Blue Cross Blue Shield of Mississippi

2019 1095-B

Please enter the information below to request a 2019 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.

Please check that your Subscriber ID has no special characters and has an M at the end. This field requires 9 numbers and an M.
Only letters, spaces, hyphens and apostrophes are allowed. Last name cannot be blank.
Please ensure that the date is formatted as MM/DD/YYYY. Only Numbers and slashes are allowed.
Only numbers are allowed. A ZIP Code must be 5 numbers.

We have received your Form 1095-B request. You will receive your Form 1095-B within 30 days.

We are unable to locate a Form 1095-B based on the information provided. Please contact our Customer Service team at 601-664-4590 or 800-942-0278 if you need assistance.