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2018 Laser 1095C Employer Provided Health Insurance

Item#: Size:
Quantity 100 200 300 400 500
TF5096  1-Part/Original $30.99 $35.99 $41.99 $48.99 $55.99
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 whether employees were offered health insurance.

  • Typically used by payroll companies

    and Applicable Large Employers (ALEs) with 50+ employees.
  • One page with backer information per form;

    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.