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Notification of Deceased Status

Learn how to notify us that a Covered California enrollee has died, and what to do if your account was incorrectly flagged as deceased.

Report a Death

If someone with health insurance through Covered California has died, notify us using the form that matches your situation. You can mail or fax the completed form using the contact information included in the form.

Before you choose a form, have the following ready: the deceased's full name, date of birth, date of death and their Covered California member ID if available.

  • I’m not on the plan.

    Download this form if you are a friend, neighbor, hospital or other third party reporting a death.

  • I am on the plan.

    Download this form if you are an enrolled Covered California member reporting the death of someone on your plan.

  • I represent the estate.

    Download this form if you are the executor, estate representative or acting on behalf of the deceased's estate.

Accepted Proof of Death Documents

Depending on which form you submit, you may need to include one of the following documents as proof of death:

  • Death certificate
  • Bureau of Vital Statistics records
  • Social Security records
  • Hospital or medical records
  • Signed funeral director's statement
  • Newspaper death notice or obituary
  • Widow or survivor's benefits on the deceased's Social Security number
  • Veterans Administration or military service records
  • Indian census records
  • Insurance company records
  • Institutional records
  • Veterans Administration death payment correspondence
  • Insurance company death settlement correspondence
  • Minister or clergy statement
  • Proof of executor or estate
  • Probate court order or Letter of Testamentary
  • Recorded Affidavit of Death of a Joint Tenant
  • Notarized Affidavit for Collection of Personal Property

Each form includes specific instructions for what to submit. Estate representatives also need to include documentation of their legal authority to act on behalf of the estate.

If You Were Incorrectly Marked as Deceased

Occasionally, a data error may incorrectly flag someone as deceased. If this has happened to you or someone on your plan, we apologize for the inconvenience. Submit a signed declaration or affidavit to correct the record.

The declaration or affidavit must include:

  • A statement that the individual is not deceased
  • A statement that the information provided is true and correct to the best of their knowledge
  • The date and signature of the individual or their authorized representative