Request of IRS Form 1095-B for 2017 Coverage Year

MediExcel Health Plan Coverage

Your MediExcel Health Plan Coverage is considered “minimum essential coverage” for tax purposes. MediExcel Health Plan provides all subscribers with IRS Form 1095-B, which lists information needed to report on your income tax return as proof that you and your eligible dependents had qualifying health coverage (referred to as “minimum essential coverage”) for some or all of 2017.

Receive IRS Form by February 15, 2018

If you have not received your IRS Form 1095-B from MediExcel Health Plan by February 15, 2018, please let us know by completing the form below with as much information as possible. If limited information is provided, we may ask for verification of identity before sending you your Form 1095-B.

Member ID Number
Last Name of Subscriber
First Name of Subscriber
Last Four Digits of SSN
Date of Birth of Subscriber (MM-DD-Year)
E-mail Address
US Mailing Address
Indicate how you want to receive your Form 1095-B
US Postal Service Mail
If we have questions, how do you prefer to be contacted?
Other Information

You may also send the above information to us by:

Processing Time. Once all necessary information has been received, Form 1095-B will
be delivered within 48 hours by e-mail and within 3 business days if mailed.