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Call us at (800) 300-1506. Get more information about your federal taxes (Form 1095-A).
The Marketplace must file form FTB 3895 to report information on all enrollments in qualified health plans in the individual market through the Marketplace. Do not file a form FTB 3895 for a catastrophic health plan or a separate dental policy (called a \u201cstand-alone dental plan\u201d in these instructions).
This form FTB 3895 provides information you need to complete form FTB 3849, Premium Assistance Subsidy (PAS) (do not use federal Form 1095-A, Health Insurance Marketplace Statement to complete form FTB 3849).
Form FTB 3895 lists under \u201cCovered Individuals\u201d everyone in your household who was enrolled in a specific plan, including when coverage began and ended. If you changed to another plan during the year, you will receive a different Form FTB 3895 with information for that plan.
California: Proof of medical coverage (form 3895) when on someone else's plan? There is a new form to fill out to confirm that one had medical coverage (somewhat equivalent to the form 1095-B for federal filings) when covered under the ACA and using the CA "marketplace".
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1. Get Form FTB 3895 by mail or online from Covered California. Your tax forms are available by signing in to your account and accessing your online mailbox. If you told Covered California that you prefer communications by mail, you should have also received a copy of the form.
If you chose email as your communication preference, you will receive an email that your tax forms are available to access through your Covered California secured mailbox. You will need to sign in to your account to download and print your forms.
You can find this information on Form 3895, which Covered California sent you, under \u201cCoverage Information.\u201d Didn't receive Form 3895? Call us at (800) 300-1506.
Form FTB 3895 is used to report certain information to the Franchise Tax Board (FTB) about individuals who enroll in a qualified health plan through the California Health Insurance Marketplace (Marketplace). The term \u201cMarketplace\u201d refers to the California state Marketplace, also known as Covered California.
Purpose. Form FTB 3895 is used to report certain information to the Franchise Tax Board (FTB) about individuals who enroll in a qualified health plan through the California Health Insurance Marketplace (Marketplace). The term \u201cMarketplace\u201d refers to the California state Marketplace, also known as Covered California.

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