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2017 Laser 1095B ACA Health Coverage

Item#: Size:
Quantity 100 200 300 400 500
TF5095  1-Part/Original $26.99 $31.99 $37.99 $43.99 $49.99
We recommend this quantity.
1.  Quantity
 

Benefits and Features

Meet your reporting requirements under the Affordable Care Act (ACA) by using this form to report employees covered by your health plan.

  • Typically used by payroll companies and smaller companies with self-funded insurance plans.
  • 1 filing per sheet; packaged in quantities of 100.
  • Paper filing due date: to IRS by February 28 / to recipient by January 31.
  • Compatible with laser or inkjet printers.