1095-B Document Request

1095-B Document Request

For the fastest and easiest access, members can view their 1095-B at any time through GHCMyChart. If you do not have a GHCMyChart account or would like to request a paper copy, please complete the form below. If you have any questions, reach out to the GHC-SCW Enrollment team at enrollment@ghcscw.com.
To receive your 1095-A form or if you have questions regarding Medicare, BadgerCare and FFM, please refer to the instructions below.
- BadgerCare – Contact Wisconsin Department of Health Services (DHS) at (608) 266-1865 or (800) 362-3002.
- Federally Facilitated Marketplace (FFM) – Contact FFM at (800) 318-2596 or visit their website at HealthCare.gov for more information.
- Medicare Select – Contact Medicare at (800) 633-4227.
Name

First NameLast Name
Member Number
How would you like to receive your 1095-B?
Email
example@example.com
If the email address you entered above doesn't match the address GHC-SCW has on file, we may reach out to you for follow up verification.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If the address you entered above doesn't match the address GHC-SCW has on file, we may reach out to you for follow up verification.
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