Free shipping on all orders of $99 or more. Click for details.

 
ACA/1095 Products

1095-B Continuation Form

B1095BCON05

1095-B Continuation Form
This form is a continuation of form 1095-B which allows for only 6 covered individuals to be listed. Use this form when there are 7 or more covered individuals to be listed on form 1095-B. 


A 1095-B form must be issued by a self-insured employer with less than 50 full-time employees (including full-time equivalent employees), or by the insurer to employees and to the IRS as proof of healthcare coverage. 

Minimum qty of 25. Order in increments of 25.