IMPORTANT HEALTH COVERAGE TAX DOCUMENTS
NOTICE OF RIGHT TO REQUEST TAX NOTIFICATION FORM
1095-B
This notice is intended to provide you with information
related to obtaining a copy of your IRS Form 1095-B (health coverage) from
the IBEW Local 234 Health and Welfare Plan (the “Plan”)
if you have not already received one via U.S. mail. Form 1095-B
provides you with information about your healthcare coverage, including who was
covered, and when the coverage was in effect.
You do not need to file a Form 1095 with your federal tax
return, but some members may need the form to comply with state reporting
requirements.
If members and beneficiaries have not already received an
IRS Form 1095-B via U.S. mail, they may request that the Plan send another copy
of their Form 1095-B to them via U.S. mail. You may make this
request by email, phone, or written request. The Plan will mail you
the form within 30 days of receiving your request. Please include your
name and address in your request. The contact information to submit a
request for Form 1095-B is:
Email to: 1095Bhelp@benesys.com
Calling: (877) 885-3753 or (408) 588-3753 between 8:00 AM and 4:00 PM PST
Mail to:
BeneSys, Inc.
6293 San Ignacio Ave
San Jose, CA 95119
ATTN: 1095-B Requests
Your request MUST include: (1) your Plan’s name, (2) the
member’s name, (3) your name if you are not the primary member, (4) the address
you would like the form sent to and (5) the phone number we can call if we have
any questions.
Please call (877) 885-3753 or (408) 588-3753 with any questions about
Form 1095-B.