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Designee
NameAddressCountyCityStatePostal Telephone
Number Armando
Delgado1395 N
COURTESY
PARKWAY,
SUITE 210BREVARDMERRITT
ISLANDFL3295300003214591888Joseph D.
Flynn5005 PORT
ST JOHN
PARKWAYBREVARDCOCOAFL3292700003212686140Michael
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To fill out form 1395n, follow these steps:
02
Start by entering your personal information, including your name, address, and Social Security number.
03
Provide details about your current health insurance coverage, including the policy number and provider.
04
Indicate the dates of your coverage and any changes or gaps in coverage during the year.
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If you received any premium tax credits, enter the amount you received and reconciled on your tax return.
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Report any penalties or exemptions related to the Affordable Care Act.
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Sign and date the form before submitting it to the appropriate authority.
Who needs 1395 n?
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Form 1395n is needed by individuals who are applying for or updating their health insurance coverage under the Affordable Care Act (ACA). It is used to report information about your insurance coverage and determine if you are eligible for premium tax credits or exemptions. Anyone who falls under the ACA requirements and has health insurance coverage should fill out this form.
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What is 1395 n?
1395 n is a form used for reporting information about Medicare Part D prescription drug coverage.
Who is required to file 1395 n?
Insurance companies, employers, unions, and other entities that provide prescription drug coverage to Medicare Part D eligible individuals are required to file 1395 n.
How to fill out 1395 n?
1395 n can be filled out electronically or on paper. The form requires information about the entity providing the coverage, the individuals covered, and the coverage itself.
What is the purpose of 1395 n?
The purpose of 1395 n is to provide the Centers for Medicare & Medicaid Services (CMS) with information about prescription drug coverage so they can coordinate benefits and payments with other insurers.
What information must be reported on 1395 n?
Information such as the entity's name, address, and identification number, the type of coverage offered, the number of individuals covered, and any specific benefits or restrictions.
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