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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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| | B95BFPREC05 |
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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 2024 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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We verify orders.
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In addition to standard credit card verification procedures which insure the credit card is not stolen, we also verify the computer IP address, phone numbers, etc., to ensure the person placing the order is not doing so for fraudulent purposes. We work with all applicable agencies to prevent and/or report fraudulent or suspicious activity.
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