Instructions For Form 1095-A - Health Insurance Marketplace Statement

2016

Department of the Treasury

Internal Revenue Service

Instructions for Form 1095-A

Health Insurance Marketplace Statement

Section references are to the Internal Revenue Code

How To File

unless otherwise noted.

Electronic filing. You must submit the information to the

Future Developments

IRS electronically. Submit the information through the

Department of Health and Human Services Data Services

For the latest information about developments related to

Hub.

Form 1095-A and its instructions, such as legislation

enacted after they were published, go to

Statements To Individuals

form1095a.

Furnishing required information to the individual.

What’s New

Marketplaces use Form 1095-A to furnish the required

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

Form revisions. The language “Do not attach to your tax

furnished for each policy and the information on the Form

return. Keep for your records.” was inserted on the Form

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

1095-A under the title of the form.

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

Additional Information

statement reporting coverage of only the members of that

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

For information related to the Affordable Care Act, visit

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

affordable-care-act.

Form 1095-A for a catastrophic health plan or a

For additional information related to Form 1095-A, visit

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

affordable-care-act/individuals-and-families/

column A.

health-insurance-marketplace-statements.

On Form 1095-A statements furnished to recipients,

filers of Form 1095-A may truncate the social security

General Instructions

number (SSN) of an individual receiving coverage by

showing only the last four digits of the SSN and replacing

Purpose of Form

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

allowed on forms filed with the IRS.

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

IRS about individuals who enroll in a qualified health plan

Statements must be furnished to recipients on paper by

through the Health Insurance Marketplace. Form 1095-A

mail, unless a recipient affirmatively consents to receive

is also furnished to individuals to allow them to take the

the statement in an electronic format. If mailed, the

premium tax credit, to reconcile the credit on their returns

statement must be sent to the recipient’s last known

with advance payments of the premium tax credit

permanent address, or if no permanent address is known,

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

to the recipient’s temporary address.

return.

Consent to furnish statement electronically. The

requirement to obtain affirmative consent to furnish a

Who Must File

statement electronically ensures that statements are sent

Health Insurance Marketplaces must file Form 1095-A to

electronically only to individuals who are able to access

report information on all enrollments in qualified health

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

plans in the individual market through the Marketplace. Do

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

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

on paper, the recipient must confirm the consent

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

electronically. An electronic statement may be furnished

in these instructions).

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

statement on a Marketplace’s website (for example, in the

When To File

recipient's Marketplace account).

File the annual report with the IRS and furnish the

statements to individuals on or before January 31, 2017,

Specific Instructions

for coverage in calendar year 2016.

The requirement to furnish a statement to individuals

Part I—Recipient Information

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

Line 1. Enter the Marketplace state name or

mailed or furnished electronically (if the recipient has

abbreviation.

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

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

Line 2. Enter the number the Marketplace assigned to

legal holiday, furnish the statement by the next business

the policy. If the policy number is greater than 15

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

characters, only enter the last 15 characters.

Sunday, or legal holiday.

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

Sep 01, 2016

Cat. No. 63016Q

Instructions For Form 1095-A - Health Insurance Marketplace Statement - 2016

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