NOTICE – IMPORTANT HEALTH COVERAGE DOCUMENTS:
In compliance with the Affordable Care Act (ACA), your Form 1095 for the 2025 tax year is available to you upon request.
This form provides information about the health insurance coverage offered to you by Town of Pine Bluffs.
Requesting a copy of your Form 1095:
You can request your Form 1095 through one of the following methods:
Email: Send a request to Leanne Person or Kim Patterson.
Phone: Call 307-245-3746 to request a copy.
Mail: Send a written request to Town of Pine Bluffs, PO Box 429, Pine Bluffs WY 82082.
Once your request is received, we will provide your Form 1095 within 30 days. This notice will remain posted through October 15, 2026.