Tax1095B_V100
OFX / Types / Tax1095B_V100
| # | Tag | Type |
|---|---|---|
| 1 | SRVRTID | ServerIdType |
| 2 | TAXYEAR | YearType |
| 3 | VOID | BooleanType |
| 4 | CORRECTED | BooleanType |
| 5 | RESPONSIBLEINDIV | anonymous complex type |
| 6 | ORIGINOFPOLICYCD | anonymous simple type |
| 7 | SHOPIDENTIFIER | GenericNameType |
| 8 | EMPLOYERSPONSORED | Employer |
| 9 | ISSUERORPROVIDER | Employer |
| 10 | CONTACTPERSONPHONE | PhoneType |
| 11 | COVEREDINDIVIDUAL | CoveredIndivGrpType |
Usages:
- Tax1095Response TAX1095B_V100
XSD
<xsd:complexType name="Tax1095B_V100">
<xsd:annotation>
<xsd:documentation>The OFX element "TAX1095B_V100" is of type "Tax1095B_V100"</xsd:documentation>
</xsd:annotation>
<xsd:complexContent>
<xsd:extension base="ofx:AbstractTaxForm1095">
<xsd:sequence>
<xsd:element name="RESPONSIBLEINDIV" minOccurs="0">
<xsd:annotation>
<xsd:documentation>The name of the responsible individual on the health plan</xsd:documentation>
</xsd:annotation>
<xsd:complexType>
<xsd:sequence>
<xsd:choice>
<xsd:element name="SSN" type="ofx:GenericNameType"/>
<xsd:element name="BIRTHDATE" type="ofx:DateTimeType">
<xsd:annotation>
<xsd:documentation>The date of birth of the responsible individual IF no SSN was provided</xsd:documentation>
</xsd:annotation>
</xsd:element>
</xsd:choice>
<xsd:element name="NAME" type="ofx:GenericNameType">
<xsd:annotation>
<xsd:documentation>First, Middle Intitial, Last name</xsd:documentation>
</xsd:annotation>
</xsd:element>
<xsd:element name="ADDR1" type="ofx:AddressType"/>
<xsd:element name="ADDR2" type="ofx:AddressType" minOccurs="0"/>
<xsd:element name="CITY" type="ofx:AddressType"/>
<xsd:element name="STATE" type="ofx:StateType"/>
<xsd:element name="POSTALCODE" type="ofx:ZipType"/>
<xsd:element name="COUNTRYSTRING" type="ofx:CountryStringType" minOccurs="0"/>
</xsd:sequence>
</xsd:complexType>
</xsd:element>
<xsd:element name="ORIGINOFPOLICYCD" minOccurs="0">
<xsd:annotation>
<xsd:documentation>Origin of Policy code from instructions. One of the following: A,B,C,D,E,F</xsd:documentation>
</xsd:annotation>
<xsd:simpleType>
<xsd:restriction base="xsd:string">
<xsd:length value="1"/>
<xsd:enumeration value="A"/>
<xsd:enumeration value="B"/>
<xsd:enumeration value="C"/>
<xsd:enumeration value="D"/>
<xsd:enumeration value="E"/>
<xsd:enumeration value="F"/>
</xsd:restriction>
</xsd:simpleType>
</xsd:element>
<xsd:element name="SHOPIDENTIFIER" type="ofx:GenericNameType" minOccurs="0">
<xsd:annotation>
<xsd:documentation>The ID of the Small Business Health Options Program (SHOP). If applicable.
