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University Health Service

Health Insurance – 1095b Form

For the 2017 Tax Year

For the 2017 tax year, University of Rochester students who were covered under the 2016-2017 fully insured Aetna Student Health Insurance Plan (474948) and those who are currently covered under the 2017-2018 self-insured UR Student Health Insurance Plan (Aetna) (686156) will receive two 1095b Tax Forms – one from Aetna for the fully insured period of 1/1/17 – 7/31/17 and one from the University of Rochester for the self-insured period of 8/1/17 – 12/31/17. You should keep these forms with your important papers.

The Aetna 1095b form was released the week of January 22nd. If you have a question pertaining to this form, you can call 855-531-6837 for further direction.

The University of Rochester 1095b form will be released by mid-February. If you have a question pertaining to this form, you can call 800-897-7042 for further direction.

If the form does not contain your Social Security Number or it is incorrect, please go to https://www.irs.gov/pub/irs-pdf/fw9.pdf to download a W-9 form. You will need to complete this form and fax it to 860-907-4672. We are not allowed to take Social Security Numbers over the phone.