You have successfully requested the following form to be mailed

Health Coverage Form 1095-Original 1/27/2025

The address below will be used for this mailing

Note that on 8/1/2025 your mailing address will revert to the address provided by your Health Care Sponsor

456 Second Street
Springfield, IL, 62704
United States of America

Please allow 3-5 business days for this form to be mailed.