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Request Form 1095-B | Health Coverage Tax Document

Dec 17, 2025

IMPORTANT HEALTH COVERAGE TAX DOCUMENT – FORM 1095-B

Form 1095-B is an annual report that identifies which months you and your dependents were enrolled in “minimum essential coverage” as set by the Affordable Care Act (ACA). If you have coverage through Regence, the Essential Worker Healthcare Trust (EWHT) will provide you with a copy of the Form 1095-B within 30 days of your request.

To request your Form 1095-B, please fill out this request form. You can also request your Form 1095-B by contacting EWHT at:

  • Email:  EssentialWorker@RISEpartnership.com
  • Mail:  PO Box 94392, Seattle, WA 98124-6692
  • Phone:  (833) 389-0027

If you have coverage through Kaiser, please contact: 1-(800)-813-2000 or visit kp.org.

If you have any other questions, please contact EWHT using the contact information above.