INSURANCE INTAKE FORM - bhhamdbbcomb 2025

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You do not have to send your Form 1095-A to the IRS with your tax return when you file and claim the premium tax credit. However, using the information on your Form 1095-A you must complete and file Form 8962, Premium Tax Credit.
If your income is more than what you told us on your application, you may have to repay some or all of the advanced premium tax credits that you got.
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The Health Insurance Claim Form (CMS-1500) is used by Allied Health professionals, physicians, laboratories and pharmacies to bill supplies and services to the Medi-Cal program. Providers are required to purchase CMS-1500 claim forms from a vendor. Claim forms ordered through vendors must include red drop-out ink.
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Your 1095-A includes information about Marketplace plans anyone in your household had in 2024. It comes from the Marketplace, not the IRS. Keep your 1095-A forms with your important tax information, like W-2 forms and other records.