Yes. Covered California will send Form FTB 3895 California Health Insurance Marketplace Statement to all enrolled members. It is used to fill out Form FTB 3849, Premium Assistance Subsidy, as part of your state tax return. you must complete form FTB 3849 and file it with your tax return. Make sure that you have entered your 1095-A in the federal section of TurboTax. When you get to your state-filing, you will be prompted to enter Form 3895 on your CA tax return.