</xsd:documentation>
</xsd:annotation>
</xsd:element>
<xsd:element name="EMPLOYERSPONSORED" type="ofx:Employer" minOccurs="0">
<xsd:annotation>
<xsd:documentation>Present if Insurance company provides employer-sponsored health coverage. Will be blank if NOT insured employer covereage. </xsd:documentation>
</xsd:annotation>
</xsd:element>
<xsd:element name="ISSUERORPROVIDER" type="ofx:Employer" minOccurs="0">
<xsd:annotation>
<xsd:documentation>Provider Information </xsd:documentation>
</xsd:annotation>
</xsd:element>
<xsd:element name="CONTACTPERSONPHONE" type="ofx:PhoneType" minOccurs="0">
<xsd:annotation>
<xsd:documentation>Contact phone number for the Coverage Provider who can answer questions regarding the form.</xsd:documentation>
</xsd:annotation>
</xsd:element>
<xsd:element name="COVEREDINDIVIDUAL" type="ofx:CoveredIndivGrpType" minOccurs="0" maxOccurs="unbounded">
<xsd:annotation>
<xsd:documentation>Covered individual info</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>
<TAX1095B_V100>
<SRVRTID>e5d4ee73bd1-9295-480f-a426-1095-B</SRVRTID>
<TAXYEAR>2020</TAXYEAR>
<RESPONSIBLEINDIV>
<SSN>xxx-xx-1234</SSN>
<BIRTHDATE>19950303</BIRTHDATE>
<NAME>Kris Q Public</NAME>
<ADDR1>1 Main St</ADDR1>
<CITY>Melrose</CITY>
<STATE>NY</STATE>
<POSTALCODE>12121</POSTALCODE>
<COUNTRYSTRING>US</COUNTRYSTRING>
</RESPONSIBLEINDIV>
<ORIGINOFPOLICYCD>B</ORIGINOFPOLICYCD>
<EMPLOYERSPONSORED>
<FEDIDNUMBER>12-3456789</FEDIDNUMBER>
<NAME1>Financial Data Exchange</NAME1>
<ADDR1>12020 Sunrise Valley Dr</ADDR1>
<ADDR2>Suite 230</ADDR2>
<CITY>Prescott</CITY>
<STATE>VA</STATE>
<POSTALCODE>20191</POSTALCODE>
</EMPLOYERSPONSORED>
<ISSUERORPROVIDER>
<FEDIDNUMBER>99-0011223</FEDIDNUMBER>
<NAME1>American People Health</NAME1>
<ADDR1>1718-1/2 Oak Blvd</ADDR1>
<CITY>Austin</CITY>
<STATE>TX</STATE>
<POSTALCODE>78735</POSTALCODE>
</ISSUERORPROVIDER>
<CONTACTPERSONPHONE>888-555-1212</CONTACTPERSONPHONE>
<COVEREDINDIVIDUAL>
<PERSONNM>Kris Q Public</PERSONNM>
<SSN>xxx-xx-1234</SSN>
<PERSONBIRTHDT>19950313</PERSONBIRTHDT>
<ALLYEARIND>Y</ALLYEARIND>
<JANUARYIND>Y</JANUARYIND>
<FEBRUARYIND>Y</FEBRUARYIND>
<MARCHIND>Y</MARCHIND>
<APRILIND>Y</APRILIND>
<MAYIND>Y</MAYIND>
<JUNEIND>Y</JUNEIND>
<JULYIND>Y</JULYIND>
<AUGUSTIND>Y</AUGUSTIND>
<SEPTEMBERIND>Y</SEPTEMBERIND>
<OCTOBERIND>Y</OCTOBERIND>
<NOVEMBERIND>Y</NOVEMBERIND>
<DECEMBERIND>Y</DECEMBERIND>
</COVEREDINDIVIDUAL>
<COVEREDINDIVIDUAL>
<PERSONNM>Tracy R Public</PERSONNM>
<SSN>xxx-xx-4321</SSN>
<PERSONBIRTHDT>19950413</PERSONBIRTHDT>
<ALLYEARIND>Y</ALLYEARIND>
<JANUARYIND>Y</JANUARYIND>
<FEBRUARYIND>Y</FEBRUARYIND>
<MARCHIND>Y</MARCHIND>
<APRILIND>Y</APRILIND>
<MAYIND>Y</MAYIND>
<JUNEIND>Y</JUNEIND>
<JULYIND>Y</JULYIND>
<AUGUSTIND>Y</AUGUSTIND>
<SEPTEMBERIND>Y</SEPTEMBERIND>
<OCTOBERIND>Y</OCTOBERIND>
<NOVEMBERIND>Y</NOVEMBERIND>
<DECEMBERIND>Y</DECEMBERIND>
</COVEREDINDIVIDUAL>
</TAX1095B_V100>
</TAX1095RS>
</TAX1095TRNRS>
</TAX1095MSGSRSV1>
</OFX>
FDX 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" ]
} ]
}
}