In compliance with the Affordable Care Act (ACA), the City of San Luis is required to provide Form 1095-C, which outlines your health insurance coverage for the previous year.

Form 1095-C is now available upon request.

If you would like to receive a copy of your Form 1095-C, please contact the HR Department using one of the following methods:

  • In-person: Visit the HR office
  • Email: Send your request via email to pcampa@sanluisaz.gov 
  • Phone: 928-341-8579

Requests can be made at any time, and the form will be provided to you by January 31 or within 30 days of your request, whichever is later.

If you have any questions, please contact Priscila Campa, at the provided contact information.