Tax Documents
Tax1095A
FDX / Data Structures / Tax1095A
Form 1095-A, Health Insurance Marketplace Statement
Extends and inherits all fields from Tax
Tax1095A Properties
| # | Id | Type | Description |
|---|---|---|---|
| 1 | marketplaceId | string | Box 1, Marketplace identifier |
| 2 | marketplacePolicyNumber | string | Box 2, Marketplace-assigned policy number |
| 3 | policyIssuerName | string | Box 3, Policy issuer's name |
| 4 | recipientName | string | Box 4, Recipient's name |
| 5 | recipientTin | string | Box 5, Recipient's SSN |
| 6 | recipientDateOfBirth | DateString | Box 6, Recipient's date of birth |
| 7 | spouseName | string | Box 7, Recipient's spouse's name |
| 8 | spouseTin | string | Box 8, Recipient's spouse's SSN |
| 9 | spouseDateOfBirth | DateString | Box 9, Recipient's spouse's date of birth |
| 10 | policyStartDate | DateString | Box 10, Policy start date |
| 11 | policyTerminationDate | DateString | Box 11, Policy termination date |
| 12 | recipientAddress | Address | Boxes 12-15, Recipient address |
| 13 | coveredIndividuals | Array of HealthInsuranceMarketplaceCoveredIndividual | Boxes 16+, Covered Individuals |
| 14 | coverages | Array of HealthInsuranceCoverage | Boxes 21-33, Coverage Information |
Tax1095A Usage:
- TaxData tax1095A
FDX Data Structure as JSON
{
"tax1095A" : {
"taxYear" : 0,
"corrected" : true,
"accountId" : "",
"taxFormId" : "",
"taxFormDate" : "2020-07-01",
"description" : "string",
"additionalInformation" : "string",
"taxFormType" : "BusinessIncomeStatement",
"attributes" : [ {
"name" : "string",
"value" : "string",
"boxNumber" : "string",
"code" : "string"
} ],
"error" : {
"code" : "string",
"message" : "string"
},
"marketplaceId" : "string",
"marketplacePolicyNumber" : "string",
"policyIssuerName" : "string",
"recipientName" : "string",
"recipientTin" : "string",
"recipientDateOfBirth" : "2020-07-01",
"spouseName" : "string",
"spouseTin" : "string",
"spouseDateOfBirth" : "2020-07-01",
"policyStartDate" : "2020-07-01",
"policyTerminationDate" : "2020-07-01",
"recipientAddress" : {
"line1" : "String64",
"line2" : "String64",
"line3" : "String64",
"city" : "String64",
"state" : "String64",
"postalCode" : "string",
"country" : "AD"
},
"coveredIndividuals" : [ {
"name" : "string",
"tin" : "string",
"dateOfBirth" : "2020-07-01",
"policyStartDate" : "2020-07-01",
"policyTerminationDate" : "2020-07-01"
} ],
"coverages" : [ {
"enrollmentPremium" : 0.0,
"slcspPremium" : 0.0,
"advancePremiumTaxCreditPayment" : 0.0,
"month" : "ANNUAL"
} ]
}
}
Example Form PDF
Example Form JSON
{
"tax1095A" : {
"taxYear" : 2022,
"taxFormId" : "e5d4ee73bd1-9295-480f-a426-1095-A",
"taxFormDate" : "2021-02-01",
"taxFormType" : "Tax1095A",
"marketplaceId" : "10001",
"marketplacePolicyNumber" : "20000002",
"policyIssuerName" : "American People Health",
"recipientName" : "Kris Q. Public",
"recipientTin" : "xxx-xx-1234",
"recipientDateOfBirth" : "1995-06-06",
"spouseName" : "Tracy R. Public",
"spouseTin" : "xxx-xxx-4321",
"spouseDateOfBirth" : "1995-09-09",
"policyStartDate" : "2020-01-01",
"policyTerminationDate" : "2020-12-31",
"recipientAddress" : {
"line1" : "1 Main St",
"city" : "Melrose",
"state" : "NY",
"postalCode" : "12121"
},
"coveredIndividuals" : [ {
"name" : "Kris Q. Public",
"tin" : "xxx-xx-1234",
"dateOfBirth" : "1995-06-06",
"policyStartDate" : "2020-01-01",
"policyTerminationDate" : "2020-12-31"
}, {
"name" : "Tracy R. Public",
"tin" : "xxx-xxx-4321",
"dateOfBirth" : "1995-09-09",
"policyStartDate" : "2020-01-01",
"policyTerminationDate" : "2020-12-31"
} ],
"coverages" : [ {
"enrollmentPremium" : 21.14,
"slcspPremium" : 21.14,
"advancePremiumTaxCreditPayment" : 21.14,
"month" : "JANUARY"
}, {
"enrollmentPremium" : 22.14,
"slcspPremium" : 22.14,
"advancePremiumTaxCreditPayment" : 22.14,
"month" : "FEBRUARY"
}, {
"enrollmentPremium" : 23.14,
"slcspPremium" : 23.14,
"advancePremiumTaxCreditPayment" : 23.14,
"month" : "MARCH"
}, {
"enrollmentPremium" : 24.14,
"slcspPremium" : 24.14,
"advancePremiumTaxCreditPayment" : 24.14,
"month" : "APRIL"
}, {
"enrollmentPremium" : 25.14,
"slcspPremium" : 25.14,
"advancePremiumTaxCreditPayment" : 25.14,
"month" : "MAY"
}, {
"enrollmentPremium" : 26.14,
"slcspPremium" : 26.14,
"advancePremiumTaxCreditPayment" : 26.14,
"month" : "JUNE"
}, {
