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  • Request To Amend Personal Information - Covered California

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STATE OF CALIFORNIA CALIFORNIA HEALTH BENEFIT EXCHANGE/COVERED CALIFORNIA (Exchange/CC) REQUEST TO AMEND PERSONAL INFORMATION HBEX 409 (8/15) Request to Amend Personal Information You have the right.

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If you provide false information, your coverage may be cancelled. The U.S. Department of Health and Human Services may also fine you for providing false information. You may be fined up to $25,000 if you negligently or with intentional disregard for the rules provide false information in your application.

If you underestimated your income for that year and received a subsidy, you will need to pay the entire subsidy back the next time you file your taxes. You must report income changes to Covered California within 30 days.

How will Covered California check my income? Covered California will check the income you reported on your application and compare it to what the IRS has on file for you.

You have the right to specify how you would like Covered California to contact you should we need to do so or to update your preferred method of contact at any time. Should you wish to do so, please: Log in to your online account. Contact the Covered California Service Center at (800) 300-1506 for assistance.

Additionally, if you don't report your income change within the required time frame, it may affect what you're eligible for in terms of savings and coverage. Essentially, the amount you earn directly impacts the amount you pay for your health insurance plan.

It's normal for most people to overestimate or underestimate their ACA premium tax credit by a small amount. There's no added penalty for taking extra subsidies. The difference will be reflected in your tax payment or refund.

Need to renew your coverage or make a change? You can do so online by logging into your account. If you are unable to log in or need further assistance, please call us at (800) 300-1506.

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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
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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