Tax1095B_V100

OFX / Types / Tax1095B_V100
#TagType
1 SRVRTID ServerIdType
2 TAXYEAR YearType
3 VOID BooleanType
4 CORRECTED BooleanType
5 RESPONSIBLEINDIV anonymous complex type
6 ORIGINOFPOLICYCD anonymous simple type
7 SHOPIDENTIFIER GenericNameType
8 EMPLOYERSPONSORED Employer
9 ISSUERORPROVIDER Employer
10 CONTACTPERSONPHONE PhoneType
11 COVEREDINDIVIDUAL CoveredIndivGrpType
Usages:

FDX JSON

{
  "tax1095B" : {
    "taxYear" : 2020,
    "taxFormId" : "e5d4ee73bd1-9295-480f-a426-1095-B",
    "taxFormDate" : "2021-02-01",
    "taxFormType" : "Tax1095B",
    "responsibleName" : {
      "first" : "Kris",
      "middle" : "Q",
      "last" : "Public"
    },
    "responsibleTin" : "xxx-xx-1234",
    "responsibleDateOfBirth" : "1995-03-03",
    "responsibleAddress" : {
      "line1" : "1 Main St",
      "city" : "Melrose",
      "state" : "NY",
      "postalCode" : "12121",
      "country" : "US"
    },
    "originOfHealthCoverageCode" : "B",
    "employerNameAddress" : {
      "line1" : "12020 Sunrise Valley Dr",
      "line2" : "Suite 230",
      "city" : "Reston",
      "state" : "VA",
      "postalCode" : "20191",
      "country" : "US",
      "name1" : "Financial Data Exchange"
    },
    "employerTin" : "12-3456789",
    "issuerNameAddress" : {
      "line1" : "1718-1/2 Oak Blvd",
      "city" : "Austin",
      "state" : "TX",
      "postalCode" : "78735",
      "country" : "US",
      "name1" : "American People Health",
      "phone" : {
        "number" : "8885551212"
      }
    },
    "issuerTin" : "99-0011223",
    "coveredIndividuals" : [ {
      "name" : {
        "first" : "Kris",
        "middle" : "Q",
        "last" : "Public"
      },
      "tin" : "xxx-xx-1234",
      "dateOfBirth" : "1995-03-13",
      "coveredAt12Months" : true,
      "coveredMonths" : [ "JAN", "FEB", "MAR", "APR", "MAY", "JUN", "JUL", "AUG", "SEP", "OCT", "NOV", "DEC" ]
    }, {
      "name" : {
        "first" : "Tracy",
        "middle" : "R",
        "last" : "Public"
      },
      "tin" : "xxx-xx-4321",
      "dateOfBirth" : "1995-04-13",
      "coveredAt12Months" : true,
      "coveredMonths" : [ "JAN", "FEB", "MAR", "APR", "MAY", "JUN", "JUL", "AUG", "SEP", "OCT", "NOV", "DEC" ]
    } ]
  }
}

OFX XML

<?xml version="1.0" encoding="UTF-8" standalone="no"?>
<?OFX OFXHEADER="200" VERSION="202" SECURITY="NONE" OLDFILEUID="NONE" NEWFILEUID="NONE"?>

