ACA Reprint Request

  • 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.
Document Type
Form