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State of California Health and Human Services Agency Department of Health Care Services David Maxwell JollyDirector ARNOLD SCHWARZENEGGER Governor NOTICE TO TERMINATING EMPLOYEES Health Insurance.

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Both the employer and the employee are free to end the employment relationship at any time, with no penalty being assessed to either. Unless the parties have previously agreed to the contrary, there is no notice required to be given by either party.

You will get a Form 1095-B for your Medi-Cal coverage from DHCS and you will also get a Form 1095‑A from Covered California. Each form will show the months of coverage that met the requirement for MEC for any months of coverage you got from either Medi‑Cal or Covered California.

Where Can I Access My Medi-Cal Member Services? You can access your member services online through your plan's website and the Covered California website. Each service manages different aspects of your coverage. Also, your local county office will take care of specific parts of your Medi-Cal membership.

How to find your 1095-A online Log in to your HealthCare.gov account. Under "Your Existing Applications," select your 2022 application — not your 2023 application. Select “Tax Forms” from the menu on the left. Download all 1095-As shown on the screen.

DHCS 9061 - Notice to Terminating Employees.

If you are filing taxes for an individual mandate state and do not have a copy of your 1095B, you may download one immediately from your member website or request one by calling the number on your ID card or other member materials.

Send this English version at the same time you send the COBRA Notice, to notify terminating employees of special state programs that provide for the state to pay the COBRA premium under certain circumstances. Be careful not to confuse HIPP, California's Health Insurance Premium Payment Program, with HIPAA.

Click the print icon in the upper left hand corner of the PDF to print. You can print the ID card using your own printer and then use it at your next doctor's appointment.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232