Edit, Download, and Sign the 1095-B Tax Form Request Instructions
Form
eSign
Add Annotation
Share Form
How do I fill this out?
To fill out the BCBSTX Form 1095-B, ensure that you provide all required personal information accurately. Start by gathering your member and group numbers. Follow the instructions for submission carefully to avoid delays.

How to fill out the 1095-B Tax Form Request Instructions?
1
Gather your Member Name, ID Number, and Group Number.
2
Ensure your personal details are accurate and up-to-date.
3
Complete the request for Form 1095-B clearly.
4
Mail your request to the designated address specified in the document.
5
Wait for your Form 1095-B to be delivered to your address within 30 days.
Who needs the 1095-B Tax Form Request Instructions?
1
Individuals filing taxes who need proof of health coverage.
2
Members of BlueCross BlueShield of Texas seeking tax documentation.
3
Employers providing health insurance coverage to employees.
4
Tax preparers needing forms for their clients.
5
Anyone needing to verify health coverage for government assistance programs.
How PrintFriendly Works
At PrintFriendly.com, you can edit, sign, share, and download the 1095-B Tax Form Request Instructions along with hundreds of thousands of other documents. Our platform helps you seamlessly edit PDFs and other documents online. You can edit our large library of pre-existing files and upload your own documents. Managing PDFs has never been easier.

Edit your 1095-B Tax Form Request Instructions online.
Editing your PDF on PrintFriendly is straightforward. Open the document and click on the edit option to make changes. You can adjust text, images, and more to suit your needs.

Add your legally-binding signature.
Signing your PDF on PrintFriendly is easy and efficient. Utilize our digital signature feature to add your signature safely. Ensure your document is completed before signing for an accurate representation.

Share your form instantly.
You can effortlessly share your PDF on PrintFriendly with just a few clicks. Use the share button to send your document via email or social media. You can also create a shareable link for easy access.
How do I edit the 1095-B Tax Form Request Instructions online?
Editing your PDF on PrintFriendly is straightforward. Open the document and click on the edit option to make changes. You can adjust text, images, and more to suit your needs.
1
Open your PDF document in PrintFriendly.
2
Select the edit option from the toolbar.
3
Make the necessary changes to text and images.
4
Review your edits to ensure accuracy.
5
Save your edited PDF for download or sharing.

What are the instructions for submitting this form?
To submit your Form 1095-B request, mail your completed form along with your personal details to Blue Cross and Blue Shield of Texas, c/o 1095-B Form Request, PO Box 660044, Dallas, TX 75266-0044. Ensure you include your member ID number and group number for swift processing. For additional inquiries, contact the customer service number listed on your member ID card.
What are the important dates for this form in 2024 and 2025?
Important dates for Form 1095-B submissions include December 31 for the end of the tax year. Ensure your request is made promptly to receive your documentation timely. Keeping track of these dates helps avoid any tax filing issues.

What is the purpose of this form?
The purpose of the Form 1095-B is to provide proof of health insurance coverage required for tax filing. It shows that you and your dependents were covered by a qualified health plan during the tax year. Compiling this form is essential for compliance with federal health coverage requirements.

Tell me about this form and its components and fields line-by-line.

- 1. Member Name: The name of the member requesting the form.
- 2. Member ID Number: Unique identifier assigned to the member.
- 3. Group Number: The number representing the member's health plan group.
- 4. Tax Year: The tax year for which the coverage is being verified.
What happens if I fail to submit this form?
Failing to submit the Form 1095-B can result in complications when filing your taxes. You may miss out on credits or face penalties related to health coverage requirements. It is crucial to ensure timely and accurate submissions.
- Tax Filing Complications: Delays in filing taxes due to lack of proof of coverage.
- Potential Fines: Risk of incurring fines for not meeting health coverage requirements.
- Impact on Tax Refunds: Potential delays or reductions in tax refunds.
How do I know when to use this form?

