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Form 8963: Report of Health Insurance Provider Information
IRS Form 8963 is the Report of Health Insurance Provider Information used to report net premiums written for U.S. health risks; covered entities providing such insurance must file it by April 15 of the fee year, and those with over $25 million in premiums must file electronically.
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IRS Form 8963 - Report of Health Insurance Provider Information
IRS Form 8963 is the Report of Health Insurance Provider Information used to report net premiums written for U.S. health risks; covered entities providing such insurance must file it by April 15 of the fee year, and those with over $25 million in premiums must file electronically.
Risk Radar
Scan points- 1Failing to file electronically when net premiums exceed $25 million results in the return not being considered filed.
- 2Filing electronically when net premiums are $25 million or less, contrary to the electronic‑filing requirement.
- 3Submitting a paper Form 8963 without a manual signature when filing electronically.
- 4Omitting the first line of Schedule A that requires the NAIC company and group code and net premiums.
- 5Entering the EIN with a dash in an electronic filing instead of the 9‑digit format.
Plain English
Form 8963 tells the IRS how much money a health‑insurance provider earned from U.S. health risks in the previous year. The agency uses that number to calculate the annual fee the provider must pay under the Affordable Care Act. It must be filed each fee year.
Submission Date
- Filing date: 2020-02-18 22:13:09
- Preparation window: collect IDs, supporting records, and signatures in advance.
- Final review: verify names, dates, and required fields before submission.
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What this form is for
- Use this form when a covered entity provides health insurance for any U.S. health risk during the fee year and must report net premiums written.
- Check Form 8453-R instead when filing electronically, as the electronic filing declaration must be uploaded with Form 8963.
Form selector
Use this form or another form?
Net premiums > $25 million
Electronic filing required; Form 8453-R provides the required signature declaration
✓ Confirm electronic filing eligibility
Filing by paper
Paper submission allowed when net premiums ≤ $25 million
✓ Verify paper filing address
Corrected report needed
Corrected Forms must be filed electronically if over $25 million
✓ Ensure correction details are complete
Deadline or filing window
The filing is triggered by the fee year; the form is due April 15 of that year. No extension is mentioned in the instructions. The deadline applies to both original and corrected reports.
Checklist
What you need before filling it out
Net premiums written
Amount of net premiums for U.S. health risks · Part I of Form 8963
Signature of Official
Date, phone, fax, name, title · Part I signature block
Electronic filing declaration
Completed Form 8453-R attached · When filing electronically
Mailing address
IRS address for paper filing · Mailing instructions section
Alternate Contact Person info
Name, title, phone, fax · Part II alternate contact section
Before you submit
- 1Verify net premiums exceed $25 million threshold if applicable
- 2Determine filing method (electronic vs. paper) based on premium amount
- 3Complete all required fields on Form 8963
- 4If filing electronically, ensure Form 8453-R is completed and attached
- 5If filing paper, manually sign Form 8963
- 6Confirm the filing deadline is April 15, 2020
- 7If mailing, use the IRS address 1973 Rulon White Blvd. Mail Stop 4916 IPF Ogden, UT 84201-0051
- 8Fax the paper submission to 877-797-0235
- 9Request acknowledgment via email to [email protected] if desired
- 10Retain a copy of the acknowledgment or receipt
How to file this form
- 1Determine filing method based on net premiums — proof: method selected
- 2Complete Form 8963 with net premiums and required information — proof: completed form
- 3If filing electronically, upload Form 8453-R with electronic signature — proof: electronic acknowledgment receipt
- 4If filing paper, manually sign Form 8963 — proof: signed form
- 5Mail the paper form to the IRS address — proof: mailing receipt or tracking number
- 6Fax the mailed form to 877-797-0235 — proof: fax confirmation
- 7Save the electronic acknowledgment or delivery receipt — proof: retained copy
Known limitations
- 1The form does not apply to entities that are not covered entities as defined in the instructions.
- 2The form does not apply to providers that did not write net premiums for U.S. health risks during the fee year.
- 3The form does not apply to reporting data for health risks outside the calendar year immediately preceding the fee year.
Field map
Compact field-by-field guide
Entity Info
1 items
Name and taxpayer ID of the entity claiming the credit.
Credit Info
1 items
Type of credit or incentive being claimed.
Calculation
2 items
The base amount used to calculate the credit.
Calculated credit amount after applying formulas and limitations.
Certification
1 items
Detailed breakdown supporting the credit calculation.
Signatures
1 items
Sign and date the form.
Almost done reviewing the fields?
