- 2 -
Enlarge image
|
Form 8851 (Rev. 2-2007) Page 2
General Instructions If an account holder has family coverage and either the account holder
or the account holder’s spouse was insured at any time during the
Section references are to the Internal Revenue Code. 6-month period before coverage under the high deductible health plan
began or the coverage began before July 1, 1996, the account holder is
What’s New
The Tax Relief and Healthcare Act of 2006 requires trustees/custodians not considered previously uninsured.An account holder is considered previously uninsured even if the
to file Form 8851. See When To File below.
account holder had any health plan coverage listed below.
Purpose of Form 1. Insurance, if substantially all the coverage provided under such
Use this form to report the total number of Archer MSAs you established, insurance relates to:
the total number of previously uninsured account holders, the total a. Liabilities incurred under workers’ compensation laws,
number of excludable account holders, and the names and social b. Tort liabilities, or
security numbers (SSNs) of account holders. The report will be used to
furnish information about Archer MSAs to Congress and to determine c. Liabilities relating to ownership or use of property.
when the maximum number of Archer MSAs allowed by law (750,000, 2. Insurance for a specified disease or illness.
excluding previously uninsured account holders) is reached. 3. Insurance paying a fixed amount per day (or other period) of
hospitalization.
Who Must File
File Form 8851 if you are the trustee or custodian of an Archer MSA. A 4. Coverage (whether through insurance or otherwise) for accidents,
trustee or custodian may be a bank or similar financial institution, an disability, dental care, vision care, or long-term care.
insurance company, or any other person approved by the IRS as a Excludable account holder. A married account holder is considered an
trustee or custodian of an individual retirement arrangement (IRA). excludable account holder if all three of the following apply.
1. The account holder is not considered previously uninsured.
When To File
For each reporting period, file a separate Form 8851 by March 20, 2007, 2. The account holder opens an Archer MSA.
for Archer MSAs established: 3. The account holder’s spouse has or had an Archer MSA and was
c For 2005, from January 1, 2005, through June 30, 2005, and not considered previously uninsured.
c For 2006, from January 1, 2006, through June 30, 2006. If you simultaneously open an Archer MSA for a husband and an
Archer MSA for his wife and neither is considered previously uninsured,
How To File treat either the husband or the wife, but not both, as an excludable
If you are required to report more than 250 or more Archer MSAs, you account holder.
must file electronically. If you are required to report fewer than 250
Archer MSAs, you may file on paper, but you are strongly encouraged to Specific Instructions
file electronically. See Announcement 2007-15 which is available in Box b. Enter the total number of Archer MSAs you established during the
Internal Revenue Bulletin 2007-8 at www.irs.gov/pub/irs-irbs/irb07-08.pdf. period covered by this Form 8851. This includes all Archer MSAs opened,
For information on filing electronically, call toll-free at 1-866-455-7438. If even those for previously uninsured or excludable account holders.
you file electronically, you must complete the trustee’s or custodian’s c Do not include Medicare Advantage MSAs.
information on Form 8851 (above line a) and transmit it to the IRS or fax c Do not report any Archer MSA established by a rollover from another
it to 304-264-5602. Archer MSA.
Where To File c Do not report any Archer MSA that was established after June 30 of
Send Form 8851 to: the reporting period.
IRS-Enterprise Computing Center—Martinsburg c Do not report any Archer MSA established in the reporting period for
Information Reporting Program the prior year.
Attn: 8851 Coordinator Box c. Enter the total number of previously uninsured Archer MSA
240 Murall Drive holders. See Previously uninsured account holder above.
Kearneysville, WV 25430 Box d. Enter the total number of excludable Archer MSA holders. See
Definitions Excludable account holder above. An Archer MSA holder cannot be both
previously uninsured and excludable. If you counted an Archer MSA
Archer MSA. An Archer MSA is a trust created or organized in the United holder in box c, do not count that holder in box d.
States as a medical savings account exclusively for the purpose of Lines 1–20. Enter each Archer MSA holder’s name and SSN. If the
paying the qualified medical expenses of the account holder or the account holder is either previously uninsured or excludable, check the
account holder’s spouse or dependent, in conjunction with a high appropriate box. Do not check both boxes for one account holder. Attach
deductible health plan. additional sheets if necessary.
High deductible health plan. A high deductible health plan for 2005 is a
health plan—
1. For self-only coverage that has an annual deductible between Paperwork Reduction Act Notice. We ask for the information on this
$1,750 and $2,650 or, for family coverage, between $3,500 and $5,250. form to carry out the Internal Revenue laws of the United States. You are
2. The annual out-of-pocket expenses required to be paid under the required to give us the information. Section 220(j) requires Archer MSA
trustees or custodians to report certain information.
plan (other than for premiums) for covered benefits does not exceed— You are not required to provide the information requested on a form
a. $3,500 for self-only coverage and that is subject to the Paperwork Reduction Act unless the form displays a
b. $6,450 for family coverage. valid OMB control number. Books or records relating to a form or its
instructions must be retained as long as their contents may become
A high deductible health plan for 2006 is a health plan— material in the administration of any Internal Revenue law. Generally, tax
1. For self-only coverage that has an annual deductible between returns and return information are confidential, as required by section
$1,800 and $2,700 or, for family coverage, between $3,650 and $5,450. 6103.
2. The annual out-of-pocket expenses required to be paid under the The time needed to complete and file this form will vary depending on
plan (other than for premiums) for covered benefits does not exceed— individual circumstances. The estimated average time is:
a. $3,650 for self-only coverage and Recordkeeping 3 hr., 35 min.
b. $6,650 for family coverage. Learning about the law or the form 6 min.
Previously uninsured account holder. An account holder is considered Preparing, copying, assembling, and
to be previously uninsured if the account holder’s coverage under a high sending the form to the IRS 9 min.
deductible health plan did not begin before July 1, 1996, and If you have comments concerning the accuracy of these time estimates
c For self-only coverage, the account holder had no health plan or suggestions for making this form simpler, we would be happy to hear
coverage at any time during the 6-month period before coverage under from you. You can write to Internal Revenue Service, Tax Products
the high deductible health plan began or Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution
c For family coverage, both the account holder and the account holder’s Avenue, NW, IR-6406, Washington, D.C. 20224. Do not send the form to
spouse had no health plan coverage at any time during the 6-month this address. Instead, see Where To File above.
period before coverage under the high deductible health plan began.
|
