Form 1095 Notice
The Pension Boards will be providing Forms 1095-B only to those eligible members who request to receive a Form 1095-B. You may request a Form 1095 from the Pension Boards through any of the below methods. Forms will be available starting on January 31, 2026.
- via email at [email protected]
- via telephone at 1.800.642.6543, or
- via mail by sending a request to: The Pension Boards—United Church of Christ, Inc., 475 Riverside Drive, New York, NY 10115, Attention: United Church of Christ Medical and Dental Benefits Plan — Form 1095-B Request.
Note: If you reside in California, Massachusetts, Rhode Island, New Jersey or the District Columbia, your Form 1095-B will automatically be mailed to you.
Benefits Plan — Form 1095-B Request
Unless you have previously provided the Pension Boards with your consent to receive communications via email, the Pension Boards will mail the requested Form 1095-B to the address that we have on file for you by the later of January 31, or 30 days after you have made the request to receive the Form 1095-B.