Part II - Employer Sponsored Coverage
Line 10: Employer name
In Line 10, enter the full name of the employer offering coverage.
Lines 10-15 contain information about issuers or carriers of insured group health plans.
You'll need to include the name, EIN, and complete mailing address for the employer sponsoring the coverage
reported on this 1095-B.
If the employer is part of a controlled group, enter the information for the employer group member that is also the covered employee's employer.
Note: Don't complete this part if the coverage is provided through a multiemployer plan.
Pro-tip: Insurance companies who entered code A or B on line 8 will complete this part. Employers reporting self-insured group health plan coverage should have entered code B on line 8 and need to skip Part II and go straight to Part III.
Line 11: Employer identification number (EIN)
In Line 11, enter the employer's 9-digit employer identification number (EIN). If you do not have an EIN, you can apply for one online at www.irs.gov, or by faxing or mailing Form SS-4 to the IRS.
Line 12: Street address (including room or suite no.)
Line 13: City or town
Line 14: State or province
Line 15: Country and ZIP or foreign postal code
From Lines 12 to 15, enter the complete address where all correspondence regarding the filing of Form 1095-B may be sent.
A P.O. Box may be entered in lieu of a street address if that's how mail is received by the filer.
Lines 10-15 contain information about issuers or carriers of insured group health plans. You'll need to include the name, EIN, and complete mailing address for the employer sponsoring the coverage reported on this 1095-B.
If the employer is part of a controlled group, enter the information for the employer group member that is also the covered employee's employer. Don't complete this part if the coverage is provided through a multiemployer plan.
Pro-tip: Insurance companies who entered code A or B on line 8 will complete this part. Employers reporting self-insured group health plan coverage should have entered code B on line 8 and need to skip Part II and go straight to Part III.
