Tax1095A_V100
OFX / Types / Tax1095A_V100
| # | Tag | Type |
|---|---|---|
| 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:
- Tax1095Response TAX1095A_V100
XSD
<xsd:complexType name="Tax1095A_V100"> <xsd:annotation> <xsd:documentation>The OFX element "TAX1095A_v100" is of type "Tax1095A_V100"</xsd:documentation> </xsd:annotation> <xsd:complexContent> <xsd:extension base="ofx:AbstractTaxForm1095"> <xsd:sequence> <xsd:element name="MARKETPLACEIDENTIFIER" type="ofx:GenericNameType"> <xsd:annotation> <xsd:documentation>Marketplace identifier</xsd:documentation> </xsd:annotation> </xsd:element> <xsd:element name="MARKETASSIGNEDPOLICYNUM" type="ofx:GenericNameType"> <xsd:annotation> <xsd:documentation>Marketplace assigned policy number</xsd:documentation> </xsd:annotation> </xsd:element> <xsd:element name="POLICYISSUERNAME" type="ofx:GenericNameType"> <xsd:annotation> <xsd:documentation>Name of the exchange providing the 1095-A</xsd:documentation> </xsd:annotation> </xsd:element> <xsd:element name="RECIPIENTINFO" type="ofx:RecipientInfo"> <xsd:annotation> <xsd:documentation>Recipient and Recipient Spouse(if applicable) info</xsd:documentation> </xsd:annotation> </xsd:element> <xsd:element name="POLICYSTARTDATE" type="ofx:DateTimeType"> <xsd:annotation> <xsd:documentation>Date policy coverage began</xsd:documentation> </xsd:annotation> </xsd:element> <xsd:element name="POLICYTERMINATIONDATE" type="ofx:DateTimeType" minOccurs="0"> <xsd:annotation> <xsd:documentation>Date policy coverage ended</xsd:documentation> </xsd:annotation> </xsd:element> <xsd:element name="COVERAGEHOUSEHOLD" type="ofx:CoverageHouseholdType" maxOccurs="unbounded"> <xsd:annotation> <xsd:documentation>Covered Individual Information Group</xsd:documentation> </xsd:annotation> </xsd:element> <xsd:element name="HOUSEHOLDINFO" type="ofx:HouseholdInformationType" maxOccurs="12"> <xsd:annotation> <xsd:documentation>Monthly premium anounts. </xsd:documentation> </xsd:annotation> </xsd:element> <xsd:element name="TOTALPLANPREMIUMAMT" type="ofx:AmountType"> <xsd:annotation> <xsd:documentation>Total Monthly Premium Amount</xsd:documentation> </xsd:annotation> </xsd:element> <xsd:element name="TOTALPREMIUMSLCSPAMT" type="ofx:AmountType"> <xsd:annotation> <xsd:documentation>Total monthly SLCSP Amount</xsd:documentation> </xsd:annotation> </xsd:element> <xsd:element name="TOTALADVANCEPTCAMT" type="ofx:AmountType"> <xsd:annotation> <xsd:documentation>Total Monthly Advanced PTC Amount</xsd:documentation> </xsd:annotation> </xsd:element> </xsd:sequence> </xsd:extension> </xsd:complexContent> </xsd:complexType>
