1095-B Continuation Form 50/Pk (1095BC-50)

Name: Nag Forms & Supplies
Address: P.O. Box 367, Holbrook, NY, 11741, US
Telephone: (631) 472-6764

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Form 1095-B Continuation Form 8-1/2" x 11" 50/Pk (1095BC-50)

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.