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Printable Form 1095-C Nassau New York: What You Should Know

You must do this before November 11, 2018. The Department of Health will send you a reminder. Consumers enrolled in Medicaid, Child Health Plus and Essential Plan (EP) and were denied, or could not be located, may fill out Form 1095-C to obtain the information in this letter. The New York State Department of Health will provide consumers with an electronic version of this letter that does not require a fax. If this is the only paper version available, you can fax it to or email it using [email protected] If you have health insurance coverage, Form 1095-C and the accompanying instructions are located here. It seems some of the information that is  being supplied by this office has been altered or inaccurate. If you receive information that is inaccurate, please send your feedback in writing as soon as possible. You can do this by visiting our website and  contacting us using the links under CONTACT US at the bottom of this page.

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