1095-B : Health Coverage

FDX

#	Id	Type	Description
1	responsibleName	IndividualName	Box 1, Name of responsible individual
2	responsibleTin	string	Box 2, Social security number (SSN or other TIN)
3	responsibleDateOfBirth	DateString	Box 3, Date of birth (if SSN or other TIN is not available)
4	responsibleAddress	Address	Boxes 4-7, Address of responsible individual
5	originOfHealthCoverageCode	string	Box 8, Enter letter identifying Origin of the Health Coverage
6	employerNameAddress	NameAddress	Boxes 10, 12-15, Employer name and address
7	employerTin	string	Box 11, Employer identification number (EIN)
8	issuerNameAddress	NameAddressPhone	Boxes 16, 18-22, Issuer name, address, and phone
9	issuerTin	string	Box 17, Employer identification number (EIN)
10	coveredIndividuals	Array of HealthInsuranceCoveredIndividual	Boxes 23+, Covered Individuals

This form is not reported in the IRS FIRE system.

The TXF standard does not support this form.