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Form 8963: Report of Health Insurance Provider Information
IRS Form 8963 is used to Report of Health Insurance Provider Information for a covered entity providing health insurance for U.S. risks. Entities with more than $25 million in net premiums written must file this form electronically by April 15, 2020.
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IRS Form 8963 - Report of Health Insurance Provider Information
IRS Form 8963 is used to Report of Health Insurance Provider Information for a covered entity providing health insurance for U.S. risks. Entities with more than $25 million in net premiums written must file this form electronically by April 15, 2020.
Risk Radar
Scan points- 1If you exceed $25M in net premiums written, the form MUST be filed electronically to count as submitted.
- 2Failing to file electronically if net premiums written exceed $25 million.
- 3Not signing Part I of Form 8963 when filing by paper.
- 4Omitting the EIN on Form 8963 if it is not available (must apply for one).
- 5Forgetting to complete Schedule A if listing controlled group members.
Plain English
This form tells the IRS how much money your company earned from selling health insurance coverage across the United States during a specific year. The information helps the IRS calculate the annual fee that your provider must pay under the Affordable Care Act (ACA).
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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Glossary Terms
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What this form is for
- Use this form when a covered entity provides health insurance for U.S. health risks during a fee year and must report net premiums written.
- Do not use it when you are filing to report an event that occurred outside of the data year (the calendar year immediately preceding the fee year).
- Check Form 8453-R instead when electronically filing, as this form is used for the Electronic Filing Declaration for Form 8963.
Form selector
Use this form or another form?
Filing by Mail
Use this if you are not required to file electronically and prefer paper submission.
✓ Check mailing address details.
Electronic Filing Required
Must be filed electronically if net premiums written exceed $25 million.
✓ Verify electronic filing requirement based on your revenue.
Filing with Third Party
Use this format when receiving mail in care of an accountant or attorney.
✓ Ensure C/O and Address (continued) lines are correctly populated.
Deadline or filing window
The filing deadline for Form 8963 is April 15, 2020. This applies to the fee year during which the annual health insurance provider fee is due. The instructions do not specify an extension period.
Checklist
What you need before filling it out
Purpose
Report net premiums written for U.S. health risks · Instructions p.1
Filer Requirement
Covered entity providing health insurance for any U.S. health risk during the 2020 fee year · Instructions p.1
Electronic Filing Threshold
More than $25 million in net premiums written · Instructions p.1
Paper Mailing Address
1973 Rulon White Blvd., Ogden, UT 84201-0051 · Instructions p.1
Electronic Filing Method
IRS e-file (or fax to 877-797-0235) · Instructions p.1
Designated Contact Info
Name, title, phone number, and fax number of the alternate contact person · Instructions p.2
Before you submit
- 1Verify that you are a covered entity providing health insurance for U.S. health risks.
- 2Confirm whether your net premiums written exceed $25 million, determining if electronic filing is mandatory.
- 3If mailing, ensure the form is in a flat envelope and not folded or taped/stapled.
- 4If using an alternate contact person, check the related box and provide all required details (name, title, phone, fax).
- 5For paper submission, manually sign the Form 8963.
- 6If filing electronically, ensure you upload the completed fillable version of the form along with Form 8453-R.
- 7Confirm that if mailing, you also fax a copy to 877-797-0235 (unless using overnight service).
How to file this form
- 1Complete all required fields on the Form 8963, ensuring proper formatting for addresses and signatures.
- 2If designating an alternate contact person, fill out Part II with their name, title, phone number, and fax number.
- 3Determine filing method: If over $25 million in net premiums written, electronically file via IRS e-file or fax to 877-797-0235; otherwise, prepare for mail submission.
- 4If mailing the paper form, send it to Internal Revenue Service, 1973 Rulon White Blvd., Mail Stop 4916 IPF, Ogden, UT 84201-0051, and also fax a copy.
- 5Upon completion of electronic filing, keep the electronic acknowledgment for your records.
Known limitations
- 1A covered entity must file Form 8963 if it provides health insurance for any U.S. health risk during the fee year, even if net premiums written are less than $25 million.
- 2If a covered entity has more than $25 million in net premiums written, its Form 8963 (including corrections) must be filed electronically and will not be considered filed unless it is submitted electronically.
- 3The information reported on Form 8963 is subject to public disclosure, meaning it is not confidential under section 6103, although returns are generally confidential.
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.