Fillable formOpen in Editor->The form is the Rev. January 2020 edition; the instructions point to IRS.gov/Form8963 for the latest information, and they note that entities reporting more than $25 million in net premiums must file electronically.
What changed or needs a fresh check
- Edition date — confirm the revision reads January 2020
- Fee — confirm the filing deadline is April 15, 2020
- Mailing address — confirm the address is Internal Revenue Service 1973 Rulon White Blvd. Mail Stop 4916 IPF Ogden, UT 84201-0051
- Signature — confirm manual signature for paper filing or upload Form 8453-R for electronic filing
Quick Facts
Downloads
After you file
- 1Retain a copy of the filed Form 8963 and any electronic acknowledgment for your records.
- 2If filed electronically, expect an electronic acknowledgment after the transaction and keep it with your records.
- 3If you mailed a paper Form 8963, also fax the form to 877-797-0235 as instructed.
- 4To correct an error, file a corrected Form 8963 (including any required Form 8453-R) using the same filing method.
- 5When filing electronically, upload the completed fillable version of the form; do not print and scan the form.
Sources
- SRCInstructions p.1 — filing deadline is April 15, 2020.
- SRCInstructions p.1 — entities with net premiums over $25 million must file electronically.
- SRCInstructions p.1 — paper filing address is Internal Revenue Service 1973 Rulon White Blvd. Mail Stop 4916 IPF Ogden, UT 84201-0051.
- SRCInstructions p.1 — paper filers must also fax the form to 877-797-0235.
- SRCInstructions p.2 — electronic filing requires uploading the completed fillable version and not printing/scanning.
- SRCInstructions p.2 — manual signature is required for paper filing; electronic filing uses Form 8453-R.
- SRCInstructions p.1 — electronic acknowledgment is provided after e‑file and should be kept with records.
- SRCInstructions p.1 — public disclosure note states information on this form is not confidential.
Common confusion points
Do I need to file electronically if my net premiums are $30 million?
Electronic filing is required for net premiums over $25 million.
→ Verify that net premiums exceed $25 million; then use e‑file.
Can I submit a paper Form 8963 if I have $30 million in premiums?
Paper filing is not accepted for entities required to file electronically.
→ Check the $25 million threshold; if exceeded, use e‑file.
Do I have to sign the form if I file electronically?
Electronic filing uses Form 8453‑R for signature, not a manual signature on Form 8963.
→ Upload a signed Form 8453‑R with the electronic submission.
What is the filing deadline for the 2020 fee year?
The deadline is stated as April 15, 2020.
→ Confirm the deadline reads April 15 2020 on the instructions.
Do I need to send the form by first‑class mail?
The instructions require first‑class mail for paper filings, though private delivery services may be used.
→ Use first‑class mail or a permitted private carrier.
Will the information I provide be kept confidential?
The form’s information is not subject to confidentiality under section 6103.
→ Do not include personal data beyond what the form requests.
Workflow map
Related forms and next steps
Before
Current
After
Often used with
⚠ If something goes wrong
- Form 8453-R – file a corrected Form 8963 with a new Form 8453-R to replace the original submission.
Questions about IRS Form 8963
What is IRS Form 8963 used for?
Form 8963 tells the IRS how much money a health‑insurance provider earned from U.S. health risks in the previous year. The agency uses that number to calculate the annual fee the provider must pay under the Affordable Care Act. It must be filed each fee year.
Who must file IRS Form 8963?
A covered entity that provides health insurance for any U.S. health risk during the fee year must file IRS Form 8963.
What information does IRS Form 8963 require?
The form collects the provider’s net premiums written, the NAIC company and group code, and required consents on Schedule A, plus the filer’s EIN and other identifying information.
When is IRS Form 8963 due?
You must file Form 8963 by April 15, 2020.
Where do I file IRS Form 8963?
If electronic filing is required, submit the form through IRS e‑file; otherwise you may fax the completed Form 8963 to 877‑797‑0235.
How do I complete IRS Form 8963?
Complete the first line of Schedule A with the NAIC company and group code and net premiums, then check the appropriate box (2a or 2b) if you are an agent or designated entity. Sign Part I on page 1; for paper filings sign manually, for electronic filings upload Form 8453‑R with the signed form. If you have more than $25 million in net premiums, file the form electronically; otherwise you may file by paper or fax.
Do I need to file electronically if my net premiums are $30 million?
Electronic filing is required for net premiums over $25 million. Verify that net premiums exceed $25 million; then use e‑file.
Can I submit a paper Form 8963 if I have $30 million in premiums?
Paper filing is not accepted for entities required to file electronically. Check the $25 million threshold; if exceeded, use e‑file.
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