IRS Form 1095-C

To receive a copy of your 1095-C tax form, you may complete the following online request form, email us at [email protected], call us at (608) 833-5550, or mail a request to us at 7700 Mineral Point Rd, Madison, WI 53717.

Upon request, the form will be provided within 30 days. This notice applies to coverage provided for the applicable tax year. Please retain the form for your records. Thank you.

IMPORTANT HEALTH COVERAGE TAX DOCUMENTS

IRS Form 1095‑C

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