Instructions For Form 1095-A - Health Insurance Marketplace Statement

2017

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

IRS.gov/

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 furnish a

For information related to the Affordable Care Act, visit

Form 1095-A for a catastrophic health plan or a

IRS.gov/Affordable-Care-Act.

stand-alone dental plan. See the instructions for Part III,

For additional information related to Form 1095-A, visit

column A.

IRS.gov/Affordable-Care-Act/Individuals-And-Families/

On Form 1095-A statements furnished to recipients,

Health-Insurance-Marketplace-Statements.

filers of Form 1095-A may truncate the social security

number (SSN) of an individual receiving coverage by

General Instructions

showing only the last four digits of the SSN and replacing

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

Purpose of Form

allowed on forms filed with the IRS.

Statements must be furnished to recipients on paper by

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

IRS about individuals who enroll in a qualified health plan

mail, unless a recipient affirmatively consents to receive

the statement in an electronic format. If mailed, the

through the Health Insurance Marketplace. Form 1095-A

also is furnished to individuals to allow them to take the

statement must be sent to the recipient’s last known

permanent address, or if no permanent address is known,

premium tax credit, to reconcile the credit on their returns

with advance payments of the premium tax credit

to the recipient’s temporary address.

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

Consent to furnish statement electronically. The

return.

requirement to obtain affirmative consent to furnish a

statement electronically ensures that statements are sent

Who Must File

electronically only to individuals who are able to access

Health Insurance Marketplaces must file Form 1095-A to

them. A recipient may provide his or her consent on paper

report information on all enrollments in qualified health

or electronically, such as by e-mail. If consent is provided

plans in the individual market through the Marketplace. Do

on paper, the recipient must confirm the consent

not file a Form 1095-A for a catastrophic health plan or a

electronically. An electronic statement may be furnished

separate dental policy (called a “stand-alone dental plan”

by e-mail or by informing the recipient how to access the

in these instructions).

statement on a Marketplace’s 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, 2018,

for coverage in calendar year 2017.

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

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

Line 2. Enter the number the Marketplace assigned to

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

the policy. If the policy number is greater than 15

legal holiday, furnish the statement by the next business

characters, enter only the last 15 characters.

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 recipient of the statement.

How To File

This 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.

Aug 30, 2017

Cat. No. 63016Q

Instructions For Form 1095-A - Health Insurance Marketplace Statement - 2017

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