Form 1095-B - Full Page Recipient

(B95BFPREC05)

Preprinted Form 1095-B
Full page with preprinted instructions on back.

Use this preprinted laser form for printing form 1095-B. Folding perforation at 5 ½”. Order by number of sheets needed.

Compatible envelopes:
- 95DWENV05
- 95DWENVS05


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
25 - 49 / $0.58
50 - 99 / $0.378
100 - 199 / $0.2955
200 - 499 / $0.2345
500 - 999 / $0.2044
1000 - 2499 / $0.1833
2500 - 4999 / $0.1642
5000+ / $0.1483
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