Article: 50279

Overview

Form 3895 is provided by Covered California to report enrollment and coverage details for individuals enrolled in a qualified health plan.

It includes coverage months, premiums, and second lowest-cost silver plan (SLCSP) values.

Add Form 3895

To add the Form 3895:

1. Go to the State taxes section.
2. Select I’d like to see the forms I’ve filled out or search for a form.
3. In the drop list, select California.
4. Select the Healthcare tab.
5. Select 3895 – Health Insurance Marketplace Statement to add and open the form.
6. Complete the form with your applicable information.
7. Click Save to apply changes.

Further Information

Go to ftb.ca.gov for more information.