Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, is available upon request. Employees who would like to receive a copy of their Form 1095-C may submit a request by contacting Payroll at [email protected] or (847) 368-0862. A copy of the form will be provided within 30 days of the request. While no longer required for income tax purposes, this form provides information about health coverage offered by VIVA USA, Inc. and is an informational form only.