Federal Health Coverage
Extracted from PDF file 2021-federal-form-1095-b.pdf, last modified October 2021
Health Coverage560118 Form 1095-B Department of the Treasury Internal Revenue Service Part I 1 Do not attach to your tax return. Keep for your records. Go to www.irs.gov/Form1095B for instructions and the latest information. Part II 5 City or town . . . 2 Social security number (SSN) or other TIN 3 Date of birth (if SSN or other TIN is not available) 6 State or province 7 Country and ZIP or foreign postal code 9 Reserved 11 Employer identification number (EIN) ▶ Information About Certain Employer-Sponsored Coverage (see instructions) Employer name 12 Street address (including room or suite no.) Part III 13 City or town 14 State or province 15 Country and ZIP or foreign postal code 17 Employer identification number (EIN) 18 Contact telephone number 21 State or province 22 Country and ZIP or foreign postal code Issuer or Other Coverage Provider (see instructions) Name 19 Street address (including room or suite no.) Part IV 2021 Responsible Individual Name of responsible individual–First name, middle name, last name 8 Enter letter identifying Origin of the Health Coverage (see instructions for codes): 16 OMB No. 1545-2252 CORRECTED ▶ ▶ 4 Street address (including apartment no.) 10 VOID Health Coverage 20 City or town Covered Individuals (Enter the information for each covered individual.) (a) Name of covered individual(s) First name, middle initial, last name (b) SSN or other TIN (c) DOB (if SSN or other (d) Covered TIN is not available) all 12 months (e) Months of coverage Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 23 24 25 26 27 28 For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 60704B Form 1095-B (2021) 560220 Page 2 Form 1095-B (2021) Instructions for Recipient This Form 1095-B provides information about the individuals in your tax family (yourself, spouse, and dependents) who had certain health coverage (referred to as “minimum essential coverage”) for some or all months during the year. 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. Before 2019, individuals who did not have minimum essential coverage and did not qualify for an exemption from this requirement could be liable for the individual shared responsibility payment. Beginning in 2019, individuals will not be responsible for the individual shared responsibility payment because the payment amount is reduced to $0. However, if individuals in your tax family are eligible for certain types of minimum essential coverage, you may not be eligible for the premium tax credit. For more information on the premium tax credit, see Pub. 974, Premium Tax Credit (PTC). Providers of minimum essential coverage are required to furnish only one Form 1095-B for all individuals whose coverage is reported on that form. As the recipient of this Form 1095-B, you should provide a copy to other individuals covered under the policy if they request it for their records. TIP Additional information. For additional information about the tax provisions of the Affordable Care Act (ACA), including the individual shared responsibility provisions, and the premium tax credit, see www.irs.gov/ACA or call the IRS Healthcare Hotline for ACA questions (800-919-0452). Part I. Responsible Individual, lines 1–9. Part I reports information about you and the coverage. Lines 2 and 3. Line 2 reports your social security number (SSN) or other taxpayer identification number (TIN), if applicable. For your protection, this form may show only the last four digits. However, the coverage provider is required to report your complete SSN or other TIN, if applicable, to the IRS. Your date of birth will be entered on line 3 only if line 2 is blank. Line 8. This is the code for the type of coverage in which you or other covered individuals were enrolled. Only one letter will be entered on this line. A. Small Business Health Options Program (SHOP) B. Employer-sponsored coverage C. Government-sponsored program D. Individual market insurance E . Multiemployer plan F . Other designated minimum essential coverage G . Individual coverage health reimbursement arrangement (HRA) If you or another family member received health insurance coverage through a Health Insurance Marketplace (also known as an Exchange), that coverage will generally be reported on a Form 1095-A rather than a Form 1095-B. If you or another family member received employer-sponsored coverage, that coverage may be reported on a Form 1095-C (Part III) rather than a Form 1095-B. For more information, see www.irs.gov/Affordable-Care-Act/Questions-and-Answers-About-HealthCare-Information-Forms-for-Individuals. TIP Line 9. Reserved. Part II. Information About Certain Employer-Sponsored Coverage, lines 10–15. If you had employer-sponsored health coverage, this part may provide information about the employer sponsoring the coverage. This part may show only the last four digits of the employer’s EIN. This part may also be left blank, even if you had employer-sponsored health coverage. If this part is blank, you do not need to fill in the information or return it to your employer or other coverage provider. Part III. Issuer or Other Coverage Provider, lines 16–22. This part reports information about the coverage provider (insurance company, employer providing self-insured coverage, government agency sponsoring coverage under a government program such as Medicaid or Medicare, or other coverage sponsor). Line 18 reports a telephone number for the coverage provider that you can call if you have questions about the information reported on the form. Part IV. Covered Individuals, lines 23–28. This part reports the name, SSN or other TIN, and coverage information for each covered individual. A date of birth will be entered in column (c) only if the SSN or other TIN is not entered in column (b). Column (d) will be checked if the individual was covered for at least 1 day in every month of the year. For individuals who were covered for some but not all months, information will be entered in column (e) indicating the months for which these individuals were covered. If there are more than six covered individuals, see Part IV, Continuation Sheet(s), for information about the additional covered individuals. 560318 Page 3 Form 1095-B (2021) Social security number (SSN) or other TIN Name of responsible individual–First name, middle name, last name Part IV Date of birth (if SSN or other TIN is not available) Covered Individuals — Continuation Sheet (a) Name of covered individual(s) First name, middle initial, last name (b) SSN or other TIN (c) DOB (if SSN or other (d) Covered TIN is not available) all 12 months (e) Months of coverage Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 29 30 31 32 33 34 35 36 37 38 39 40 Form 1095-B (2021)
2021 Form 1095-B
More about the Federal Form 1095-B Corporate Income Tax TY 2021
We last updated the Health Coverage in January 2022, so this is the latest version of Form 1095-B, fully updated for tax year 2021. You can download or print current or past-year PDFs of Form 1095-B directly from TaxFormFinder. You can print other Federal tax forms here.
Other Federal Corporate Income Tax Forms:
|Form Code||Form Name|
|1040 (Schedule B)||Interest and Ordinary Dividends|
|941 (Schedule B)||Report of Tax Liability for Semiweekly Schedule Depositors|
|1041 (Schedule D)||Capital Gains and Losses|
|Form 4684||Casualties and Thefts|
|Form 1040||U.S. Individual Income Tax Return|
The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 1095-B from the Internal Revenue Service in January 2022.
About the Corporate Income Tax
The IRS and most states require corporations to file an income tax return, with the exact filing requirements depending on the type of company.
Sole proprietorships or disregarded entities like LLCs are filed on Schedule C (or the state equivalent) of the owner's personal income tax return, flow-through entities like S Corporations or Partnerships are generally required to file an informational return equivilent to the IRS Form 1120S or Form 1065, and full corporations must file the equivalent of federal Form 1120 (and, unlike flow-through corporations, are often subject to a corporate tax liability).
Additional forms are available for a wide variety of specific entities and transactions including fiduciaries, nonprofits, and companies involved in other specific types of business.
Historical Past-Year Versions of Federal Form 1095-B
We have a total of seven past-year versions of Form 1095-B in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
2021 Form 1095-B
2020 Form 1095-B
2019 Form 1095-B
2018 Form 1095-B
2017 Form 1095-B
2016 Form 1095-B
2015 Form 1095-B
While we do our best to keep our list of Federal Income Tax Forms up to date and complete, we cannot be held liable for errors or omissions. Is the form on this page out-of-date or not working? Please let us know and we will fix it ASAP.