Californians who applied for health insurance through Covered California in 2014 will receive within the next weeks a 1095- A form. This is a health Insurance Medical Statement. In Section 1 it lists the health insurance policy name, the health insurance you were signed up with at the start & end date of coverage. Section 2 list the individuals who were covered in the health plan. In Section 3 it will list the month the premium you paid, the subsidy California paid, and the total amount the insurance company received. Handle the 1095-A like a W-2 form or 1099 and give them to the person who is preparing your taxes. Usingthe 1095-A form, your tax accountant will be able to to fill out the IRS form 8962 (which lists the premium tax credit). It will be then be determined if you will receive a tax credit or if you will have to pay the money back that you received with the subsidy.