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>
<TAX1095A_V100>
<SRVRTID>e5d4ee73bd1-9295-480f-a426-1095-A</SRVRTID>
<TAXYEAR>2020</TAXYEAR>
<MARKETPLACEIDENTIFIER>10001</MARKETPLACEIDENTIFIER>
<MARKETASSIGNEDPOLICYNUM>20000002</MARKETASSIGNEDPOLICYNUM>
<POLICYISSUERNAME>American People Health</POLICYISSUERNAME>
<RECIPIENTINFO>
<RECIPIENTNAME>Kris Q. Public</RECIPIENTNAME>
<SSN>xxx-xx-1234</SSN>
<DOB>19950606</DOB>
<SPOUSENAME>Tracy R. Public</SPOUSENAME>
<SPOUSESSN>xxx-xxx-4321</SPOUSESSN>
<SPOUSEDOB>19950909</SPOUSEDOB>
<ADDR1>1 Main St</ADDR1>
<CITY>Melrose</CITY>
<STATE>NY</STATE>
<POSTALCODE>12121</POSTALCODE>
</RECIPIENTINFO>
<POLICYSTARTDATE>20200101</POLICYSTARTDATE>
<POLICYTERMINATIONDATE>20201231</POLICYTERMINATIONDATE>
<COVERAGEHOUSEHOLD>
<COVEREDINDIVNAME>Kris Q. Public</COVEREDINDIVNAME>
<COVEREDINDIVSSN>xxx-xx-1234</COVEREDINDIVSSN>
<COVEREDINDIVBIRTHDT>19950606</COVEREDINDIVBIRTHDT>
<COVEREDINDIVSTARTDT>20200101</COVEREDINDIVSTARTDT>
<COVEREDINDIVENDDT>20201231</COVEREDINDIVENDDT>
</COVERAGEHOUSEHOLD>
<COVERAGEHOUSEHOLD>
<COVEREDINDIVNAME>Tracy R. Public</COVEREDINDIVNAME>
<COVEREDINDIVSSN>xxx-xxx-4321</COVEREDINDIVSSN>
<COVEREDINDIVBIRTHDT>19950909</COVEREDINDIVBIRTHDT>
<COVEREDINDIVSTARTDT>20200101</COVEREDINDIVSTARTDT>
<COVEREDINDIVENDDT>20201231</COVEREDINDIVENDDT>
</COVERAGEHOUSEHOLD>
<HOUSEHOLDINFO>
<MONTHCD>JAN</MONTHCD>
<MONTHLYPLANPREMIUMAMT>21.14</MONTHLYPLANPREMIUMAMT>
<MONTHLYPREMIUMSLCSPAMT>21.14</MONTHLYPREMIUMSLCSPAMT>
<MONTHLYADVANCEPTCAMT>21.14</MONTHLYADVANCEPTCAMT>
</HOUSEHOLDINFO>
<HOUSEHOLDINFO>
<MONTHCD>FEB</MONTHCD>
<MONTHLYPLANPREMIUMAMT>22.14</MONTHLYPLANPREMIUMAMT>
<MONTHLYPREMIUMSLCSPAMT>22.14</MONTHLYPREMIUMSLCSPAMT>
<MONTHLYADVANCEPTCAMT>22.14</MONTHLYADVANCEPTCAMT>
</HOUSEHOLDINFO>
<HOUSEHOLDINFO>
<MONTHCD>MAR</MONTHCD>
<MONTHLYPLANPREMIUMAMT>23.14</MONTHLYPLANPREMIUMAMT>
<MONTHLYPREMIUMSLCSPAMT>23.14</MONTHLYPREMIUMSLCSPAMT>
<MONTHLYADVANCEPTCAMT>23.14</MONTHLYADVANCEPTCAMT>
</HOUSEHOLDINFO>
<HOUSEHOLDINFO>
<MONTHCD>APR</MONTHCD>
<MONTHLYPLANPREMIUMAMT>24.14</MONTHLYPLANPREMIUMAMT>
