Form 1095-C Request

 

Full-time employees may request a copy of their Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, by

contacting us at:

 

 

Email: [email protected]

Mail: Monroe County Government

103 College Street S

Suite 9

Madisonville, TN 37354

Phone: Department of Finance ask for Haleigh Steele at (423) 442-9383

We will furnish the requested form within 30 days from our receipt of your request. If you request a copy of your form and

have opted-in to electronic delivery, we will deliver it via MyBenefitsChannel. If you request a copy and have not opted in to

electronic delivery, a paper copy will be mailed to your address on file.