Tax Documents
Tax1095B
FDX / Data Structures / Tax1095B
Form 1095-B, Health Coverage
Extends and inherits all fields from Tax
Tax1095B Properties
| # | 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 |
Tax1095B Usage:
- TaxData tax1095B
FDX Data Structure as JSON
{
"tax1095B" : {
"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"
},
"responsibleName" : {
"first" : "string",
"middle" : "string",
"last" : "string",
"suffix" : "string"
},
"responsibleTin" : "string",
"responsibleDateOfBirth" : "2020-07-01",
"responsibleAddress" : {
"line1" : "String64",
"line2" : "String64",
"line3" : "String64",
"city" : "String64",
"state" : "String64",
"postalCode" : "string",
"country" : "AD"
},
"originOfHealthCoverageCode" : "string",
"employerNameAddress" : {
"line1" : "String64",
"line2" : "String64",
"line3" : "String64",
"city" : "String64",
"state" : "String64",
"postalCode" : "string",
"country" : "AD",
"name1" : "String64",
"name2" : "String64"
},
"employerId" : "string",
"employerTin" : "string",
"issuerNameAddressPhone" : {
"line1" : "String64",
"line2" : "String64",
"line3" : "String64",
"city" : "String64",
"state" : "String64",
"postalCode" : "string",
"country" : "AD",
"name1" : "String64",
"name2" : "String64",
"phone" : {
"type" : "HOME",
"country" : "string",
"number" : "string",
"extension" : "string"
}
},
"issuerNameAddress" : {
"line1" : "String64",
"line2" : "String64",
"line3" : "String64",
"city" : "String64",
"state" : "String64",
"postalCode" : "string",
"country" : "AD",
"name1" : "String64",
"name2" : "String64",
"phone" : {
"type" : "HOME",
"country" : "string",
"number" : "string",
"extension" : "string"
}
},
"issuerId" : "string",
"issuerTin" : "string",
"coveredIndividuals" : [ {
"name" : {
"first" : "string",
"middle" : "string",
"last" : "string",
"suffix" : "string"
},
"tin" : "string",
"dateOfBirth" : "2020-07-01",
"coveredAt12Months" : true,
"coveredMonths" : [ "JAN" ]
} ]
}
}
Example Form PDF
Example Form JSON
{
"tax1095B" : {
"taxYear" : 2022,
"taxFormId" : "e5d4ee73bd1-9295-480f-a426-1095-B",
"taxFormDate" : "2021-03-30",
"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" : "12021 Sunset Valley Dr",
"line2" : "Suite 230",
"city" : "Preston",
"state" : "VA",
"postalCode" : "20191",
"country" : "US",
"name1" : "Tax Form Issuer, Inc"
},
"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",
"coveredAll12Months" : 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",
"coveredAll12Months" : true,
"coveredMonths" : [ "JAN", "FEB", "MAR", "APR", "MAY", "JUN", "JUL", "AUG", "SEP", "OCT", "NOV", "DEC" ]
} ]
}
}
Example Form JSON for QR Code Purposes
Example Data As Flattened Map (Key, Value Pairs)
{
"taxYear": "2022",
"taxFormId": "e5d4ee73bd1-9295-480f-a426-1095-B",
"taxFormDate": "2021-03-30",
"taxFormType": "Tax1095B",
"responsibleName.first": "Kris",
"responsibleName.middle": "Q",
"responsibleName.last": "Public",
"responsibleTin": "xxx-xx-1234",
"responsibleDateOfBirth": "1995-03-03",
"responsibleAddress.line1": "1 Main St",
"responsibleAddress.city": "Melrose",
"responsibleAddress.state": "NY",
"responsibleAddress.postalCode": "12121",
"responsibleAddress.country": "US",
"originOfHealthCoverageCode": "B",
"employerNameAddress.line1": "12021 Sunset Valley Dr",
"employerNameAddress.line2": "Suite 230",
"employerNameAddress.city": "Preston",
"employerNameAddress.state": "VA",
"employerNameAddress.postalCode": "20191",
"employerNameAddress.country": "US",
"employerNameAddress.name1": "Tax Form Issuer, Inc",
"employerTin": "12-3456789",
"issuerNameAddress.line1": "1718-1/2 Oak Blvd",
"issuerNameAddress.city": "Austin",
"issuerNameAddress.state": "TX",
"issuerNameAddress.postalCode": "78735",
"issuerNameAddress.country": "US",
"issuerNameAddress.name1": "American People Health",
"issuerNameAddress.phone.number": "8885551212",
"issuerTin": "99-0011223",
"coveredIndividuals-1.name.first": "Kris",
"coveredIndividuals-1.name.middle": "Q",
"coveredIndividuals-1.name.last": "Public",
"coveredIndividuals-1.tin": "xxx-xx-1234",
"coveredIndividuals-1.dateOfBirth": "1995-03-13",
"coveredIndividuals-1.coveredAll12Months": "true",
"coveredIndividuals-1.coveredMonths-1": "JAN",
"coveredIndividuals-1.coveredMonths-2": "FEB",
"coveredIndividuals-1.coveredMonths-3": "MAR",
"coveredIndividuals-1.coveredMonths-4": "APR",
"coveredIndividuals-1.coveredMonths-5": "MAY",
"coveredIndividuals-1.coveredMonths-6": "JUN",
"coveredIndividuals-1.coveredMonths-7": "JUL",
"coveredIndividuals-1.coveredMonths-8": "AUG",
"coveredIndividuals-1.coveredMonths-9": "SEP",
"coveredIndividuals-1.coveredMonths-10": "OCT",
"coveredIndividuals-1.coveredMonths-11": "NOV",
"coveredIndividuals-1.coveredMonths-12": "DEC",
"coveredIndividuals-2.name.first": "Tracy",
"coveredIndividuals-2.name.middle": "R",
"coveredIndividuals-2.name.last": "Public",
"coveredIndividuals-2.tin": "xxx-xx-4321",
"coveredIndividuals-2.dateOfBirth": "1995-04-13",
"coveredIndividuals-2.coveredAll12Months": "true",
"coveredIndividuals-2.coveredMonths-1": "JAN",
"coveredIndividuals-2.coveredMonths-2": "FEB",
"coveredIndividuals-2.coveredMonths-3": "MAR",
"coveredIndividuals-2.coveredMonths-4": "APR",
"coveredIndividuals-2.coveredMonths-5": "MAY",
"coveredIndividuals-2.coveredMonths-6": "JUN",
"coveredIndividuals-2.coveredMonths-7": "JUL",
"coveredIndividuals-2.coveredMonths-8": "AUG",
"coveredIndividuals-2.coveredMonths-9": "SEP",
"coveredIndividuals-2.coveredMonths-10": "OCT",
"coveredIndividuals-2.coveredMonths-11": "NOV",
"coveredIndividuals-2.coveredMonths-12": "DEC"
}
Issuer Instructions
