FORM 1095-C – AVAILABLE BY REQUEST ONLY

Form 1095-C is an annual statement of information about the health care coverage offered by Acloché. 

All full-time employees are eligible to receive this informational form regardless of whether they participate in the company health plan.

Form 1095-C can assist you in determining eligibility for a premium tax credit, but it is not necessary to have Form 1095-C to file your tax return.

As of 2024, form 1095-C will only be provided to eligible employees upon written request.

You must submit your request for your 1095-C to Acloché in writing using one of the following methods:

  • Email: HR@acloche.com
  • US Mail: 1800 Watermark Drive, Ste 430, Columbus, OH 43215

Please include the following information in your request:

  • Your full name (first and last) 
  • Last four digits of your SSN
  • Confirmation of your mailing address

Your 2024 1095C will be mailed within 30 days of receiving your written request.

If no address is provided, your 1095-C will be mailed to the address Acloché currently has on file.  Under no circumstances will 1095-Cs be sent via email or other methods.

Please contact Acloché at 614-824-3700 with questions.