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Printable Form 1095 B San Jose California: What You Should Know

PDF — 8.4 MB Form 1095-B for Individuals Who File Their Own Tax Return — IRS This form is for those individuals who were covered by minimum essential coverage based on the  Federal Minimum Essential Coverage and did not qualify for other minimum essential Coverage (MEC). Income and Family Size for Individuals Who Failed to Qualify for a Minimum Essential Coverage — IRS This Form 1095-B is for individuals who had MEC based on one of three conditions: • Medical loss ratios • Inflated premium costs • An income below 138 percent of FICA. Information Note — Minimum Essential Coverage for Individuals — IRS Additional Information Note — Minimum Essential Coverage for Individuals — IRS This document is for taxpayers who: • Are reporting coverage for a change in age; or • Are filing a joint return and their coverage change date is October 1, 2013. • Do not meet the conditions of other forms of minimum essential coverage (MEC). • Did not claim exemptions for themselves or a family member. • Exemptions (for yourself or a family member) will be applied to your Form 1040 when due.

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