"enrollmentPremium" : 27.14,
"slcspPremium" : 27.14,
"advancePremiumTaxCreditPayment" : 27.14,
"month" : "JULY"
}, {
"enrollmentPremium" : 28.14,
"slcspPremium" : 28.14,
"advancePremiumTaxCreditPayment" : 28.14,
"month" : "AUGUST"
}, {
"enrollmentPremium" : 29.14,
"slcspPremium" : 29.14,
"advancePremiumTaxCreditPayment" : 29.14,
"month" : "SEPTEMBER"
}, {
"enrollmentPremium" : 30.14,
"slcspPremium" : 30.14,
"advancePremiumTaxCreditPayment" : 30.14,
"month" : "OCTOBER"
}, {
"enrollmentPremium" : 31.14,
"slcspPremium" : 31.14,
"advancePremiumTaxCreditPayment" : 31.14,
"month" : "NOVEMBER"
}, {
"enrollmentPremium" : 32.14,
"slcspPremium" : 32.14,
"advancePremiumTaxCreditPayment" : 32.14,
"month" : "DECEMBER"
}, {
"enrollmentPremium" : 319.68,
"slcspPremium" : 319.68,
"advancePremiumTaxCreditPayment" : 319.68,
"month" : "ANNUAL"
} ]
}
}
Example Form JSON for QR Code Purposes
Example Data As Flattened Map (Key, Value Pairs)
{
"taxYear": "2022",
"taxFormId": "e5d4ee73bd1-9295-480f-a426-1095-A",
"taxFormDate": "2021-02-01",
"taxFormType": "Tax1095A",
"marketplaceId": "10001",
"marketplacePolicyNumber": "20000002",
"policyIssuerName": "American People Health",
"recipientName": "Kris Q. Public",
"recipientTin": "xxx-xx-1234",
"recipientDateOfBirth": "1995-06-06",
"spouseName": "Tracy R. Public",
"spouseTin": "xxx-xxx-4321",
"spouseDateOfBirth": "1995-09-09",
"policyStartDate": "2020-01-01",
"policyTerminationDate": "2020-12-31",
"recipientAddress.line1": "1 Main St",
"recipientAddress.city": "Melrose",
"recipientAddress.state": "NY",
"recipientAddress.postalCode": "12121",
"coveredIndividuals-1.name": "Kris Q. Public",
"coveredIndividuals-1.tin": "xxx-xx-1234",
"coveredIndividuals-1.dateOfBirth": "1995-06-06",
"coveredIndividuals-1.policyStartDate": "2020-01-01",
"coveredIndividuals-1.policyTerminationDate": "2020-12-31",
"coveredIndividuals-2.name": "Tracy R. Public",
"coveredIndividuals-2.tin": "xxx-xxx-4321",
"coveredIndividuals-2.dateOfBirth": "1995-09-09",
"coveredIndividuals-2.policyStartDate": "2020-01-01",
"coveredIndividuals-2.policyTerminationDate": "2020-12-31",
"coverages-1.enrollmentPremium": "21.14",
"coverages-1.slcspPremium": "21.14",
"coverages-1.advancePremiumTaxCreditPayment": "21.14",
"coverages-1.month": "JANUARY",
"coverages-2.enrollmentPremium": "22.14",
"coverages-2.slcspPremium": "22.14",
"coverages-2.advancePremiumTaxCreditPayment": "22.14",
"coverages-2.month": "FEBRUARY",
"coverages-3.enrollmentPremium": "23.14",
"coverages-3.slcspPremium": "23.14",
"coverages-3.advancePremiumTaxCreditPayment": "23.14",
"coverages-3.month": "MARCH",
"coverages-4.enrollmentPremium": "24.14",
"coverages-4.slcspPremium": "24.14",
"coverages-4.advancePremiumTaxCreditPayment": "24.14",
"coverages-4.month": "APRIL",
"coverages-5.enrollmentPremium": "25.14",
"coverages-5.slcspPremium": "25.14",
"coverages-5.advancePremiumTaxCreditPayment": "25.14",
"coverages-5.month": "MAY",
"coverages-6.enrollmentPremium": "26.14",
"coverages-6.slcspPremium": "26.14",
"coverages-6.advancePremiumTaxCreditPayment": "26.14",
"coverages-6.month": "JUNE",
"coverages-7.enrollmentPremium": "27.14",
"coverages-7.slcspPremium": "27.14",
"coverages-7.advancePremiumTaxCreditPayment": "27.14",
"coverages-7.month": "JULY",
"coverages-8.enrollmentPremium": "28.14",
"coverages-8.slcspPremium": "28.14",
"coverages-8.advancePremiumTaxCreditPayment": "28.14",
"coverages-8.month": "AUGUST",
"coverages-9.enrollmentPremium": "29.14",
"coverages-9.slcspPremium": "29.14",
"coverages-9.advancePremiumTaxCreditPayment": "29.14",
"coverages-9.month": "SEPTEMBER",
"coverages-10.enrollmentPremium": "30.14",
"coverages-10.slcspPremium": "30.14",
"coverages-10.advancePremiumTaxCreditPayment": "30.14",
"coverages-10.month": "OCTOBER",
"coverages-11.enrollmentPremium": "31.14",
"coverages-11.slcspPremium": "31.14",
"coverages-11.advancePremiumTaxCreditPayment": "31.14",
"coverages-11.month": "NOVEMBER",
"coverages-12.enrollmentPremium": "32.14",
"coverages-12.slcspPremium": "32.14",
"coverages-12.advancePremiumTaxCreditPayment": "32.14",
"coverages-12.month": "DECEMBER",
"coverages-13.enrollmentPremium": "319.68",
"coverages-13.slcspPremium": "319.68",
"coverages-13.advancePremiumTaxCreditPayment": "319.68",
"coverages-13.month": "ANNUAL"
}
Issuer Instructions
