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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 to all recipients. They are only provided upon request but may be downloaded using the portal at the bottom of this page. By entering the requested information, you will be able to download a PDF copy of your 1095-B Tax form for calendar year 2021.

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 to this email.

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 for this year or a previous year, you may call 800-403-0864.

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