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Laser 1095B ACA Health Coverage
Sku: TF5095
Qty
Price
Unit Price
100
$35.00
$0.35
200
$44.00
$0.22
300
$52.00
$0.17
400
$59.00
$0.15
500
$70.00
$0.14
600
$79.00
$0.13
700
$86.00
$0.12
800
$95.00
$0.12
900
$104.00
$0.12
1000
$115.00
$0.12
Description
This form is used to fulfil reporting requirements under the Affordable Care Act (ACA). Use this form to report employees covered by your health plan.
Specifications
Product Details
Size: 8 1/2" x 11"
Form is used by payroll companies and smaller companies with self-funded insurance plans
