Instructions For Form 8963 - Report Of Health Insurance Provider Information printable pdf download

Instructions for Form 8963

Department of the Treasury

Internal Revenue Service

(Rev. February 2016)

Report of Health Insurance Provider Information

Section references are to the Internal Revenue

electronic acknowledgment once you

Net premiums written. Net premiums

Code unless otherwise noted.

complete the transaction. Keep it with your

written means premiums written, including

records.

reinsurance premiums written, reduced by

Future Developments

reinsurance ceded, and reduced by

Where To File

For the latest information about

ceding commissions and medical loss

developments related to Form 8963 and

If you are not filing electronically,

ratio (MLR) rebates with respect to the

its instructions, such as legislation

send your paper Form 8963 to

data year. Net premiums written includes

enacted after they were published, go to

premiums written for assumption

the following address.

reinsurance and is reduced by assumption

Internal Revenue Service

reinsurance premiums ceded. Net

Note. See

for

1973 Rulon White Blvd.

premiums written does not include

additional guidance.

Mail Stop 4916 IPF

premiums written for indemnity

Ogden, UT 84201-0051

reinsurance and is not reduced by

General Instructions

indemnity reinsurance ceded.

Assumption reinsurance is

Purpose of Form

If you mail your form, please also

reinsurance for which there is a novation

fax it to 877–797–0235.

File Form 8963 during each fee year (year

TIP

and the reinsurer takes over the entire risk

the annual health insurance provider fee is

of loss pursuant to a new contract.

due) to report net premiums written for

If you would like to request an

Indemnity reinsurance is an

U.S. health risks during the data year

acknowledgment that we received your

agreement between one or more

(calendar year immediately preceding the

Form 8963, please email

LBI.IPF@irs.gov

reinsuring companies and a covered entity

fee year). The IRS will use that information

with the company information and/or

under which (a) the reinsuring company

when figuring the annual fee imposed by

tracking number and we will reply when

agrees to accept, and to indemnify the

Affordable Care Act (ACA) section 9010.

we receive the form. If you use an

issuing company for, all or part of the risk

(Public Law 111–148, section 9010; PL

overnight service, add the email address

of loss under policies specified in the

111–148, section 10905; PL 111–152,

LBI.IPF@irs.gov

in the recipient email and

agreement; and (b) the covered entity

section 1406; and PL 113–235, division

we will reply when we receive the form.

retains its liability to, and its contractual

M.)

relationship with, the individuals whose

Public Disclosure

health risks are insured under the policies

Who Must File

The information on this form is not

specified in the agreement.

Generally, a covered entity that provides

confidential. Although, generally, returns

In determining net premiums

health insurance for any U.S. health risk

and return information are confidential, as

written, filers must take

during the 2016 fee year (the calendar

required by section 6103, the information

TIP

assumption reinsurance into

year in which the fee must be paid) must

on this form is not subject to section 6103,

file Form 8963.

account by including assumption

pursuant to ACA section 9010, as

reinsurance written in direct premiums

amended. All information on this form is

If you are not a covered entity,

written and deducting assumption

subject to public disclosure. Do not

you do not have to file this form.

reinsurance ceded from direct premiums

TIP

include personal information other than

written. However, filers may not include

that requested by this form.

When To File

indemnity reinsurance written in direct

Definitions

premiums written and may not deduct

You must file Form 8963 by April 18, 2016.

indemnity reinsurance ceded from direct

Covered entity. Generally, covered

How To File

premiums written.

entity means any entity with net premiums

written for health insurance for U.S. health

There are two ways to file your Form 8963.

U.S. health risk. A U.S. health risk

risks during the fee year that is:

1. You can file Form 8963 (with Form

means the health risk of any individual

A health insurance issuer within the

8453-R, Declaration and Signature for

who is:

meaning of section 9832(b)(2);

Electronic Filing of Forms 8947 and 8963)

A U.S. citizen,

A health maintenance organization

electronically by accessing IRS e-file

A resident of the United States (within

within the meaning of section 9832(b)(3);

using your own computer, or

the meaning of section 7701(b)(1)(A)), or

An insurance company that is subject

2. You can file a paper Form 8963.

Located in the United States, with

to tax under subchapter L, Part I or II, or

respect to the period that individual is so

that would be subject to tax under

Note. If filing electronically, upload the

located.

subchapter L, Part I or II, but for the entity

completed fillable version of the form. Do

being exempt from tax under section

Health insurance. In general, the term

not print and scan the form.

501(a);

“health insurance” has the same meaning

E-File: It’s Convenient, Safe and

An insurer that provides health

as the term “health insurance coverage” in

insurance under Medicare Advantage,

section 9832(b)(1)(A), defined to mean

Secure

Medicare Part D, or Medicaid; or

benefits consisting of medical care

IRS e-file is the IRS’s electronic filing

A non-fully insured multiple employer

(provided directly, through insurance or

program. For more information about IRS

welfare arrangement (MEWA).

reimbursement, or otherwise) under any

e-file, go to

hospital or medical service policy or

By filing electronically, you will receive an

certificate, hospital or medical service plan

Feb 02, 2016

Cat. No. 60499R

Instructions For Form 8963 - Report Of Health Insurance Provider Information

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