1095-A : Health Insurance Marketplace Statement

 

FDX / Data Structures / Tax1095A
Form 1095-A, Health Insurance Marketplace Statement
Extends and inherits all fields from Tax  
Tax1095A Properties
#IdTypeDescription
1marketplaceIdstringBox 1, Marketplace identifier
2marketplacePolicyNumberstringBox 2, Marketplace-assigned policy number
3policyIssuerNamestringBox 3, Policy issuer's name
4recipientNamestringBox 4, Recipient's name
5recipientTinstringBox 5, Recipient's SSN
6recipientDateOfBirthDateStringBox 6, Recipient's date of birth
7spouseNamestringBox 7, Recipient's spouse's name
8spouseTinstringBox 8, Recipient's spouse's SSN
9spouseDateOfBirthDateStringBox 9, Recipient's spouse's date of birth
10policyStartDateDateStringBox 10, Policy start date
11policyTerminationDateDateStringBox 11, Policy termination date
12recipientAddressAddressBoxes 12-15, Recipient address
13coveredIndividualsArray of HealthInsuranceMarketplaceCoveredIndividualBoxes 16+, Covered Individuals
14coveragesArray of HealthInsuranceCoverageBoxes 21-33, Coverage Information
Tax1095A Usage:

 

OFX / Types / Tax1095A_V100
#TagType
1 SRVRTID ServerIdType
2 TAXYEAR YearType
3 VOID BooleanType
4 CORRECTED BooleanType
5 MARKETPLACEIDENTIFIER GenericNameType
6 MARKETASSIGNEDPOLICYNUM GenericNameType
7 POLICYISSUERNAME GenericNameType
8 RECIPIENTINFO RecipientInfo
9 POLICYSTARTDATE DateTimeType
10 POLICYTERMINATIONDATE DateTimeType
11 COVERAGEHOUSEHOLD CoverageHouseholdType
12 HOUSEHOLDINFO HouseholdInformationType
13 TOTALPLANPREMIUMAMT AmountType
14 TOTALPREMIUMSLCSPAMT AmountType
15 TOTALADVANCEPTCAMT AmountType
Usages:

 

FIRE

This form is not reported in the IRS FIRE system.

TXF

The TXF standard does not support this form.

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