Please enter the information below to request a 2021 Form 1095-B in the mail. Only the primary Subscriber (i.e., not a Dependent) on the policy/plan may request and receive a Form 1095-B.
If you have coverage through a self-insured employer plan, the Federal Employee Program, or the Mississippi State and School Employees’ Life and Health Insurance Plan, or have a Medicare Supplement policy, Blue Cross & Blue Shield of Mississippi does not issue your Form 1095-B and you should not submit the request below.
We have received your Form 1095-B request. A Form 1095-B will be mailed to the primary subscriber within 30 days.
We are unable to locate a 2021 Form 1095-B based on the information provided. Please check the information you provided and try again. Please contact our Customer Support team at 601-664-4590 or 800-942-0278 if you need assistance.