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

form1095a.

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

Affordable-Care-Act.

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,

Affordable-Care-Act/Individuals-and-

filers of Form 1095-A may truncate the social security

Families/Health-Insurance-Marketplace-Statements.

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

return.

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

account).

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.

abbreviation.

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

Hub.

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

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

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