1095-B Forms - Pressure Seal 14" EZ

(81651)
Use this preprinted pressure seal form for printing form 1095-B.
8 ½” x 14” Sheet


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.
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Quantity / Unit Price
1 / Free Sample
500 - 999 / $0.3
1000 - 1999 / $0.2419
2000 - 2999 / $0.2222
3000 - 3999 / $0.1982
4000 - 4999 / $0.1853
5000 - 5999 / $0.174
6000 - 7999 / $0.1649
8000 - 9999 / $0.1554
10000 - 19999 / $0.1397
20000+ / $0.1305
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