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560118Form1095BDepartment of the Treasury Internal Revenue ServicePart I 1Do not attach to your tax return. Keep for your records. Go to www.irs.gov/Form1095B for instructions and the latest information.5City
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How to fill out draft form 1095-b

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To fill out draft form 1095-B, follow these steps:
02
Start by providing your personal information, including your name, address, and social security number.
03
Check the box indicating whether you were enrolled in a qualified health plan for each month of the year.
04
If you were not enrolled in a qualified health plan for the entire year, indicate the months when you were covered.
05
If you had any coverage gaps during the year, specify the start and end dates of each gap.
06
If you had any dependents who were covered by the same health plan, provide their names, social security numbers, and months of coverage.
07
Once you have completed all the necessary information, review it for accuracy and make any necessary corrections.
08
Sign and date the form before submitting it to the appropriate authority.

Who needs draft form 1095-b?

01
Draft form 1095-B is required for individuals who received minimum essential coverage during the tax year.
02
This form is typically issued by insurance providers, government-sponsored programs, and certain employers.
03
Individuals who received health coverage from one of these sources may need to include form 1095-B when filing their tax returns.
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Draft Form 1095-B is a tax form used by health coverage providers to report information about individuals who are covered by minimum essential coverage.
Health insurance providers, including insurance companies, government programs, and employers that offer self-insured health plans, are required to file Draft Form 1095-B.
To fill out Draft Form 1095-B, providers should enter their information along with details of the covered individuals, including names, Social Security numbers, and months of coverage.
The purpose of Draft Form 1095-B is to report information to the IRS and to individuals about health coverage to help ensure compliance with the Affordable Care Act.
Draft Form 1095-B must report information such as the name, SSN or other identifying number of the covered individuals, months of coverage, and the name of the coverage provider.
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