| During tax season, Covered California sends two forms to our members: 1. The federal IRS Form 1095-A Health Insurance Marketplace Statement; and 2. The California Form FTB 3895 California Health Insurance Marketplace Statement. |
| IRS Form 1095-A IRS Form 1095-A is an important federal tax document that serves as proof of coverage for individuals to claim the premium tax credit, reconcile any Advanced Premium Tax Credit (APTC) received, and to file an accurate tax return for the 2020 tax year. The amount displayed on the IRS Form 1095-A reflect how much was paid to Covered California Health Insurance companies to help with the cost of a consumer’s health coverage. An IRS Form 1095-A helps ensure the amount of APTC applied in 2020 is accurately reported and serves as proof of Minimum Essential Coverage. |
| Form FTB 3895 The Form FTB 3895 is an important state tax document that serves as proof of coverage for individuals to claim the Premium Assistance Subsidy (state subsidy), reconcile any advanced state subsidy received, and to file an accurate tax return to avoid paying the state individual mandate penalty for the 2020 tax year. The amount displayed on the Form FTB 3895 reflect how much was paid to Covered California Health Insurance companies to help with the cost of a consumer’s health coverage. A Form FTB 3895 helps ensure the amount of state subsidy applied in 2020 is accurately reported and serves as proof of Minimum Essential Coverage. Please Note: The IRS Form 1095-A and Form FTB 3895 is generated for each enrolled plan (except minimum coverage plans), regardless of if APTC/state subsidy was applied. Important Information to Help Consumers:Consumers should receive IRS Form 1095-A and Form FTB 3895 from Covered California by January 31, 2021, if they have not received it already.If a consumer’s communication preference is email, they will receive an email from Covered California with instructions to sign into their CalHEERS account and download their forms. They will not receive their forms in the mail.If a consumer’s communication preference is mail, they will receive their forms in the mail.All consumers can access their IRS Form 1095-A and Form FTB 3895 in their CalHEERS account Home Page, or under Documents & Correspondence, even if their preference is mail. Now Available: IRS Form 1095-A and Form FTB 3895 Toolkit for Certified Enrollers contains detailed information about the Form 1095-A and Form FTB 3895 as well as other important resources and the premium assistance reconciliation process. For additional information, you can also visit the Tax Forms and Filing page on the Covered California website. |