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PEBB and Other Carrier Forms

1095 Proof of Coverage for the 2021 tax year

  • All full-time employees in 2021 who enrolled or opted out of a PEBB plan should receive a 1095-C.  
  • Part-time employees in 2021 who enrolled in Providence or Moda should also receive a 1095-C. 
  • Any employee enrolled in a Kaiser plan should receive a 1095-B from Kaiser. 
When will 1095-C's be sent?
The IRS granted an extension of due date for furnishing statements. The due date for furnishing Form 1095-C to individuals is extended from January 31, 2022, to March 2, 2022. See Proposed Regulations section 301.6056-1(g) and Extensions of time to furnish statements to recipients.

Do 1095-Cs need to be sent with my tax returns?
No. These forms should not be attached to the return or sent to the IRS. The issuers of the forms (State of Oregon) are required to send the information to the IRS separately. You should keep the forms for your records, with your other important tax documents. For more information: https://www.irs.gov/affordable-care-act/questions-and-answers-about-health-care-information-forms-for-individuals


Not sure which form to fill out or have other benefit related questions?  
Contact Member Services at (503) 373-1102 or inquiries.pebb@dhsoha.state.or.us

We are experiencing a higher than normal call volume. Please leave a message for Member Services and they will return your call within 24-48 hours, or you may choose to email your question instead. 

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