- 1. During Tax Filing: To prove health coverage while filing individual tax returns.
- 2. When Applying for Benefits: Necessary when seeking government assistance or benefits.
- 3. For Employer Reporting: Used by employers to report health coverage for their employees.
Frequently Asked Questions
How do I request my 1095-B Form?
Simply provide your personal information as specified and mail it to the address listed.
What information do I need to provide?
You need to submit your name, member ID number, and group number.
How long does it take to receive my form?
Your Form 1095-B will be mailed to you within 30 days.
Can I edit this form online?
Yes, you can edit your PDF using PrintFriendly's PDF editor.
What if I have questions about my form?
Call the number on the back of your BCBSTX member ID card for assistance.
Is the PDF editor user-friendly?
Absolutely, it is designed to be intuitive and easy to use.
Can I share my PDF after editing?
Yes, sharing your edited PDF is simple through our platform.
What types of edits can I make?
You can change text, images, and formats to customize your document.
Do I need a membership to use PrintFriendly?
No, anyone can access PrintFriendly's PDF editing features.
How do I download my edited PDF?
Simply click the download button after editing your document.
Related Documents - BCBSTX 1095-B Form Request

Preparticipation Physical Evaluation Form
The Preparticipation Physical Evaluation Form is used to assess the physical health and fitness of individuals before they participate in sports activities. It covers medical history, heart health, bone and joint health, and other relevant medical questions.

Health Insurance Tax Credits Guide 2015
This document provides a comprehensive guide on health insurance and premium tax credits for the 2015 tax year. It explains the tax filing rules, eligibility criteria, and detailed instructions for claiming and reporting premium tax credits. Essential for individuals who bought health insurance through the ACA Marketplaces.

TSP-77 Partial Withdrawal Request for Separated Employees
The TSP-77 form is used by separated employees to request a partial withdrawal from their Thrift Savings Plan account. It includes instructions for completing the form, certification, and notarization requirements. The form must be filled out completely and submitted along with necessary supporting documents.

Ray's Food Place Donation Request Form Details
This file contains the donation request form for Ray's Food Place. Complete the general information section and follow the guidelines to submit your donation request at least 30 days in advance. The form includes fields for organization details and donation specifics.

Pastoral Ministry Evaluation Form for Board of Elders
This evaluation form is designed for the Board of Elders to assess and provide feedback on a pastor's ministry. It aims to offer affirmation and identify areas for improvement. The form covers preaching, worship leading, pastoral care, administration, and more.

Health Provider Screening Form for PEEHIP Healthcare
This file contains the Health Provider Screening Form for PEEHIP public education employees and spouses. It includes instructions on how to fill out the form for wellness program participation. The form collects personal, medical, and screening details to assess wellness.

Common Law Marriage Declaration Form for FEHB Program
This form is used to declare a common law marriage for the purpose of enrolling a spouse under the Federal Employees Health Benefits (FEHB) Program. It requires personal details, marriage information, and additional documentation. Submission instructions and legal implications are included.

MyPRALUENT™ Enrollment Form Instructions and Details
This document provides comprehensive instructions and details for enrolling in the MyPRALUENT™ program, including benefits, patient assistance, and clinical support. It outlines the required patient, insurance, and prescriber information, as well as the steps for treatment verification and household income documentation.

Application for Certified Copy of Birth Certificate
This form is used to request a certified copy of a birth certificate from the Clerk of Court Office. It includes details about the applicant, the person named on the certificate, and requires a photo ID and the correct fee. This form is only for walk-in services.

Torrance Memorial Physician Network Forms for Patients 18+
This file contains important forms for patients 18 years and older registered with Torrance Memorial Physician Network. It includes patient registration, acknowledgment of receipt of privacy practices, and financial & assignment of benefits policy forms. Complete these forms to ensure your medical records are up-to-date and to understand your financial responsibilities.

Vodafone Phone Unlocking Guide: Steps to Unlock Your Phone
This guide from Vodafone provides a step-by-step process to unlock your phone. Learn how to obtain your unlock code by filling out an online form. Follow the instructions to complete the unlocking process.

Texas Automobile Club Agent Application Form
This file is the Texas Automobile Club Agent Application or Renewal form, which must be submitted within 30 days after hiring an agent. The form includes fields for agent identification, moral character information, and requires signature from both the agent and an authorized representative of the automobile club. Filing fees and submission instructions are also provided.