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FORMS & DOCUMENTS

Medical form with stethoscope
forms
2026 pRE-65 forms

BCBSM Open Enrollment Form 

Form for all Medical Plans, Dental & Vision

2026 post-65 forms

Medicare Enrollment Form

Form for Medicare Advantage, Hartford,

Dental & Vision, PDP Plans

The Hartford Enrollment Form (GRIP)

Hartford Form and Enrollment Form both required for enrollment

Open enrollment form

Copper Plan

IRS 13441A Form

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Stay Informed!  Please click here to sign up for the Eblast 

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Benistar DSRA Benefit Trust Customer Service/Call Center

1-888-588-6682

DSRA Benefit Trust website  

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