Form 1095-B

Consumers enrolled in Medicaid, Child Health Plus and Essential Plan (EP) may request a copy of Form 1095-B from the NYS Department of Health.  For Medicaid, this includes individuals whose coverage is through Local Departments of Social Services (LDSS), Human Resources Administration (HRA), or NY State of Health.  Health plans send the Form 1095-B to consumers who were enrolled in Catastrophic plans, purchased their plan directly from the insurer, or had coverage through the Small Business Marketplace.

  • Phone: 1-800-541-2831
  • E-mail:
  • Mail: P.O. Box 11774, Albany, NY 12211


Frequently asked questions about Form 1095-B are available here.



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