<MONTHLYPREMIUMSLCSPAMT>24.14</MONTHLYPREMIUMSLCSPAMT>
<MONTHLYADVANCEPTCAMT>24.14</MONTHLYADVANCEPTCAMT>
</HOUSEHOLDINFO>
<HOUSEHOLDINFO>
<MONTHCD>MAY</MONTHCD>
<MONTHLYPLANPREMIUMAMT>25.14</MONTHLYPLANPREMIUMAMT>
<MONTHLYPREMIUMSLCSPAMT>25.14</MONTHLYPREMIUMSLCSPAMT>
<MONTHLYADVANCEPTCAMT>25.14</MONTHLYADVANCEPTCAMT>
</HOUSEHOLDINFO>
<HOUSEHOLDINFO>
<MONTHCD>JUN</MONTHCD>
<MONTHLYPLANPREMIUMAMT>26.14</MONTHLYPLANPREMIUMAMT>
<MONTHLYPREMIUMSLCSPAMT>26.14</MONTHLYPREMIUMSLCSPAMT>
<MONTHLYADVANCEPTCAMT>26.14</MONTHLYADVANCEPTCAMT>
</HOUSEHOLDINFO>
<HOUSEHOLDINFO>
<MONTHCD>JUL</MONTHCD>
<MONTHLYPLANPREMIUMAMT>27.14</MONTHLYPLANPREMIUMAMT>
<MONTHLYPREMIUMSLCSPAMT>27.14</MONTHLYPREMIUMSLCSPAMT>
<MONTHLYADVANCEPTCAMT>27.14</MONTHLYADVANCEPTCAMT>
</HOUSEHOLDINFO>
<HOUSEHOLDINFO>
<MONTHCD>AUG</MONTHCD>
<MONTHLYPLANPREMIUMAMT>28.14</MONTHLYPLANPREMIUMAMT>
<MONTHLYPREMIUMSLCSPAMT>28.14</MONTHLYPREMIUMSLCSPAMT>
<MONTHLYADVANCEPTCAMT>28.14</MONTHLYADVANCEPTCAMT>
</HOUSEHOLDINFO>
<HOUSEHOLDINFO>
<MONTHCD>SEP</MONTHCD>
<MONTHLYPLANPREMIUMAMT>29.14</MONTHLYPLANPREMIUMAMT>
<MONTHLYPREMIUMSLCSPAMT>29.14</MONTHLYPREMIUMSLCSPAMT>
<MONTHLYADVANCEPTCAMT>29.14</MONTHLYADVANCEPTCAMT>
</HOUSEHOLDINFO>
<HOUSEHOLDINFO>
<MONTHCD>OCT</MONTHCD>
<MONTHLYPLANPREMIUMAMT>30.14</MONTHLYPLANPREMIUMAMT>
<MONTHLYPREMIUMSLCSPAMT>30.14</MONTHLYPREMIUMSLCSPAMT>
<MONTHLYADVANCEPTCAMT>30.14</MONTHLYADVANCEPTCAMT>
</HOUSEHOLDINFO>
<HOUSEHOLDINFO>
<MONTHCD>NOV</MONTHCD>
<MONTHLYPLANPREMIUMAMT>31.14</MONTHLYPLANPREMIUMAMT>
<MONTHLYPREMIUMSLCSPAMT>31.14</MONTHLYPREMIUMSLCSPAMT>
<MONTHLYADVANCEPTCAMT>31.14</MONTHLYADVANCEPTCAMT>
</HOUSEHOLDINFO>
<HOUSEHOLDINFO>
<MONTHCD>DEC</MONTHCD>
<MONTHLYPLANPREMIUMAMT>32.14</MONTHLYPLANPREMIUMAMT>
<MONTHLYPREMIUMSLCSPAMT>32.14</MONTHLYPREMIUMSLCSPAMT>
<MONTHLYADVANCEPTCAMT>32.14</MONTHLYADVANCEPTCAMT>
</HOUSEHOLDINFO>
<TOTALPLANPREMIUMAMT>319.68</TOTALPLANPREMIUMAMT>
<TOTALPREMIUMSLCSPAMT>319.68</TOTALPREMIUMSLCSPAMT>
<TOTALADVANCEPTCAMT>319.68</TOTALADVANCEPTCAMT>
</TAX1095A_V100>
</TAX1095RS>
</TAX1095TRNRS>
</TAX1095MSGSRSV1>
</OFX>
FDX JSON
{
"tax1095A" : {
"taxYear" : 2022,
"taxFormId" : "e5d4ee73bd1-9295-480f-a426-1095-A",
"taxFormDate" : "2021-02-01",
"taxFormType" : "Tax1095A",
"marketplaceId" : "10001",
"marketplacePolicyNumber" : "20000002",
