1095-A : Health Insurance Marketplace Statement

FDX

#	Id	Type	Description
1	marketplaceId	string	Box 1, Marketplace identifier
2	marketplacePolicyNumber	string	Box 2, Marketplace-assigned policy number
3	policyIssuerName	string	Box 3, Policy issuer's name
4	recipientName	string	Box 4, Recipient's name
5	recipientTin	string	Box 5, Recipient's SSN
6	recipientDateOfBirth	DateString	Box 6, Recipient's date of birth
7	spouseName	string	Box 7, Recipient's spouse's name
8	spouseTin	string	Box 8, Recipient's spouse's SSN
9	spouseDateOfBirth	DateString	Box 9, Recipient's spouse's date of birth
10	policyStartDate	DateString	Box 10, Policy start date
11	policyTerminationDate	DateString	Box 11, Policy termination date
12	recipientAddress	Address	Boxes 12-15, Recipient address
13	coveredIndividuals	Array of HealthInsuranceMarketplaceCoveredIndividual	Boxes 16+, Covered Individuals
14	coverages	Array of HealthInsuranceCoverage	Boxes 21-33, Coverage Information

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The TXF standard does not support this form.