Instructions For Form 1095-A Draft - 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

1095-A should relate only to that policy. If two or more tax

DRAFT AS OF

unless otherwise noted.

filers are enrolled in one policy, each tax filer receives a

statement reporting coverage of only the members of that

Future Developments

tax filer's tax household. See the instructions for line 4 for

For the latest information about developments related to

more information about who is a recipient. Don't file a

Form 1095-A and its instructions, such as legislation

Form 1095-A for a catastrophic health plan or a separate

enacted after they were published, go to

August 4, 2015

dental policy. See the instructions for Part III, column A.

form1095a.

On Form 1095-A statements furnished to recipients,

Additional Information

filers of Form 1095-A may truncate the social security

number (SSN) of an individual receiving coverage by

For information related to the Affordable Care Act, visit

showing only the last four digits of the SSN and replacing

Affordable-Care-Act.

the first five digits with asterisks (*) or Xs. Truncation isn't

allowed on forms filed with the IRS.

General Instructions

Statements must be furnished to recipients on paper by

mail, unless a recipient affirmatively consents to receive

Purpose of Form

the statement in an electronic format. If mailed, the

Form 1095-A is used to report certain information to the

statement must be sent to the recipient’s last known

IRS about individuals who enroll in a qualified health plan

permanent address, or if no permanent address is known,

through the Health Insurance Marketplace. Form 1095-A

to the recipient’s temporary address.

is also furnished to individuals to allow them to take the

Consent to furnish statement electronically. The

premium tax credit, to reconcile the credit on their returns

requirement to obtain affirmative consent to furnish a

with advance payments of the premium tax credit

statement electronically ensures that statements are sent

(advance credit payments), and to file an accurate tax

electronically only to individuals who are able to access

return.

them. A recipient may consent on paper or electronically,

such as by e-mail. If consent is on paper, the recipient

Who Must File

must confirm the consent electronically. An electronic

Health Insurance Marketplaces must file Form 1095-A to

statement may be furnished by e-mail or by informing the

report information on all enrollments in qualified health

recipient how to access the statement on a Marketplace’s

plans in the individual market through the Marketplace.

website (for example, in the recipient's Marketplace

account).

When To File

File the annual report with the IRS and furnish the

Specific Instructions

statements to individuals on or before January 31, 2016,

for coverage in calendar year 2015.

Part I—Recipient Information

The requirement to furnish a statement to individuals

Line 1. Enter the Marketplace state name or

will be met if the Form 1095-A is properly addressed and

abbreviation.

mailed or furnished electronically (if the recipient has

Line 2. Enter the number the Marketplace assigned to

consented to electronic receipt) on or before the due date.

the policy. If the policy number is greater than 15

If the regular due date falls on a Saturday, Sunday, or

characters, only enter the last 15 characters.

legal holiday, furnish the statement by the next business

day. A business day is any day that isn't a Saturday,

Line 3. Enter the name of the issuer of the policy.

Sunday, or legal holiday.

Line 4. Enter the name of the statement recipient. This

How To File

should be the person identified at enrollment as the tax

filer (the person who is expected to file a tax return, to

Electronic filing. You must submit the information to the

claim other family members as dependents, and who, if

IRS electronically. Submit the information through the

qualified, would take the premium tax credit for the year of

Department of Health and Human Services Data Services

coverage for his or her household). If the tax filer can't be

Hub.

identified from the information provided at enrollment (for

example, because no financial assistance was

Statements To Individuals

requested), enter the name of the primary applicant for the

Furnishing required information to the individual.

coverage.

Marketplaces use Form 1095-A to furnish the required

Line 5. Enter the social security number (SSN) for the

statement to recipients. A separate Form 1095-A must be

recipient shown on line 4.

furnished for each policy and the information on the Form

Jul 27, 2015

Cat. No. 63016Q

Instructions For Form 1095-A Draft - Health Insurance Marketplace Statement - 2015 Page 2

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