1095-B Health Coverage Tax Forms

The Form 1095-B is a document to help you complete your federal tax return. The form is to help you complete your federal tax return only. Do not send it to IRS with your tax return. This information will be sent to the IRS. Because the form is not required, you will not be mailed a copy.

The 1095-B shows the months during the tax year that members of your household had health coverage that qualified as "minimal essential coverage" or MEC. The 1095-B lists each individual in your household and the months they had MEC under either the Medicaid or CHIP program.

To view or print a copy of the Form 1095-B, go to mybenefits.utah.gov. Once you log in to your account, on the top of the screen select "tax information" and select the tax year you want to view.

To request a hard copy be printed and mailed to you, or for previous tax years, call 1-866-608-9422

You may also send a written email request for the information to email hpr@utah.gov.

Hard copy requests may also be mailed to:
Cannon Building
C/O Office of Eligibility Policy
288 N 1460 W
Salt Lake City, UT 84116

Reminder: This form is not required to file your taxes and should not be submitted to the IRS.