Form 1095-B Proof of Health Coverage
NOTE: Your Form 1095-B is proof of healthcare insurance for the IRS and does not require completion or submission to DHCS.
Please keep this form for your records. To understand more about the Federal and State Individual Mandates, please see the information and links below. The new California Individual Mandate (SB 78) went into effect January 1, 2020.
DHCS mails the Form 1095-B to individuals with MEC via Medi-Cal on or before January 31 of each year.
Federal Individual Mandate
The Affordable Care Act (ACA) requires individuals to have health coverage that meets a minimum standard called Minimum Essential Coverage (MEC). This requirement is also known as the “ACA Individual Mandate" or “Federal Individual Mandate".
Form 1095-B will report the months of MEC a Medi-Cal beneficiary received during the calendar year. DHCS will send your MEC information to the IRS and beneficiaries are not required to provide Form 1095-B to the IRS, if they chose to file their taxes. Beneficiaries should keep Form 1095-B for their records as proof they received health coverage during the tax year.
Form 1095-B does not require completion or submission to DHCS.
Per the Internal Revenue Code Section 6055 the California Department of Health Care Services (DHCS) began issuing Internal Revenue Service (IRS) Form 1095-B to all Medi-Cal beneficiaries annually, starting in January 2016.
For questions regarding this notice or for additional information regarding Form 1095-B, contact a live agent at DHCS' Medi-Cal Helpline 1-844-253-0883.
To ensure Form 1095-B contains the correct information, beneficiaries should contact their county human services agency to report changes such as their new address, income, employment, or a change in household size. Failure to report changes may result in delays and inaccurate information on Form 1095-B.
California Individual Mandate (SB 78)
With the passage of California Senate Bill 78 [Chapter 38, Statutes of 2019], California created an individual mandate, also known as the California Individual Mandate. This law requires individuals to have MEC or pay a penalty to the State of California. The mandate generally requires every California resident to enroll in and maintain MEC beginning January 1, 2020. Californians who do not meet this requirement, or an exemption from the requirement, must pay a penalty.
California Franchise Tax Board (FTB) is responsible for assessing the mandate and any potential penalties through the state tax filing process. For more information on California's Health Care Mandate, visit FTB's website using the link labeled California Individual Mandate (SB 78) under the Resources section.
Sample Letters & Form 1095-B
DHCS' Letters and Forms are produced in English and Spanish.Sample Form 1095-B: This form is mailed to you along with one of the three sample letters below.
Keep this with your other tax information. You do not need to return it to DHCS.
NOTE: DHCS removes the first five digits of the beneficiary's Social Security number and date of birth from the Form 1095-B to protect the identity of our beneficiaries.
Each mailing of a Form 1095-B will contain a letter explaining the purpose of the Form 1095-B. DHCS uses three different letters when mailing Form 1095-Bs:
- Sample Original Letter: This is mailed with original Form 1095-Bs for a given tax year. This is the letter used for DHCS' annual Form 1095-B mailing.
- Sample Reprint Letter: This is mailed with reprinted Form 1095-Bs when a reprint is requested by the beneficiary for a given tax year.
- Sample Correction Letter: This is mailed with Corrected Form 1095-Bs when a change occurred on the Medi-Cal record that required DHCS to correct information previously reported on the original Form 1095-B for a given tax year.
- Sample Notice For Requested Action (NFRA): This notice is sent from DHCS to inform beneficiaries their Medi-Cal record may contain incorrect information. Usually, the error is a result of the first and last name and/or Social Security number on the Medi-Cal record not matching what was used on the federal tax filings.