<OFX>
    <SIGNONMSGSRSV1>
        <SONRS>
            <STATUS>
                <CODE>0</CODE>
                <SEVERITY>INFO</SEVERITY>
                <MESSAGE>Successful Login</MESSAGE>
            </STATUS>
            <DTSERVER>39210131000000</DTSERVER>
            <LANGUAGE>ENG</LANGUAGE>
            <FI>
                <ORG>fiName</ORG>
                <FID>fiId</FID>
            </FI>
        </SONRS>
    </SIGNONMSGSRSV1>
    <TAX1095MSGSRSV1>
        <TAX1095TRNRS>
            <TRNUID>_GUID_</TRNUID>
            <STATUS>
                <CODE>0</CODE>
                <SEVERITY>INFO</SEVERITY>
                <MESSAGE>SUCCESS</MESSAGE>
            </STATUS>
            <TAX1095RS>
                <TAX1095B_V100>
                    <SRVRTID>e5d4ee73bd1-9295-480f-a426-1095-B</SRVRTID>
                    <TAXYEAR>2020</TAXYEAR>
                    <RESPONSIBLEINDIV>
                        <SSN>xxx-xx-1234</SSN>
                        <BIRTHDATE>19950303</BIRTHDATE>
                        <NAME>Kris Q Public</NAME>
                        <ADDR1>1 Main St</ADDR1>
                        <CITY>Melrose</CITY>
                        <STATE>NY</STATE>
                        <POSTALCODE>12121</POSTALCODE>
                        <COUNTRYSTRING>US</COUNTRYSTRING>
                    </RESPONSIBLEINDIV>
                    <ORIGINOFPOLICYCD>B</ORIGINOFPOLICYCD>
                    <EMPLOYERSPONSORED>
                        <FEDIDNUMBER>12-3456789</FEDIDNUMBER>
                        <NAME1>Financial Data Exchange</NAME1>
                        <ADDR1>12020 Sunrise Valley Dr</ADDR1>
                        <ADDR2>Suite 230</ADDR2>
                        <CITY>Reston</CITY>
                        <STATE>VA</STATE>
                        <POSTALCODE>20191</POSTALCODE>
                    </EMPLOYERSPONSORED>
                    <ISSUERORPROVIDER>
                        <FEDIDNUMBER>99-0011223</FEDIDNUMBER>
                        <NAME1>American People Health</NAME1>
                        <ADDR1>1718-1/2 Oak Blvd</ADDR1>
                        <CITY>Austin</CITY>
                        <STATE>TX</STATE>
                        <POSTALCODE>78735</POSTALCODE>
                    </ISSUERORPROVIDER>
                    <CONTACTPERSONPHONE>888-555-1212</CONTACTPERSONPHONE>
                    <COVEREDINDIVIDUAL>
                        <PERSONNM>Kris Q Public</PERSONNM>
                        <SSN>xxx-xx-1234</SSN>
                        <PERSONBIRTHDT>19950313</PERSONBIRTHDT>
                        <ALLYEARIND>Y</ALLYEARIND>
                        <JANUARYIND>Y</JANUARYIND>
                        <FEBRUARYIND>Y</FEBRUARYIND>
                        <MARCHIND>Y</MARCHIND>
                        <APRILIND>Y</APRILIND>
                        <MAYIND>Y</MAYIND>
                        <JUNEIND>Y</JUNEIND>
                        <JULYIND>Y</JULYIND>
                        <AUGUSTIND>Y</AUGUSTIND>
                        <SEPTEMBERIND>Y</SEPTEMBERIND>
                        <OCTOBERIND>Y</OCTOBERIND>
                        <NOVEMBERIND>Y</NOVEMBERIND>
                        <DECEMBERIND>Y</DECEMBERIND>
                    </COVEREDINDIVIDUAL>
                    <COVEREDINDIVIDUAL>
                        <PERSONNM>Tracy R Public</PERSONNM>
                        <SSN>xxx-xx-4321</SSN>
                        <PERSONBIRTHDT>19950413</PERSONBIRTHDT>
                        <ALLYEARIND>Y</ALLYEARIND>
                        <JANUARYIND>Y</JANUARYIND>
                        <FEBRUARYIND>Y</FEBRUARYIND>
                        <MARCHIND>Y</MARCHIND>
                        <APRILIND>Y</APRILIND>
                        <MAYIND>Y</MAYIND>
                        <JUNEIND>Y</JUNEIND>
                        <JULYIND>Y</JULYIND>
                        <AUGUSTIND>Y</AUGUSTIND>
                        <SEPTEMBERIND>Y</SEPTEMBERIND>
                        <OCTOBERIND>Y</OCTOBERIND>
                        <NOVEMBERIND>Y</NOVEMBERIND>
                        <DECEMBERIND>Y</DECEMBERIND>
                    </COVEREDINDIVIDUAL>
                </TAX1095B_V100>
            </TAX1095RS>
        </TAX1095TRNRS>
    </TAX1095MSGSRSV1>
</OFX>

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