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Affordable Care Act (ACA) Recipient Form (Portrait Style) Self-Insured Employer <50 Employees
Use this pre-printed laser form for printing form 1095-B.
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Use this pre-printed laser form for printing form 1095-B. Folding perforation at 5 ½. Full page form with instructions printed on the back. 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.
Order one sheet per employee.
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Priced by the sheet. We are currently shipping 2025 forms |
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Use envelope 95DWENV05/95DWENVS05 with the portrait style recipient form.
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Affordable Care Act, ACA, less than 50, Self insured, Self-Insured
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