Health Coverage Tax Form 1095

Form 1095-A screenshot

2016 Form 1095 Available Online

Form 1095 is used to report offers of health coverage and enrollment in health coverage for federal tax purposes. Depending on the source of your health care coverage during the year, you may receive a Form 1095-B, a Form 1095-C, or even both.

If you're eligible for Chevron health coverage, your Form 1095 will be mailed to you automatically; you don't have to do anything. These forms are typically distributed by January 31 of each year, just like a Form W-2. However the Internal Revenue Service (IRS) recently extended the deadline for employers and health care providers to deliver the 2016 Form 1095s to plan participants until March 2, 2017. You generally will not need to file it with your Federal income tax return but you should keep your Form 1095 with your other income tax documents. Learn more about Form 1095.

Form 1095 Online

Start or stop electronic delivery, view present and historical Form 1095s, request reprints, and provide an alternate mailing or email address for your Form 1095 on the Benefits Connection website.

Electronic delivery and the ability to view historical documents online applies only to the Form 1095 provided through Chevron; it doesn't apply to a Form 1095 provided directly from an insurance carrier, another employer, or through Medicare.

Expatriate Employees: The electronic delivery option may not be available for Form 1095s that reflect health coverage for periods of time when you were a U.S.–payroll expatriate on a residential assignment.

Medicare-Eligible Participants: If Medicare was the primary coverage for you or any of your covered, Medicare-eligible dependents, you will not receive a Form 1095 from Chevron. Medicare is responsible for reporting your Medicare coverage to the IRS. Electronic delivery and the ability to view historical documents online as described in this document pertains only to the forms provided by Chevron.



Sign Up for Electronic Delivery*

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Did you know that you can choose to suspend mail delivery and consent to receive it electronically by registering through the Benefits Connection website? If you want to use this service for your 2016 Form 1095 from Chevron, you must register for electronic delivery by February 3, 2017. You will be notified by email from DoNotReply-1095@xerox.com to view your form as soon as it's available. You can also view present and historical Form 1095s, request reprints, start or stop electronic delivery, and provide an alternate mailing or email address for your Form 1095 when you go online to the Benefits Connection website.

You can update your Form 1095 delivery preference for the 2016 tax year until February 3, 2017. You can start or stop electronic delivery at any time, but the election you make by the deadline will apply to your 2016 Form 1095 provided by Chevron. Note: Your previous delivery election for the 2015 tax year will also automatically continue to apply to your 2016 form. If you wish to change your delivery preference, you must update your preferences on Benefits Connection by February 3.

  • Login to Benefits Connection.
  • After you are logged in, choose the Affordable Care Act 1095 Tax Form under the photo on the home screen.
  • Choose Profile from the top navigation, and follow the instructions under the Form 1095 Delivery Preferences section on the page.

Please note the alternate mailing or email address you provide applies only to your Form 1095; your email and permanent mailing address on file with the HR Service Center will not be affected and will not apply to other Chevron benefit or tax mailings and emails.

Electronic delivery and the ability to view historical documents online applies only to the Form 1095 provided through Chevron; it doesn't apply to a Form 1095 provided directly from an insurance carrier, another employer, or through Medicare.

Expatriate Employees: The electronic delivery option may not be available for Form 1095s that reflect health coverage for periods of time when you were a U.S.–payroll expatriate on a residential assignment.

Medicare-Eligible Participants: If Medicare was the primary coverage for you or any of your covered, Medicare-eligible dependents, you will not receive a Form 1095 from Chevron. Medicare is responsible for reporting your Medicare coverage to the IRS. Electronic delivery and the ability to view historical documents online as described in this document pertains only to the forms provided by Chevron.


Employees: View Electronic Form 1095

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Chevron Network Only

If you are on the Chevron network, you don't need a PIN.

Login to Benefits Connection, then choose the Affordable Care Act 1095 Tax Form under the photo on the home screen.

Benefits Connection


All Others: View Electronic Form 1095

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Off Chevron Network, Retirees, COBRA, Employees on Leave

Use your PIN to login. Forgot your PIN?

Login to Benefits Connection, then choose the Affordable Care Act 1095 Tax Form under the photo on the home screen.

Benefits Connection


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Learn More About Form 1095

Read more details about the new Form 1095, including common questions.

Learn More

HR Service Center

1-888-825-5247 (U.S.)
610-669-8595

Monday through Friday
6 a.m. to 5 p.m. Pacific
8 a.m. to 7 p.m. Central

Alternate Addresses

Please note the alternate mailing or email address you provide applies only to your Form 1095; your email and permanent mailing address on file with the HR Service Center will not be affected and will not apply to other Chevron benefit or tax mailings and emails.