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Mapping the 1095-B Excel Template to the Form for Easier Data Input

Here is a mapping tool to use when entering data into the 1095-B Excel Template:

Column A – Form Type

Column B-K – Part III Issuer or Other Coverage Provider

Column L-W – Part I:  Responsible Individual

Column X-AE – Part II:  Employer Sponsored Coverage

Column AF-AU – Part IV:  First Covered Individual (Name, SSN or DOB and months of coverage)

Column AV-BK– Part IV:  Second Covered Individual (Name, SSN or DOB and months of coverage)

Column BL-CA– Part IV:  Third Covered Individual (Name, SSN or DOB and months of coverage)

Column CB-CQ– Part IV:  Fourth Covered Individual (Name, SSN or DOB and months of coverage)

Column CR-DG– Part IV:  Fifth Covered Individual (Name, SSN or DOB and months of coverage)

Column DH-DW– Part IV:  Sixth Covered Individual (Name, SSN or DOB and months of coverage)

Column DX-EM– Part IV:  Seventh Covered Individual (Name, SSN or DOB and months of coverage)

Column EN-FC– Part IV:  Eight Covered Individual (Name, SSN or DOB and months of coverage)

Column FD-FS– Part IV:  Ninth Covered Individual (Name, SSN or DOB and months of coverage)

Column FT-GI– Part IV:  Tenth Covered Individual (Name, SSN or DOB and months of coverage)

Column GJ-GY– Part IV:  Eleventh Covered Individual (Name, SSN or DOB and months of coverage)

Column GZ-HO– Part IV:  Twelfth Covered Individual (Name, SSN or DOB and months of coverage)

Column HP-IE– Part IV:  Thirteenth Covered Individual (Name, SSN or DOB and months of coverage)

Column IF-IU– Part IV:  Fourteenth Covered Individual (Name, SSN or DOB and months of coverage)

Column IV-JK– Part IV:  Fifteenth Covered Individual (Name, SSN or DOB and months of coverage)

Column JL-KA– Part IV:  Sixteenth Covered Individual (Name, SSN or DOB and months of coverage)

Column KB-KQ– Part IV:  Seventeenth Covered Individual (Name, SSN or DOB and months of coverage)

Column KR-LG– Part IV:  Eighteenth Covered Individual (Name, SSN or DOB and months of coverage)

 

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