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Contact Us About Your 1095-B Tax Form

Complete all required fields to submit your 1095-B Tax Form.

Please fill out the form below to request or inquire about your 1095-B tax document. Please note any mail requests will be sent to the subscribers address we have on file.

*indicates required fields

Please confirm how you receive your insurance. UPMC Health Plan is only able to assist with 1095-B’s.

How do you receive your insurance?*

Please enter your first name
Please enter your last name
Please enter a valid email address
If you wish to receive this form electronically, your email must be in our records.
Please enter a valid member ID
Please enter a valid tax year

NOTE: If you received Health Insurance Coverage through either the PA Exchange (PENNIE), or the Federally Facilitated Marketplace (FFM) you would receive a 1095-A, and not form 1095-B. Please see below for how to obtain 1095A Documents.

If receiving coverage through the PA Marketplace Exchange, obtain your 1095-A from Pennie.

If receiving coverage through the Federal Marketplace, obtain your 1095-A from

Upon request, the Department of Human Services will mail 1095-B tax forms to member households. View the 1095-B request form from COMPASS.