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Form 1095-B gives you information about your Horizon health insurance coverage to help you properly prepare your tax return. You should keep this form for your records. You do not need to attach it to your tax return, but you must prove you have qualifying health coverage or report your shared responsibility payment.

The form includes the following information for you and any covered dependents:

• Name(s)
• Last four digits of Social Security Number(s) (SSN)
• Date(s) of birth (if SSN is not available)
• Months of health insurance coverage with Horizon BCBSNJ for the previous tax year

Under the Affordable Care Act (ACA), you are required to verify on your federal income tax return that you, and your spouse/partner and/or individuals you claim as dependents, had qualifying health coverage (referred to as “minimum essential coverage”) each month during the tax year. Form 1095-B provides you with this information. Additionally, Horizon is required to report this same information to the IRS.