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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-V – Part I:  Responsible Individual

Column W-AD – Part II:  Employer Sponsored Coverage

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

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