Blank Form 1095-B. Use this blank laser form for printing form 1095-B. Instructions are preprinted 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 and to the IRS as proof of healthcare coverage. Order by the number of sheets needed.

Note:  Please check your software for 1095 Envelope compatibility.

Specifications:
Construction: Laser Blank
Form: 1095-B
Pages: 1
Size: 8 1/2" x 11"
Forms /Sheet: 2up
Horizontal Perforation: 5 1/2"

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Choice Checks believes in customer service and were glad to help you in any way that we can. We're proud to have earned an A+ Rating with the Better Business Bureau. We always provide a proof for your business checks (emailed in a PDF file format) to make sure each order is 100% accurate. We are very responsive even after hours and on the weekends. Just email us and we’ll reach back out to you!