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This is the Official website of the Delphi Salaried Retiree Association (DSRA) VEBA (Voluntary Employees Beneficiary Association) managed by the DSRA Benefit Trust. The VEBA is for Delphi Salaried and hourly retirees that provides medical and life insurance programs for eligible members.
We have had several people who misunderstood our eblast sent 2 days ago regarding the use of IRS Form 14095. This form can be used if you have a glitch with your Advanced Monthly Process (AMP) payment from the IRS to BCBSM after you have been approved for the AMP program. In these cases, someone had to pay BCBSM directly for the full premium for that month. This only affected about 50-60 of our members.
Additionally, for those of you who may have signed up for the AMP mid-year it is quite possible that you paid BCBSM the full premium for at least one month while your AMP application was processed. You can use Form 14095 to recoup the 72.5% of premiums for those early months but the IRS must receive the form by October 1. If you miss this deadline, you will have to wait until you file your 2017 tax return to recoup the credit.
We hope this clears up any confusion.
DSRA-BT Board of Directors
The IRS has announced an October 1, 2017 deadline for submitting Form 14095 to request reimbursement for premiums paid directly to Blue Cross Blue Shield Michigan if you are an approved AMP (Advance Monthly Payment) recipient. If you wish to receive reimbursement for any 2017 payments, you must complete Form 14095 and submit to the IRS no later than October 1, 2017. Forms received after October 1, 2017 will not be processed and you will need to seek credit for those premiums when filing your 2017 IRS tax return.
PBGC Pension Recipient Age Up From 64 to 65 – Spouse Under Age 65
2 Person Contract
PBGC pension recipient turns 65 in May (their BCBSM medical ends April 30th).
Mail letter to the IRS on April 10th stating that PBGC pension recipient will be eligible for Medicare May 1st. Include PIN and SS# in this letter. This will key them to cancel the PBGC pension recipient in their system. In the same envelope include Form 13441-A for their Qualified Family Member (QFM). A sample form (Sample) is at the DSRA-BT website. Be very careful that you have the correct premium, both total and 27.5%, for the correct individual HCTC plan.
BCBSM will establish a new contract for spouse only of same metal tier but in a non-HCTC division 60 days before the retiree turns 65. The spouse may see an invoice from BCBSM for the full amount of the premium in the month prior to the PBGC pension recipient turning 65. DO NOT pay this unless there is a delay in getting a new PIN number from the IRS and you are not able to make the May 10th payment cut-off. Note: The person turning 65 will be automatically enrolled in their own dental & vision by BCBSM. If you do not want this coverage, call BCBSM to cancel.
Once the spouse receives their enrolled letter from the IRS, fill out a new BCBSM enrollment form (DSRABT17) and check the HCTC box at the top. Include your new PIN number on the enrollment form and a copy of your letter from the IRS. To speed this process it is recommended that you email or fax this information.
Print out the IRS payment coupon (Form 13973) and make new payment to US Treasury - HCTC by May 10th.
If payment cannot be made by the 10th of the month, full payment must be made to BCBSM. BCBSM in this instance must indicate in their records that the retiree made the payment. In this situation, the IRS has introduced a new procedure that allows the HCTC AMP enrollee to request an immediate refund of the 72.5% HCTC credit. The retiree files form 14095 with the IRS for HCTC refund for the month of May. (Up to 12 week turnaround time.) Form available at the IRS website or the DSRA-BT website.
Spouse of PBGC Recipient, Age Up from 64 to 65 – PBGC Pension Recipient is Under 65
2 Person Contract
Spouse of PBGC pension recipient turns 65 in May (their BCBSM medical ends April 30th).
PBGC pension recipient will mail a new 13441-A form to the IRS on April 10th. Check box 6 on page 1, drop your spouse and fill in the single premium, both total and 27.5%. Write a short note by box 6 stating, “I am removing my spouse from the policy because they will be eligible for Medicare as of May 1st.”
BCBSM will establish a new contract for PBGC pension recipient only of same metal tier but in a non-HCTC division 60 days before the spouse turns 65. The PBGC pension recipient may see an invoice from BCBSM for the full amount of the premium in the month prior to the spouse turning 65. DO NOT pay this unless there is a delay in the IRS processing and you are not able to make the May 10th payment cut-off.
PBGC pension recipient should call the IRS around April 27th and confirm they have received their change and processed it (assuming IRS has not issued Welcome letter yet). Fill out new BCBSM enrollment form (DSRABT17) and check the HCTC box at the top. Include your PIN number on the enrollment form.
Print out IRS payment coupon (Form 13973), fill out with new amount, and send to US Treasury - HCTC by May 10th. Your PIN number will not change.
PBGC Pension Recipient Age Up From 66 to 67
Spouse (under age 65) is in HCTC AMP program as a QFM.
PBGC pension recipient turns 67 in May. Spouse’s eligibility for the HCTC expires May 1st. Mail a letter to the IRS, approximately April 10th, stating that PBGC pension recipient is turning 67 in May and they need to cancel QFM HCTC AMP coverage effective May 1st. This should go to the address on the 13441-A form. Remember, if you’re caught using the HCTC beyond your eligibility date, you could face severe monetary penalties.
If the salaried retiree started drawing their PBGC pension before April 2, 2009 and the spouse is still under 65, the spouse is eligible for the DSRA-BT Qualified Family Member (QFM) subsidy. To request the subsidy for May, you must fill out a new BCBSM enrollment form (DSRABT17) and submit to BCBSM in early April. Eligibility for this subsidy is for 24 months which for most households are the months the retiree is age 67 and 68.
Even if the spouse does not qualify for the DSRA-BT QFM subsidy, they will have to notify BCBSM that they are no longer in the HCTC AMP program. Again, submit a new enrollment form and check “Change of Status” box in Section 1 and write that HCTC eligibility has expired effective May 1st due to PBGC pension recipient aging up to 67.
QFM in HCTC AMP program Age Up to 65
QFM in HCTC AMP turns 65 in May. Their eligibility for the HCTC AMP expires May 1st. Mail a letter to the IRS address on the 13441-A form, approximately April 10th, stating that they are eligible for Medicare May 1st and they should remove them from the program.
BCBSM will automatically cancel the QFM’s coverage effective May 1st.
The IRS will now accept your check or money order due no later than February 10, 2017 for your insurance premium payment for the month of February. Please remember, premium payments received before the 22nd of the month prior to the premium payment will be returned to the sender.
If your 27.5% premium payment is not received by the IRS between the 24th of the current month and the 10th of the month your premium is due, you will have to pay 100% of that months premium directly to Blue Cross Blue Shield of Michigan and you will have to request an IRS refund of the 72.5% on your federal tax return the following year. We strongly encourage you to send your payment along with the completed voucher during the specified window in order to avoid paying 100% of the month’s premium.
We would like to inform you that the Board of the DSRA Benefit Trust has decided to change the benefits advisor/insurance broker we will work with from Lawley to First Person effective January 1, 2017. Lawley had asked for a substantial increase in their fees and really didn’t have the Health Care Tax Credit expertise that we needed since the HCTC reinstatement.
You may remember that First Person was previously our broker and worked closely with us from 2011-2015. They have the past experience with the HCTC, our insurance suppliers and our unique group makeup. Your Board is excited to work with this expert and capable group again.
We would also like to announce the resignation of one of our board members, Robert (Bob) Mikoleizik. Bob decided that his past experience was just not a fit for the experience needed to best serve the participants in the DSRA-BT. The Board would like to extend our thanks to Bob for his service and dedication for almost a year.
DSRA-BT Board of Directors