1095-C Form Request
If you would like to receive your 1095-C form, which provides important health coverage information required for your tax returns, complete and submit this form.

Alternatively, you can send an email or letter with the same information to:
- Email: llichliter@chc.com
- Physical Mail: 7950 Legacy, Suite 1000
                            Plano Texas, 75024 
                            Attn: Human Resources

If you have an questions, you can call 972-943-6412.

Confidentiality and Security: Rest assured that all personal information is handled with the utmost confidentiality and security in compliance with applicable laws and regulations.
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