Laser 1095B ACA Continuation Sheet

Benefits and Features

Meet your reporting requirements under the Affordable Care Act (ACA) by using this form to report employees covered by your health plan.

• Continuation form is used in addition to 1095B

  when an employee has more than 6 dependents.

• 1 filing per sheet;

  shrink-wrapped in packs of 25.

• Paper filing due date:

  to IRS by February 28 / to recipient by January 31.

• Compatible with laser

  or inkjet printers.