Retired Employees

2020 ACA 1095-C Documents

If you are currently insured with St. Croix County Retiree Insurance through PreferredOne and retired before 01/01/2019 you may request a 1095 form by emailing Human Resources at HumanResources@sccwi.gov. Please include the following:

  • Full name
  • Current address

All requests will be processed within 30 days from the date received.