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Form 1095 – Notice to Medicare Eligible Retirees
If you were enrolled in Medicare for all 12 months, the PUD will not be providing a Form 1095-C for the HRA Plan automatically, since your Medicare enrollment was your primary medical and you will receive a Form 1095 from Medicare.
You may request a Form 1095-C for your HRA Plan coverage a variety of ways; email email@example.com, call 425-783-8655 or mail your request to Snohomish County PUD Human Resources – Benefits at PO Box 1504, Everett, WA 98206.