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Los Angeles California Form 1095-A: What You Should Know

Form 1095-A/ 1095-B Proof of Health Insurance — DOCS — CA.gov In June 2024 Covered California will begin to mail proof of healthcare insurance to all members. Form 1095-C You will receive copies of your insurance information from your primary provider (doctor, hospital, or health insurer) via email or a paper copy to complete the application for a State Health Benefits Exchange. The form will include your name, address, policyholder ID#, policyholder signature, and the date of the premium. This form will also show which plan you've selected and enrollment deadline. The form will be mailed to you. There is also a free version that you can fill out online.  The final version you received in the mail has the name of the healthcare carrier and a code in the footer. You may need to use that code to determine the actual application for your State Exchange. The state exchange forms to be downloaded are located on page 11 of the 2024 Blue Book.  If you have further questions, please contact a staff member in your area or call. Please keep this in mind. Please also note, that if you have questions about your application, please call for assistance. Please contact us at [email protected] if you wish to place an order using this PDF form.

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