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Copy of TF5095 2022 Laser ACA 1095B Health Coverage 8 1/2 x 11"  QTY 1 Carton

Copy of TF5095 2022 Laser ACA 1095B Health Coverage 8 1/2 x 11" QTY 1 Carton

$53.13

TF5095B 2020 Laser ACA 1095B Health Coverage Bulk Quantity
Size: 8 1/2 X 11"
Bulk quantity of our standard TF5095. 
This form is used by insurance carriers for reporting which months the insured and his or her family were covered under the plan.
Meet your reporting requirements under the Affordable Care Act (ACA) by using this form to report employees covered by your health plan.

    • 2-sided form
    • Black ink imprint
    • Laser form - for Pressure Seal please see product TF5506
    • For bulk IRS copy in landscape format you must use product TF5095L
    • For employers with fewer than 50 full-time employees (FTEs) that worked at least one month during the year, that provide health plans.
    • For self-insured employers, with fewer than 50 full-time employees that worked at least one month during the year, that provide health plans.
    • This form is not available in multiple copies.  You must order for the total number of copies you need (ex. 50 employees - in most cases you will need one copy for the employee, one for the employer, and one for the IRS so you must order quantity 150).
    • Compatible with laser or inkjet printers.
    • 500 per carton


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