1095 Form

Q: What is 1095 form?
A: The Affordable Care Act (ACA) requires everyone to have minimum essential health insurance coverage, or you may have to pay a financial penalty imposed by the Internal Revenue Service (IRS). You will need to provide proof of coverage when you file your 2017 Federal Income Tax return in 2018. BCBSNE will provide you a 1095 tax form which should be used when filing taxes to prove that you and/or your dependents had minimum essential health insurance coverage.

Q: When will I receive the form?
A: By January 31, 2018, Blue Cross and Blue Shield of Nebraska will send fully insured members an IRS 1095 Form listing the individuals who had health insurance coverage.

At this time, the form is not available online but you can request a duplicate by calling the number on the back of your ID card and follow the prompts.

Note: If you obtained coverage through the Federal Marketplace, the 1095-A form will be sent to you from the Marketplace.

Q:Why am I being asked for my (or a family members) Social Security number?
A: Blue Cross Blue Shield of Nebraska is required to report certain member information each year to the IRS, which includes:
  • Name, Address, and Tax Identification Number (TIN) of the contract holder [Your Social Security Number (SSN) is commonly used as your TIN.]
  • Name and TIN of each dependent who is covered under your plan.
  • For each member covered under your plan, the months each of you has been enrolled in your plan.
  • Name, Address, and Employer Identification Number (EIN) of the entity that sponsors your health insurance coverage.
We will use this information to report to the IRS and prepare your individual 1095 tax form.

For more information regarding the 1095 form please view the links below:

Reporting Social Security Numbers to Your Health Insurance Company: http://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/Your-Health-Insurance-Company-May-Ask-for-Your-Social-Security-Number


Form 1095-B, Health Coverage IRS information: http://www.irs.gov/uac/About-Form-1095-B



The percentage of the bill you pay after your deductible has been met.


A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 


The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.


Includes behavioral health treatment, counseling, and psychotherapy

in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)


Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.


If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.


The amount you pay to your health insurance company each month. 

Preventive services

Health care services that focus on the prevention of disease and health maintenance.


Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).


A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.