"policyIssuerName" : "American People Health",
"recipientName" : "Kris Q. Public",
"recipientTin" : "xxx-xx-1234",
"recipientDateOfBirth" : "1995-06-06",
"spouseName" : "Tracy R. Public",
"spouseTin" : "xxx-xxx-4321",
"spouseDateOfBirth" : "1995-09-09",
"policyStartDate" : "2020-01-01",
"policyTerminationDate" : "2020-12-31",
"recipientAddress" : {
"line1" : "1 Main St",
"city" : "Melrose",
"state" : "NY",
"postalCode" : "12121"
},
"coveredIndividuals" : [ {
"name" : "Kris Q. Public",
"tin" : "xxx-xx-1234",
"dateOfBirth" : "1995-06-06",
"policyStartDate" : "2020-01-01",
"policyTerminationDate" : "2020-12-31"
}, {
"name" : "Tracy R. Public",
"tin" : "xxx-xxx-4321",
"dateOfBirth" : "1995-09-09",
"policyStartDate" : "2020-01-01",
"policyTerminationDate" : "2020-12-31"
} ],
"coverages" : [ {
"enrollmentPremium" : 21.14,
"slcspPremium" : 21.14,
"advancePremiumTaxCreditPayment" : 21.14,
"month" : "JANUARY"
}, {
"enrollmentPremium" : 22.14,
"slcspPremium" : 22.14,
"advancePremiumTaxCreditPayment" : 22.14,
"month" : "FEBRUARY"
}, {
"enrollmentPremium" : 23.14,
"slcspPremium" : 23.14,
"advancePremiumTaxCreditPayment" : 23.14,
"month" : "MARCH"
}, {
"enrollmentPremium" : 24.14,
"slcspPremium" : 24.14,
"advancePremiumTaxCreditPayment" : 24.14,
"month" : "APRIL"
}, {
"enrollmentPremium" : 25.14,
"slcspPremium" : 25.14,
"advancePremiumTaxCreditPayment" : 25.14,
"month" : "MAY"
}, {
"enrollmentPremium" : 26.14,
"slcspPremium" : 26.14,
"advancePremiumTaxCreditPayment" : 26.14,
"month" : "JUNE"
}, {
"enrollmentPremium" : 27.14,
"slcspPremium" : 27.14,
"advancePremiumTaxCreditPayment" : 27.14,
"month" : "JULY"
}, {
"enrollmentPremium" : 28.14,
"slcspPremium" : 28.14,
"advancePremiumTaxCreditPayment" : 28.14,
"month" : "AUGUST"
}, {
"enrollmentPremium" : 29.14,
"slcspPremium" : 29.14,
"advancePremiumTaxCreditPayment" : 29.14,
"month" : "SEPTEMBER"
}, {
"enrollmentPremium" : 30.14,
"slcspPremium" : 30.14,
"advancePremiumTaxCreditPayment" : 30.14,
"month" : "OCTOBER"
}, {
"enrollmentPremium" : 31.14,
"slcspPremium" : 31.14,
"advancePremiumTaxCreditPayment" : 31.14,
"month" : "NOVEMBER"
}, {
"enrollmentPremium" : 32.14,
"slcspPremium" : 32.14,
"advancePremiumTaxCreditPayment" : 32.14,
"month" : "DECEMBER"
}, {
"enrollmentPremium" : 319.68,
"slcspPremium" : 319.68,
"advancePremiumTaxCreditPayment" : 319.68,
"month" : "ANNUAL"
} ]
}
}