Instructions For Form 1095-A - Health Insurance Marketplace Statement - 2015


Department of the Treasury
Internal Revenue Service
Instructions for Form 1095-A
Health Insurance Marketplace Statement
Section references are to the Internal Revenue Code
Statements To Individuals
unless otherwise noted.
Furnishing required information to the individual.
Future Developments
Marketplaces use Form 1095-A to furnish the required
statement to recipients. A separate Form 1095-A must be
For the latest information about developments related to
furnished for each policy and the information on the Form
Form 1095-A and its instructions, such as legislation
1095-A should relate only to that policy. If two or more tax
enacted after they were published, go to
filers are enrolled in one policy, each tax filer receives a
statement reporting coverage of only the members of that
Additional Information
tax filer's tax household. See the instructions for line 4 for
more information about who is a recipient. Don't file a
For information related to the Affordable Care Act, visit
Form 1095-A for a catastrophic health plan or a separate
dental policy. See the instructions for Part III, column A.
For additional information related to Form 1095-A, visit
On Form 1095-A statements furnished to recipients,
filers of Form 1095-A may truncate the social security
number (SSN) of an individual receiving coverage by
showing only the last four digits of the SSN and replacing
General Instructions
the first five digits with asterisks (*) or Xs. Truncation isn't
allowed on forms filed with the IRS.
Purpose of Form
Statements must be furnished to recipients on paper by
Form 1095-A is used to report certain information to the
mail, unless a recipient affirmatively consents to receive
IRS about individuals who enroll in a qualified health plan
the statement in an electronic format. If mailed, the
through the Health Insurance Marketplace. Form 1095-A
statement must be sent to the recipient’s last known
is also furnished to individuals to allow them to take the
permanent address, or if no permanent address is known,
premium tax credit, to reconcile the credit on their returns
to the recipient’s temporary address.
with advance payments of the premium tax credit
Consent to furnish statement electronically. The
(advance credit payments), and to file an accurate tax
requirement to obtain affirmative consent to furnish a
statement electronically ensures that statements are sent
electronically only to individuals who are able to access
Who Must File
them. A recipient may consent on paper or electronically,
Health Insurance Marketplaces must file Form 1095-A to
such as by e-mail. If consent is on paper, the recipient
report information on all enrollments in qualified health
must confirm the consent electronically. An electronic
plans in the individual market through the Marketplace.
statement may be furnished by e-mail or by informing the
recipient how to access the statement on a Marketplace’s
When To File
website (for example, in the recipient's Marketplace
File the annual report with the IRS and furnish the
statements to individuals on or before January 31, 2016,
for coverage in calendar year 2015.
Specific Instructions
The requirement to furnish a statement to individuals
will be met if the Form 1095-A is properly addressed and
Part I—Recipient Information
mailed or furnished electronically (if the recipient has
Line 1. Enter the Marketplace state name or
consented to electronic receipt) on or before the due date.
If the regular due date falls on a Saturday, Sunday, or
legal holiday, furnish the statement by the next business
Line 2. Enter the number the Marketplace assigned to
day. A business day is any day that isn't a Saturday,
the policy. If the policy number is greater than 15
Sunday, or legal holiday.
characters, only enter the last 15 characters.
Line 3. Enter the name of the issuer of the policy.
How To File
Line 4. Enter the name of the statement recipient. This
Electronic filing. You must submit the information to the
should be the person identified at enrollment as the tax
IRS electronically. Submit the information through the
filer (the person who is expected to file a tax return, to
Department of Health and Human Services Data Services
claim other family members as dependents, and who, if
qualified, would take the premium tax credit for the year of
coverage for his or her household). If the tax filer can't be
identified from the information provided at enrollment (for
Sep 08, 2015
Cat. No. 63016Q


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