Tax Forms and Filing

During tax season, Covered California sends two forms to members:

1. The federal IRS Form 1095-A Health Insurance Marketplace Statement.
2. The California Form FTB 3895 California Health Insurance Marketplace Statement. Use the California Franchise Tax Board forms finder to view this form.

These forms are used when you file your federal and state tax returns to:

• Calculate your tax refund or credit or the tax amount you owe.
• Show that you were insured so that you don’t pay a state penalty for the months you were covered.

Please consult the California Franchise Tax Board, the Internal Revenue Service, or a tax advisor if you have questions about your specific forms, penalty amount, or tax return.