting requirements may be subject to  
the general information reporting penalty provisions for failure to  
file correct information returns and failure to furnish correct  
payee statements. For returns required to be made and  
statements required to be furnished for 2023 tax year returns, the  
following apply.  
The provider must provide clear and conspicuous notice, in  
a location on its website that is reasonably accessible to all  
responsible individuals, stating that responsible individuals  
may receive a copy of their statement upon request. The  
notice must include an email address, a physical address to  
which a request for a statement may be sent, and a  
The penalty for failure to file a correct information return is  
$310 for each return for which the failure occurs, with the  
total penalty for a calendar year not to exceed $3,783,000.  
The penalty for failure to provide a correct payee statement  
is $310 for each statement for which the failure occurs, with  
the total penalty for a calendar year not to exceed  
$3,783,000.  
telephone number that responsible individuals may use to  
contact the provider with any questions. A notice posted on  
a provider’s website must be written in plain, non-technical  
terms and with letters of a font size large enough, including  
any visual clues or graphical figures, to call to a viewer’s  
attention that the information pertains to tax statements  
reporting that individuals had health coverage. For example,  
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  
Special rules apply that increase the per-return and  
per-statement and total penalties with no maximum  
limitations if there is intentional disregard of the requirement  
to file the returns and furnish recipient statements.  
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Instructions for Forms 1094-B and 1095-B (2023)  
   
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  
section 301.6724-1, and Regulations section 1.6055-1(h). For  
additional information, see Pub. 1586.  
This part is completed only by issuers or carriers of insured  
group health plans, including coverage purchased through the  
SHOP.  
Insurance companies entering code A or B on line 8 will  
complete Part II. Employers reporting self-insured group  
health plan coverage on Form 1095-B, except for an  
TIP  
Specific Instructions for Form 1094-B  
Line 1. Enter the filer’s complete name.  
Line 2. Enter the filer’s nine-digit employer identification number  
(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,  
Application for Employer Identification Number, to the IRS. See  
the Instructions for Form SS-4 and Pub. 1635 for more  
information.  
Lines 3 and 4. Enter the name and telephone number,  
including area code, of the person to contact who is responsible  
for answering any questions from the IRS regarding the filing of  
or information reported on Form 1094-B or 1095-B.  
individual coverage HRA, enter code B on line 8, but don't  
complete Part II. If you entered code B for self-insured coverage,  
skip Part II and go to Part III.  
Lines 10–15. Enter the name, EIN, and complete mailing  
address for the employer sponsoring the coverage. If mail isn't  
delivered to the street address and the employer has a P.O. box,  
enter the box number instead of the street address. See  
Statements Furnished to Individuals, earlier, for information on  
truncating the employer's EIN. If the employer is a member of a  
controlled group, enter information for the specific controlled  
group member that is the covered employee’s employer. If the  
coverage is provided through an association or a Multiple  
Employer Welfare Arrangement, enter information for the  
participating employer of the covered employee. Don't complete  
Part II if the coverage is provided through a multiemployer plan.  
Lines 5–8. Enter the filer’s complete address where all  
correspondence will be sent. If mail is delivered to a P.O. box and  
not a street address, enter the box number instead of the street  
address.  
Part III—Issuer or Other Coverage Provider  
Line 9. Enter the total number of Forms 1095-B that are  
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  
insured coverage, sponsor of a self-insured employer plan,  
government agency providing government-sponsored coverage,  
or other coverage sponsor. Enter on line 18 the telephone  
number that an individual seeking additional information may call  
to speak to a person.  
Specific Instructions for Form 1095-B  
Part I—Responsible Individual  
Line 1. Enter the name of the responsible individual (statement  
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  
responsible individual (111-11-1111). If the responsible  
individual doesn't have an SSN, enter the responsible  
individual’s other TIN. No SSN or other TIN is required if the  
responsible individual isn't a covered individual identified in Part  
IV. See Statements Furnished to Individuals, earlier, for  
information on truncating the SSN or other TIN.  
Column (a). Enter the name of each covered individual.  
Column (b). Enter the nine-digit SSN or other TIN for each  
covered individual (111-11-1111). The field may be left blank if  
the covered individual doesn’t have a TIN. See Statements  
Furnished to Individuals, earlier, for information on truncating the  
SSN or other TIN.  
Column (c). Enter a date of birth (YYYY/MM/DD) for the  
covered individual only if an SSN or other TIN isn't entered in  
column (b).  
Line 3. Enter the responsible individual’s date of birth  
(YYYY/MM/DD) only if line 2 is blank.  
Lines 4–7. Enter the complete mailing address of the  
responsible individual. If mail isn't delivered to the street address  
and the responsible individual has a P.O. box, enter the box  
number instead of the street address.  
Column (d). Check this box if the individual was covered for at  
least 1 day per month for all 12 months of the calendar year.  
Column (e). If the individual wasn't covered for all 12 months,  
check the applicable box(es) for the month(s) in which the  
individual was covered for at least 1 day.  
If there are more than six covered individuals, complete this  
information for the additional covered individuals on Part IV,  
Continuation Sheet(s). Do not count the Continuation Sheet(s)  
as additional Forms 1095-B in the count of forms submitted with  
the accompanying Form 1094-B.  
Line 8. Enter the letter identifying the Origin of the Health  
Coverage. See Who Must File, earlier, to determine which types  
of coverage fall under each category listed below.  
A. Small Business Health Options Program (SHOP).  
B. Employer-sponsored coverage, except for an individual  
coverage HRA.  
C. Government-sponsored program.  
D. Individual market insurance.  
Privacy Act and Paperwork Reduction Act Notice. We ask  
for the information on these forms to carry out the Internal  
Revenue laws of the United States and the Patient Protection  
and Affordable Care Act. Our legal right to ask for the information  
on this form is Internal Revenue Code section 6055 and its  
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  
E. Multiemployer plan.  
F. Other designated minimum essential coverage.  
G. Employer-sponsored coverage that is an individual coverage  
HRA.  
Line 9. For 2023, leave this line blank.  
administering their tax laws. We may also disclose this  
-6-  
Instructions for Forms 1094-B and 1095-B (2023)  
information to other countries under a tax treaty, to federal and  
state agencies to enforce federal nontax criminal laws, or to  
federal law enforcement and intelligence agencies to combat  
terrorism.  
Form 1094-B . . . . . . . . . . . . . . .  
Form 1095-B . . . . . . . . . . . . . . .  
10 min.  
1 min.  
You aren't required to provide the information requested on a  
form that is subject to the Paperwork Reduction Act unless the  
form displays a valid OMB control number. Books or records  
relating to a form or its instructions must be retained as long as  
their contents may become material in the administration of any  
Internal Revenue law. Generally, tax returns and return  
If you have comments concerning the accuracy of these time  
estimates or suggestions for making this form simpler, we would  
be happy to hear from you. You can send us comments from  
IRS.gov/FormComments. Or you can write to the Internal  
Revenue Service, Tax Forms and Publications Division, 1111  
Constitution Ave. NW, IR-6526, Washington, DC 20224. Don't  
send the form to this office.  
information are confidential, as required by section 6103.  
The time needed to complete the following forms will vary  
depending on individual circumstances. The estimated average  
time is:  
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Instructions for Forms 1094-B and 1095-B (2023)