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.
Frequently asked questions about Form 1095-B are available below. They are also available here.
From the NYS Department of Health
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.
These FAQs are about the Form 1095-B for consumers enrolled in Medicaid, Child Health Plus and EP.
Form 1095-B is available by request for consumers who, were enrolled in Medicaid, Child Health Plus or EP during the past year. A separate form will be available for each Medicaid, Child Health Plus and EP consumer, even if multiple children are on the same Child Health Plus policy. These forms are only provided upon request. Please contact NY State of Health to request a Form 1095-B.
If you would like a copy of your Form 1095-B for your records, you can contact NY State of Health at 1-800-541-2831 or at the email or mailing address listed above. This document provides information to verify coverage provided by Medicaid, Child Health Plus or EP. You do not need to attach Form 1095-B to your federal income tax return. To determine whether you are required to file a federal income tax return, be sure to check with the IRS at their website, www.irs.gov.
The NYS Department of Health will only mail Form 1095-B to consumers upon request. Please contact NY State of Health at 1-800-541-2831 or at the email or mailing address listed above.
Under federal rules, you may not file an appeal regarding the Form 1095-B. If you think the information on your Form 1095-B is not correct, please call NY State of Health at 1-855-766-7860 for assistance. If the information is found to be incorrect, the NYS Department of Health will correct the form.