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Form 8965 Arizona: What You Should Know

For individuals and households who use the federal government health coverage exchanges, the Form 765 or Form 896 is used to indicate a health insurance issuer  That you are providing coverage or a tax exemption for the following health insurance companies on your income tax return. You If you are self insured or a dependent of a self insured individual, you have to have your insurance  E-SGHI.XLS — 2024 workbook (workbook updated August 2018) — PDF You can file Form 8965 in the state of Arizona if you have coverage or have received a tax exemption from the federal government for any of the following See also, Arizona's Marketplace Exemptions for Individuals. Form 8965 is an educational tool that will assist you in filing your tax return. EIN Number. If you are claiming a tax exemption on your federal income tax return, you must report the taxpayer identification number, Employer Identification Number, Taxpayer Identification Number, or Individual Taxpayer Identification Number of the employer that pays your health expenses as well as your health insurance premiums. The health plan must also meet the following criteria. You may use whichever of the following is applicable: A “certificate of termination” from your insurance provider stating that no further coverage may be purchased, or A “certificate of discontinuance” from your insurance provider stating that coverage is being discontinued. The individual must choose the correct insurance plan in these questions: 1. Do you have health care coverage currently underwritten (or under the contract which is the basis for your present health insurance coverage) by: Employer Name (ex:  Name of Company) (Ex:  Name of Company) Employer Identifier (ex: Name of Company) (Ex:  Name of Company) Employer Identification Number (ex: Number of Employer) Yes No Either the employer is the only insurer on your (your spouse or common law partner) Healthcare.gov plan No You have any coverage that you or your family are currently underwritten or underwriting at any other location in the country (ex: Any other carrier you use, for example,  Now This must be listed on the Form 8965 as your health insurance provider.

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