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# Form 1095-B, Health Coverage - Document Skill

> Extract data from IRS Form 1095-B (Health Coverage) used to report minimum essential health coverage and exemption from the shared responsibility payment.

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. |
