How to Prove Minimum Health Insurance Coverage in California (2024)

In some cases, you may need to provide proof that you have minimum essential coverage. To help you understand when you may find yourself in this scenario, we cover what minimum essential coverage is, what documents you can submit for minimum essential coverage proof and how you can submit these documents.

How to Prove Minimum Health Insurance Coverage in California (1)

What Is Minimum Essential Coverage?

Minimum essential coverage is a type of coverage you may need to purchase to meet the Affordable Care Act’s individual responsibility requirement. This coverage includes:

  • Children’s Health Insurance Program, also known as CHIP
  • Medicare
  • Medicaid
  • TRICARE
  • Job-based coverage
  • Individual market policies

Covered California may request proof that you have minimum essential coverage. This proof determines whether you are already enrolled in a qualified health plan, also known as an Obamacare California plan, that meets the individual responsibility requirement and may disqualify you from subsidies through Covered California.

In order to be enrolled into aCovered California Exchange Planwith a subsidy, you must not have any of the following scenarios apply to you:

  • Be currently enrolled in a group health insurance plan through your employer
  • Be currently offered “affordable” group health insurance through your employer
  • Be currently enrolled in a government-sponsored plan like Medi-Cal or Medicare

If you used to but no longer have this type of coverage, you will need to show a letter of the discontinuance of the insurance.It is important to know this requirement applies throughout the year, duringSpecial EnrollmentandOpen Enrollment Periods.

Why You Need Proof of Minimum Essential Coverage

Previously, underthe Affordable Care Act, Americans needed to have minimum essential coverage or they would be forced to pay a tax penalty. As of 2019, this mandate has been discontinued at the federal level, though the requirement and penalty still apply to California residents.

To ensure you have this coverage, you may need to submit proof. By submitting your proof to Covered California, you can avoid being penalized when you file your state tax return.

Acceptable Documents for Proof ofMinimum Essential Coverage

Below is a list of the acceptable minimum essential coverage documents you can offer as proof of your coverage with Covered California:

  • Notice of Action of discontinuance from Medicaid
  • Notice of Action of discontinuance from Medi-Cal
  • Confirmation of disenrollment from your health insurance plan
  • Confirmation of disenrollment from your employer-sponsored health insurance plan

If none of the above-mentioned scenarios apply to your situation, then this proof may have been requested in error.

How to Send Documents

You can send your documents to Covered California via snail mail, fax or electronic upload.

Snail Mail

While this method is acceptable, it’s not the preferred method for submitting your documents. If you choose to send your documents via snail mail, send them to:

Covered California
P.O. Box 989725
West Sacramento, CA 95798-9725

Though you are not required to include a return receipt, this can be helpful, as it may take weeks for mailed-in documents to be processed.

Fax

A better method for submitting your documents than snail mail is faxing. If you want to fax your acceptable documents for proof of minimum essential coverage to Covered California, fax them to 1-888-329-3700.

Ensure each of your documents lists your first and last name and your Covered California case number. If you have been provided a cover sheet from Covered California, send this with your proof. Include these regardless of the method you choose to send your documents.

Electronic Upload

The best method for submitting your documents is uploading them electronically. This is the best method because it ensures your documents are received quickly and can be processed in a timely manner. Electronically uploading your documents is also the most secure way of sending them, ensuring your private information is kept safe and confidential.

Get More Answers WithHealth for California

Still have questions about proof of minimum essential coverage?Review our minimum essential coverage FAQs to learn more. Feel free to reach out to us with other questions, and if you need health care coverage, get a quote from Health for California.

How to Prove Minimum Health Insurance Coverage in California (2024)

FAQs

What is the form for proof of minimum essential coverage? ›

Form 1095-B is used as proof of Minimum Essential Coverage (MEC) when filing your state and/or federal taxes. It should be kept with your other tax information in the event the Internal Revenue Service (IRS) or Franchise Tax Board (FTB) requires you to provide it as proof of your health care coverage.

How to get proof of Medi-Cal coverage? ›

The Form 1095-B shows your Medi-Cal coverage and can be used to verify that you had minimum essential coverage (MEC) during the reported tax year in the upper right corner of your Form 1095-B.

