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Form 1095-C Availability Notice
Health Coverage Tax Information
Diversify provides Form 1095-C (Employer-Provided Health Insurance Offer and Coverage) as required under the Affordable Care Act.
Rather than mailing this form to all individuals, Form 1095-C is available upon request.
If you would like a copy of your Form 1095-C for your tax records, we’re happy to provide it. Requests can be made using any of the contact options below, and the form will be provided within the timeframe required by law.
To request your Form 1095-C:
Email: HR@diversify.com
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Phone: (385) 446-6221
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Mail:
Diversify
Attn: Benefits / HR
9017 S. Riverside Drive, Suite 210
Sandy, UT 84070
This notice will remain available through October 15 of the year following the calendar year to which the Form 1095-C relates.
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