Guide for active employees with enrollment instructions and a simple explanation of each benefit, including current rates.
- This form is to order a duplicate IRS Form 1095-C “Employer-Provided Health Insurance Offer and Coverage.”
- To request a reprint for the most recent year, do not submit your request until after March 1 to allow time for postal delivery of the original form.
- Requests received prior to March 1 are not processed until after March 1. Requests are processed in the order received.
- Requests will be delivered by our secure email system called Virtru.
About This Service
Have a question for our agency? We provide an easy way to reach out to us online through our website. Simply by clicking on the contact us page, you can submit a form to ask us any questions you may have for our agency or the services that we provide. Please provide us a detailed message with all of your contact information so that we may get back to you in a timely manner.
Requirements of the Customer
When you submit your form, please provide us with the following info: