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The Form 1095-B, Health Coverage skill extracts data from Forms 1095-B, which are used to report certain information to the Internal Revenue Service (IRS) and to taxpayers about individuals who have minimum essential coverage and are exempt from paying the individual shared responsibility payment. The Form 1095-B, Health Coverage skill is a preview skill. It has been trained on a limited set of documents and is designed to help you quickly get started with processing Forms 1095-B. For production use, you may need to uptrain the skill with your own document samples. This skill recognizes handwritten text. The option is enabled by default. If you do not import handwritten forms, disable the Handwritten option in the skill settings.

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Countries and Languages

CountriesLanguages
USAEnglish

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Extracted Fields

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Form Information

FieldDescription
YearThe reporting fiscal year.
VoidSpecifies that the processed form should be annulled.
CorrectedSpecifies that the processed form is being submitted to correct data provided earlier.

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Part I - Responsible Individual

FieldDescription
NameThe name of the responsible individual.
Social Security Number or Other TINThe Social Security Number (SSN) or other Taxpayer Identification Number (TIN) of the responsible individual.
Date of BirthThe date of birth of the responsible individual.
Street AddressThe address of the responsible individual.
City or TownThe address of the responsible individual.
State or ProvinceThe address of the responsible individual.
Country and ZIP or Foreign Postal CodeThe address of the responsible individual.
Letter Identifying Origin of the Health CoverageThe letter identifying the Origin of the Health Coverage.

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Part II - Information About Certain Employer-Sponsored Coverage

FieldDescription
Employer NameThe name of the employer sponsoring the coverage.
Employer Identification NumberThe Employer Identification Number (EIN) of the employer sponsoring the coverage.
Street AddressThe address of the employer sponsoring the coverage.
City or TownThe address of the employer sponsoring the coverage.
State or ProvinceThe address of the employer sponsoring the coverage.
Country and ZIP or Foreign Postal CodeThe address of the employer sponsoring the coverage.

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Part III - Issuer or Other Coverage Provider

FieldDescription
NameThe name of the issuer or other coverage provider.
Employer Identification NumberThe Employer Identification Number (EIN) of the issuer or other coverage provider.
Contact Telephone NumberThe phone number of the issuer or other coverage provider.
Street AddressThe address of the issuer or other coverage provider.
City or TownThe address of the issuer or other coverage provider.
State or ProvinceThe address of the issuer or other coverage provider.
Country and ZIP or Foreign Postal CodeThe address of the issuer or other coverage provider.

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Part IV - Covered Individuals (table)

FieldDescription
NameThe name of each covered individual.
SSN or TINThe Social Security Number (SSN) or other Taxpayer Identification Number (TIN) for each covered individual.
DOBThe date of birth (YYYY/MM/DD) for the covered individual.
Covered All 12 MonthsIndicates that the individual was covered for at least one day per month for all 12 months of the calendar year.

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Monthly Coverage

FieldDescription
JanThe month(s) in which the individual was covered for at least one day.
FebThe month(s) in which the individual was covered for at least one day.
MarThe month(s) in which the individual was covered for at least one day.
AprThe month(s) in which the individual was covered for at least one day.
MayThe month(s) in which the individual was covered for at least one day.
JuneThe month(s) in which the individual was covered for at least one day.
JulyThe month(s) in which the individual was covered for at least one day.
AugThe month(s) in which the individual was covered for at least one day.
SeptThe month(s) in which the individual was covered for at least one day.
OctThe month(s) in which the individual was covered for at least one day.
NovThe month(s) in which the individual was covered for at least one day.
DecThe month(s) in which the individual was covered for at least one day.

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Key Fields

  • Part I - Responsible Individual/Name
  • Part I - Responsible Individual/Social Security Number or Other TIN
  • Part III - Issuer or Other Coverage Provider/Name
  • Part III - Issuer or Other Coverage Provider/Employer Identification Number

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Validation Rules

RuleDescription
Clean NameChecks for unsupported characters such as | and ] in name fields. It also cleans multiple spaces, tabs, and newlines.
Clean YearChecks the value in the Year field. It converts a 2-digit year (such as 24) into a 4-digit format (such as 2024). It assumes all 2-digit years are in the 2000s.