How is minimum essential coverage determined? ›

Understanding Minimum Essential Coverage

You are considered to have minimum essential coverage if you have: An employer-sponsored plan (including COBRA) Any health insurance plan sold on the Health Insurance Marketplace. Medicare Part A coverage and Medicare Advantage plans.

How do you calculate the minimum value standard for health insurance? ›

An employer-sponsored plan provides minimum value if it covers at least 60 percent of the total allowed cost of benefits that are expected to be incurred under the plan.

How do I know if I have mec? ›

Employer-provided plans

Under Obamacare, any health insurance plan offered to you by an employer qualifies as minimum essential coverage (MEC). So if you and your family get health insurance through a job, you should have MEC which includes: Coverage for current employees. Coverage for retirees.

What is California minimum essential coverage? ›

Minimum Essential Coverage is defined as the type of health insurance coverage that you must have in order to comply with the individual mandate set forth by the Affordable Care Act (ACA) . From January 1, 2014, and onward, individuals must have MEC insurance or they will be subject to a tax penalty.

How does California know if you have health insurance? ›

How does the IRS and state of California know that I had minimum essential coverage in 2023? Health Net submits the information on Form 1095-B to the IRS and the California State Franchise Tax Board to document your health coverage in 2023.

Does California require proof of health insurance? ›

Starting in 2020, California residents must either: Have qualifying health insurance coverage, or. Pay a penalty when filing a state tax return, or. Get an exemption from the requirement to have coverage.

What happens if you don't have a 1095 form? ›

Q: What should I do if I don't receive a Form 1095-A? If you purchased coverage through the Marketplace and you have not received your Form 1095-A, you should contact the Marketplace from which you received coverage. You should wait to receive your Form 1095-A before filing your taxes.

What does minimum coverage mean? ›

Minimum coverage car insurance will help pay for the injuries and property damage you cause if you're the driver in the at-fault accident. In some states, minimum coverage car insurance also includes PIP and uninsured motorist coverage, which can help pay for your injuries in a variety of scenarios.

Do employers have to offer minimum essential coverage? ›

Under the Shared Responsibility for Employers Regarding Health Coverage (PDF) final rule, applicable large employers (ALEs) - generally defined as employers with 50 or more full-time or full-time equivalent employees in the prior year - are required to offer to at least 95 percent of their full-time employees - ...

What does minimum value mean for health insurance? ›

A health plan meets the minimum value standard if both of these apply: It's designed to pay at least 60% of the total cost of medical services for a standard population. Its benefits include substantial coverage of physician and inpatient hospital services.

What is the difference between minimum value and minimum essential coverage? ›

But they mean two different things. Minimum essential coverage, as described above, is coverage that satisfies the ACA's individual mandate. Minimum value, on the other hand, is a measure of whether a plan offered by a large employer provides adequate coverage.

How to calculate insurance values? ›

A total insurable value (TIV) is calculated by adding together the total physical property, equipment, inventory, tools, etc. at each location and combining it with the final number calculated on a fully completed business income worksheet.

What is an employer's health plan to satisfy minimum value under the ACA? ›

Minimum Value (MV)

A plan provides minimum value if it has an actuarial value of at least 60 percent, meaning the plan pays for at least 60 percent of covered benefits.

What is Form 1095 A health coverage? ›

Form 1095-A gives you information about the amount of advanced premium tax credit (APTC) that was paid during the year to your health plan in order to reduce your monthly premium. This information was also reported to the IRS.

What are the three types of coverage forms? ›

Basic, Broad, and Special form are three common coverage forms when insuring property. Basic form is the most restrictive, while Special offers the greater level of protection.

What is a coverage form in insurance? ›

The coverage form generally contains the insuring agreement, coverage conditions, exclusions, and policy definitions.

Is minimum essential coverage the same as creditable coverage? ›

Minimum creditable coverage is the minimum level of benefits needed for taxpayers to be considered insured and avoid state tax penalties. The following coverage types meet MCC. Minimum essential coverage is the minimum level of benefits needed for taxpayers to be considered insured under federal law.

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