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Rhode Island Free Printable 2023 IND-HEALTH for 2024 Rhode Island Individual Health Insurance Mandate Form

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Individual Health Insurance Mandate Form
2023 IND-HEALTH

State of Rhode Island Division of Taxation Form IND-HEALTH 23106299990101 Individual Health Insurance Mandate Form Name Social security number Coverage Exemption Reasons and Codes G1 A Aggregate Self Only Coverage Considered Unaffordable Member of Tax Household Born or Adopted During the Year B Member of Tax Household Died During the Year H2 Citizens Living Abroad & Certain Noncitizens C Nonresident of Rhode Island N Members of Healthcare Sharing Ministry D E F Had Minimum Essential Health Coverage X HealthSource RI Exemption RI M Income Below Filing Threshold NC Coverage Considered Unaffordable Short Coverage Gap Members of Indian Tribes Incarceration Medicaid H1 Enter the name and social security number for each member of your tax household. For each household member, use the chart above to enter an exemption code for each corresponding month in which the household member had minimum essential health coverage or an exemption. If an individual qualified for an exemption through HealthSource RI, enter the exemption number(s) in the space provided. Refer to the Individual Mandate Instructions for details and instructions on each of the coverage exemption types listed above. If there are more than five (5) members in your tax household, please complete multiple IND-HEALTH Forms. Name: Social Security Number: 1) Jan Feb Mar Apr May Jun Check ü if under 18 years of age as of 01/01/2023 Exemption Number: Number of months for which an exemption did not apply: Name: Social Security Number: 2) Jan Feb Mar Apr May Jun Number of months for which an exemption did not apply: Name: 3) Jan Feb Mar Apr May Jun Number of months for which an exemption did not apply: Name: 4) 5) Jul Aug Sep Oct Nov Dec Check ü if under 18 years of age as of 01/01/2023 Exemption Number: Social Security Number: Jul Aug Sep Oct Nov Dec Check ü if under 18 years of age as of 01/01/2023 Exemption Number: Social Security Number: Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Check ü if under 18 years of age as of 01/01/2023 Exemption Number: Number of months for which an exemption did not apply: Name: Jan Feb Mar Apr May Jun Social Security Number: Exemption Number: Jul Aug Sep Oct Nov Dec Check ü if under 18 years of age as of 01/01/2023 Number of months for which an exemption did not apply: 6a) Total periods that adults did not have coverage: 6b) Total periods that children did not have coverage:
Extracted from PDF file 2023-rhode-island-form-ind-health.pdf, last modified April 2012

More about the Rhode Island Form IND-HEALTH Individual Income Tax TY 2023

We last updated the Individual Health Insurance Mandate Form in February 2024, so this is the latest version of Form IND-HEALTH, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form IND-HEALTH directly from TaxFormFinder. You can print other Rhode Island tax forms here.

Other Rhode Island Individual Income Tax Forms:

TaxFormFinder has an additional 78 Rhode Island income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Schedule W Schedule W - Rhode Island W-2 and 1099 Information
Form 1040H Property Tax Relief Claim
Form 1040NR-Schedule-II Schedule II - Nonresident Tax Calculation
Form 1040V Resident/Nonresident Return Payment Voucher
Form 4868 Application for Automatic Extension

Download all RI tax forms View all 79 Rhode Island Income Tax Forms


Form Sources:

Rhode Island usually releases forms for the current tax year between January and April. We last updated Rhode Island Form IND-HEALTH from the Division of Taxation in February 2024.

Show Sources >

About the Individual Income Tax

The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.

Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!

Historical Past-Year Versions of Rhode Island Form IND-HEALTH

We have a total of three past-year versions of Form IND-HEALTH in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2023 Form IND-HEALTH

2023 IND-HEALTH

2022 Form IND-HEALTH

Microsoft Word - Incentive and Credit Overview for DLT

2021 Form IND-HEALTH

Microsoft Word - Incentive and Credit Overview for DLT


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