Form 1095-B, Health Coverage - Document Skill

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.

Countries and Languages

Countries	Languages
USA	English

Extracted Fields

Form Information

Field	Description
Year	The reporting fiscal year.
Void	Specifies that the processed form should be annulled.
Corrected	Specifies that the processed form is being submitted to correct data provided earlier.

Part I - Responsible Individual

Field	Description
Name	The name of the responsible individual.
Social Security Number or Other TIN	The Social Security Number (SSN) or other Taxpayer Identification Number (TIN) of the responsible individual.
Date of Birth	The date of birth of the responsible individual.
Street Address	The address of the responsible individual.
City or Town	The address of the responsible individual.
State or Province	The address of the responsible individual.
Country and ZIP or Foreign Postal Code	The address of the responsible individual.
Letter Identifying Origin of the Health Coverage	The letter identifying the Origin of the Health Coverage.

Part II - Information About Certain Employer-Sponsored Coverage

Field	Description
Employer Name	The name of the employer sponsoring the coverage.
Employer Identification Number	The Employer Identification Number (EIN) of the employer sponsoring the coverage.
Street Address	The address of the employer sponsoring the coverage.
City or Town	The address of the employer sponsoring the coverage.
State or Province	The address of the employer sponsoring the coverage.
Country and ZIP or Foreign Postal Code	The address of the employer sponsoring the coverage.

Part III - Issuer or Other Coverage Provider

Field	Description
Name	The name of the issuer or other coverage provider.
Employer Identification Number	The Employer Identification Number (EIN) of the issuer or other coverage provider.
Contact Telephone Number	The phone number of the issuer or other coverage provider.
Street Address	The address of the issuer or other coverage provider.
City or Town	The address of the issuer or other coverage provider.
State or Province	The address of the issuer or other coverage provider.
Country and ZIP or Foreign Postal Code	The address of the issuer or other coverage provider.

Part IV - Covered Individuals (table)

Field	Description
Name	The name of each covered individual.
SSN or TIN	The Social Security Number (SSN) or other Taxpayer Identification Number (TIN) for each covered individual.
DOB	The date of birth (YYYY/MM/DD) for the covered individual.
Covered All 12 Months	Indicates that the individual was covered for at least one day per month for all 12 months of the calendar year.

Monthly Coverage

Field	Description
Jan	The month(s) in which the individual was covered for at least one day.
Feb	The month(s) in which the individual was covered for at least one day.
Mar	The month(s) in which the individual was covered for at least one day.
Apr	The month(s) in which the individual was covered for at least one day.
May	The month(s) in which the individual was covered for at least one day.
June	The month(s) in which the individual was covered for at least one day.
July	The month(s) in which the individual was covered for at least one day.
Aug	The month(s) in which the individual was covered for at least one day.
Sept	The month(s) in which the individual was covered for at least one day.
Oct	The month(s) in which the individual was covered for at least one day.
Nov	The month(s) in which the individual was covered for at least one day.
Dec	The month(s) in which the individual was covered for at least one day.

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

Validation Rules

Rule	Description
Clean Name	Checks for unsupported characters such as \| and ] in name fields. It also cleans multiple spaces, tabs, and newlines.
Clean Year	Checks 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.

Form 1095-A, Health Insurance Marketplace Statement

Form 1095-C, Employer Health Insurance Coverage

⌘I

​Countries and Languages

​Extracted Fields

​Form Information

​Part I - Responsible Individual

​Part II - Information About Certain Employer-Sponsored Coverage

​Part III - Issuer or Other Coverage Provider

​Part IV - Covered Individuals (table)

​Monthly Coverage

​Key Fields

​Validation Rules