If more than one Form 1095-A is filed for coverage of the recipient’s family for the same months because, for example, a family member enrolled in a separate policy, include the portion of the premium for pediatric dental coverage in the amount in column A on only one Form 1095-A. If a covered individual is enrolled in a stand-alone dental plan, include the portion of the premiums for the stand-alone dental plan that is allocable to pediatric dental coverage in the total monthly enrollment premiums. Include only the premiums allocable to essential health benefits. Įnter the total monthly enrollment premiums for the policy in which the covered individuals enrolled. If the coverage was in effect at the end of the year, enter. Enter in column E the date of termination if the individual's coverage was terminated during the year. Enter in column D the date the coverage started for the individual. Information about individuals enrolled in the same policy as the tax filer’s tax family who are not members of that tax family, including children, must be reported on a separate Form 1095-A.įor each line, enter a date of birth in column C only if column B is blank. If advance credit payments were made for the coverage or a tax family can be identified, enter in Part II information only for covered individuals whom the tax filer certified at enrollment would be a part of the tax filer's tax family. If advance credit payments were not made for any coverage under the policy and a tax family cannot be identified, enter in Part II information for all covered individuals. If mailed, the statement must be sent to the recipient’s last known permanent address, or if no permanent address is known, to the recipient’s temporary address.Įnter on lines 16 through 20 and columns A through E information for each individual covered under the policy, including the recipient and the recipient's spouse, if covered. Statements must be furnished to recipients on paper by mail, unless a recipient affirmatively consents to receive the statement in an electronic format. Truncation isn't allowed on forms filed with the IRS. On Form 1095-A statements furnished to recipients, filers of Form 1095-A may truncate the social security number (SSN) of an individual receiving coverage by showing only the last four digits of the SSN and replacing the first five digits with asterisks (*) or Xs. See the instructions for Part III, column A. Don't furnish a Form 1095-A for a catastrophic health plan or a stand-alone dental plan. See the instructions for line 4 for more information about who is a recipient. If two or more tax filers are enrolled in one policy, each tax filer receives a statement reporting coverage of only the members of that tax filer's tax family (a tax family may include the tax filer, the tax filer’s spouse if the tax filer is filing a joint return with his or her spouse, and the tax filer’s dependents).
A separate Form 1095-A must be furnished for each policy, and the information on the Form 1095-A should relate only to that policy. Marketplaces use Form 1095-A to furnish the required statement to recipients. Furnishing required information to the individual.