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1095-B Form - Minimum essential coverage

The federal government requires you to have health insurance and indicate your coverage status when you file your taxes. This coverage is reported in forms 1095-A, 1095-B, 1095-C depending on who provided your health insurance. The Indiana Family and Social Service Administration generates 1095-B Forms every year for all recipients of eligible Indiana health minimum essential coverage for at least one day in the tax year.

Please note that the 1095-B Tax form is NOT required by the IRS for filing your federal income taxes.

FSSA does not mail these forms. However, to view or print a copy of your form online for your own records, visit the website, at getmy1095b.com

If you are unable to download your 1095-B and still wish to have a physical copy, please send an email to Request1095b@fssa.in.gov.  Be sure to include your first and last name, your date of birth, and the last 4 digits of your Social Security Number when submitting your request.

If you do not have access to email, you can also request your 1095-B by mailing your first and last name, your date of birth, and the last 4 digits of your Social Security Number to:

FSSA\DFR 1095B Request
402 W. Washington Street, Rm W392
Indianapolis, IN  46204

If the information on the form is not correct or you have a question about how to receive the 1095-B Tax form, you may call 1-800-403-0864.

If you have further questions on this form or tax preparation, please visit www.irs.gov.