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Fillable formOpen in Editor->The current edition is January 2020 (Rev.). The instructions direct users to IRS.gov/Form8963 for the latest information regarding Form 8963.
What changed or needs a fresh check
- Edition date — confirm the revision reads January 2020.
- Filing Deadline — confirm the due date is April 15, 2020.
- Mailing address — confirm the IRS address is 1973 Rulon White Blvd., Ogden, UT 84201-0051.
- Signature — confirm you manually sign if filing paper or electronically uploading Form 8453-R with Form 8963.
- Electronic Requirement — confirm the threshold for electronic filing is more than $25 million in net premiums written.
Quick Facts
Downloads
After you file
- 1If filing electronically via IRS e-file, retain the electronic acknowledgment received upon completion of the transaction.
- 2If mailing Form 8963, keep a copy of the submitted paper form for your records.
- 3When sending forms by mail, if you are sending large packages, write your name on each package and number them consecutively.
- 4If filing electronically, do not manually sign the form; instead, manually sign, scan, and upload Form 8453-R with Form 8963.
Sources
- SRCInstructions p.1 — Form 8963 must be filed during each fee year to report net premiums written for U.S. health risks during the data year.
- SRCInstructions p.1 — A covered entity that provides health insurance for any U.S. health risk during the 2020 fee year must file Form 8963.
- SRCInstructions p.1 — The filing deadline for Form 8963 is April 15, 2020.
- SRCInstructions p.1 — Entities with more than $25 million in net premiums written must file Form 8963 electronically.
- SRCInstructions p.1 — If you are not required to file electronically and prefer paper filing, send it to Internal Revenue Service, 1973 Rulon White Blvd. Mail Stop 4916 IPF Ogden, UT 84201-0051.
- SRCInstructions p.2 — When filing electronically, you must manually sign, scan, and upload Form 8453-R with Form 8963.
- SRCInstructions p.1 — If you mail your form, it must also be faxed to 877-797-0235.
- SRCInstructions p.1 — To request an acknowledgment of receipt when mailing, email [email protected] with company information/tracking number.
Common confusion points
Must I file a paper copy if my company has less than $25 million in net premiums written?
The source states that entities reporting more than $25 million must file electronically, implying those below the threshold may use paper filing.
If I file electronically, do I still need to sign it physically?
No; when filing electronically, you manually sign and then scan/upload Form 8453-R along with Form 8963.
Where do I send my paper Form 8963 if I am not required to file electronically?
Send the paper form to Internal Revenue Service, 1973 Rulon White Blvd. Mail Stop 4916 IPF Ogden, UT 84201-0051.
If you mail your Form 8963, should you also fax it somewhere?
Yes; if you mail the form, you must also fax it to 877-797-0235.
What happens if I file by mail but want proof of receipt?
Email [email protected] with your company information and/or tracking number to request an acknowledgment that the IRS received Form 8963.
Does the filing deadline apply only to companies over $25 million in net premiums written?
No; you must file Form 8963 by April 15, 2020, which applies generally to any covered entity.
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Questions about IRS Form 8963
What is IRS Form 8963 used for?
This form tells the IRS how much money your company earned from selling health insurance coverage across the United States during a specific year. The information helps the IRS calculate the annual fee that your provider must pay under the Affordable Care Act (ACA).
Who must file IRS Form 8963?
Generally, a covered entity that provides health insurance for any U.S. health risk during the 2020 fee year must file Form 8963.
What information does IRS Form 8963 require?
The form collects details about the net premiums written and requires identification in Part I (including EIN) and potentially lists designated contacts in Part II. Schedule A allows for listing controlled group members included in the report.
When is IRS Form 8963 due?
You must file Form 8963 by April 15, 2020.
Where do I file IRS Form 8963?
If filing electronically, you can use IRS e-file or fax it to 877-797-0235. If mailing a paper copy, the form is sent to the designated address (implied by instructions).
How do I complete IRS Form 8963?
First, complete Part I with the required entity details (like EIN) and check boxes for designation status. If filing by mail, manually sign Part I; if electronic, upload a signed Form 8453-R along with Form 8963. Finally, fill out Schedule A to list controlled group members.
What happens if IRS Form 8963 is filed incorrectly?
If you have more than $25 million in net premiums written and fail to file electronically, your Form 8963 will not be considered filed unless it is submitted electronically.
Must I file a paper copy if my company has less than $25 million in net premiums written?
The source states that entities reporting more than $25 million must file electronically, implying those below the threshold may use paper filing.
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