Get What Is 3895 Form

The What Is 3895 Form, also known as the California Health Insurance Marketplace Statement, is essential for individuals who have enrolled in a qualified health plan through the California Health Insurance Marketplace. This guide provides a detailed walkthrough to help users fill out the form effectively online.

Follow the steps to complete the What Is 3895 Form online.

1. Click ‘Get Form’ button to obtain the What Is 3895 Form and open it in the editor.
2. Begin by filling out the recipient information section, which includes your name, social security number (SSN), and date of birth. If married, also provide your spouse’s details.
3. In Part I, report information about each covered individual under your policy, including their name, SSN, and date of birth. Enter the coverage start and termination dates as applicable.
4. Proceed to Part II, where you will document the monthly coverage information, including the enrollment premiums and any advance payment subsidies for each month of coverage.
5. For each month of coverage, fill in the applicable premium amounts and subsidy amounts in the provided columns.
6. Once all sections are completed, review the information for accuracy and completeness.
7. Finally, save your changes. You can choose to download, print, or share the completed What Is 3895 Form.

Start filling out your What Is 3895 Form online today to ensure your health coverage information is accurately reported.