FORM 1095-B File Schema

Sample File = Schema\2019\TEXT\T1095B.txt


String fields are displayed within quotations

CRLF=Carriage Return Line Feed (Hex 0D0A)

 

"Import ID"

"Control number"

"First name"

"Middle initial"

"Last name"

"Suffix"

"Name control"

"Social Security Number"

"Date of birth" ²

"Street address line 1"

"Street address line 2"

"City"

"State"

"Zip code"

"Zip code extension"

"USPS Delivery Point"

"Foreign address indicator" ¹

"Foreign city"

"Foreign state or province"

"Foreign postal code"

"Foreign country code (2 characters)"

"Origin of Health Coverage code"

"Sponsor ID"

12 months coverage indicator ¹

January coverage indicator ¹

February coverage indicator ¹

March coverage indicator ¹

April coverage indicator ¹

May coverage indicator ¹

June coverage indicator ¹

July coverage indicator ¹

August coverage indicator ¹

September coverage indicator ¹

October coverage indicator ¹

November coverage indicator ¹

December coverage indicator ¹

"Do not print indicator" ¹

"E-Mail address"

"Client ID"

CRLF

 

¹ "X" if applicable, otherwise, enter a null string ""

² Use format MMDDYYYY or MMDDYY