Form 1095 Notice

Starting on January 1, 2025, the Pension Boards will be providing Forms1095-B only to those eligible employees who request to receive a Form 1095-B. You may request a Form 1095 from the Pension Boards through any of the following methods:

• via email at This email address is being protected from spambots. You need JavaScript enabled to view it.
• 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.

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 January 31, or 30 days after you have made the request to receive the Form 1095-B.