Form 1095-B Generator by Jotform
Health insurers, government programs, and some employers use Form 1095-B to report who had minimum essential coverage and for which months. Fill out the form online for free with Jotform and download a completed PDF in minutes.
Safeguard covered individuals' data
Form 1095-B lists names, SSNs or dates of birth, and coverage months for everyone on a policy. Jotform protects that data with 256-bit SSL encryption and GDPR and CCPA friendly features, and you can use encrypted forms for another layer of security.
Prepare forms on any device
Enter coverage details from a computer at the office or a tablet on the go. Form 1095-B adapts to any screen size, phones included.
Check off coverage months and download
Mark all 12 months or only the specific months each person was covered, then download the completed Form 1095-B as a PDF ready to share.
Keeps the official IRS layout
Jotform turns your entries into the original Form 1095-B layout, so the statement you give the responsible individual looks just like the IRS version.
FAQ
What is Form 1095-B?
Form 1095-B, Health Coverage, shows which individuals had minimum essential coverage and for which months of the year. Minimum essential coverage includes government-sponsored programs, eligible employer-sponsored plans, individual market plans, and other designated coverage.
Who files Form 1095-B?
Providers of minimum essential coverage file it. That typically includes health insurance companies, government programs such as Medicaid and CHIP, and some employers with self-insured plans. Providers send the forms to the IRS along with transmittal Form 1094-B.
Coverage from the Health Insurance Marketplace is reported on Form 1095-A instead, and many large employers report coverage in Part III of Form 1095-C.
Do I need Form 1095-B to file my tax return?
No. Don't attach it to your tax return, just keep it with your records. There's no longer a federal penalty for going without coverage, so you generally don't need the form to file your federal return. A few states have their own coverage requirements, and it can be useful there.
What are the parts of Form 1095-B?
Part I identifies the responsible individual, usually the policyholder or primary insured, and includes a code for the origin of the coverage. Part II covers certain employer-sponsored coverage, Part III identifies the issuer or other coverage provider, and Part IV lists each covered individual with the months they were covered.
How do I fill out Form 1095-B?
In Part I, enter the responsible individual's name, SSN or other TIN (or date of birth if there's no TIN), and address, then enter the letter code for the origin of the coverage, from A through G. Complete Part II only when it applies to insured coverage sponsored by an employer.
In Part III, add the coverage provider's name, EIN, contact phone number, and address. In Part IV, list each covered person with their SSN or date of birth, then check All 12 months or the specific months they had coverage.
Is Jotform's Form 1095-B generator free?
Yes. You can fill out Form 1095-B online for free and download the completed PDF to print or share. Jotform doesn't transmit forms to the IRS, and filers with many information returns are generally required to e-file, so check the current filing rules.
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