Welcome

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.

PRE-65 Insurance Plans

Under 65 and looking for health insurance information?

POST-65 Insurance Plans

Post-65 and looking for health insurance information?

Dear Delphi Retiree or Eligible Dependent:

Open Enrollment has arrived!

What is Open Enrollment?

Open Enrollment is your opportunity to make changes to your benefit elections. You may enroll for the first time, switch medical plans, add dependents, or terminate your coverage. (Certain restrictions apply; please see the “Eligibility” section in the 2019 Guide to Benefits for Pre-65 Members or the 2019 Health Matters Guide for Post-65 Members for further details.)

We encourage you to review the benefit information carefully. As in the past, you are only able to make a change to your benefits after the open enrollment period if you experience a qualifying life event, see page four in the 2019 Guide to Benefits for Pre-65 Members.

New premium levels will go into effect January 1, 2019. (For rate information, refer to the 2019 Guide to Benefits for Pre-65 Members. Rates can also be found on the benefit enrollment form.)

Where Can I Learn More?

Additional details about our benefit plans can be found on our website – www.dsrabenefittrust.net. There you will find:

  • 2019 Guide to Benefits for Pre-65 Members, an all-inclusive guide that educates you about your benefit options
  • 2019 Health Matters Guide for Post-65 Members
  • 2019 Enrollment Form
  • And much more!

What Do I Need to Do?

For those currently in the AMP wanting to change their medical plan for 2019, you only need to submit an enrollment form to BCBSM. They will update the IRS. If you do not want to make any changes, no action is required. The new premium amounts will go into effect January 1, 2019. If you are in the HCTC AMP, the IRS and BCBSM will work together to update their files. 

HOW DO I MAKE BENEFIT ELECTIONS?

Below are the necessary steps for you to complete to elect benefit coverage:

 

PRE-65 & PRE-65 MEDICARE DISABLED

POST-65

 

1.    Complete the benefit enrollment form(s) if you are electing medical, dental, and/or vision coverage for the first time or making a change to your current coverage. If you are not making any changes, no action is required.

 

2.    Return your form to BCBSM, our pre-65 plan administrator, as indicated below.

 

3.    If you wish to make any modifications to your current voluntary life election (e.g. increase or decrease your elected amount) or wish to elect voluntary life for the first time, you must complete the Guardian enrollment form and Statement of Health and return it to Mercer, as indicated below.

 

4.    Special Instructions for HCTC Members –

Newly Eligible to HCTC & Not Currently Enrolled in AMP

 

If you are enrolling in the HCTC AMP for the first time and are currently enrolled in a DSRA-BT healthcare plan, IRS Form 13441-A Monthly Health Coverage Tax Credit Group Registration is required along with a copy of your healthcare invoice from the last 60 days. Handwrite the 2019 premium on this invoice (i.e. 2019 Premium = $_______). It must be completely filled out and mailed to the IRS, as indicated below. (Visit our website at www.dsrabenefittrust.net or go to the IRS website at https://www.irs.gov/credits-deductions/individuals/hctc to obtain this form.)

 

Once you receive your enrollment confirmation letter from the IRS, mail it and your DSRA-BT/BCBSM benefit enrollment form to BCBSM.

 

Current HCTC AMP Participants with No Benefit Changes

 

If you are a current AMP participant and not making any changes to your benefit elections, no action is required.

 

Current HCTC AMP Participants with Benefit Changes

 

If you are a current AMP participant and will be changing coverage, you must complete the BCBSM/DSRA-BT enrollment form and send to BCBSM. You do not have to file a new IRS Form 13441-A.

 

1.     Complete the benefit enrollment form(s).

 

2.     If you are enrolling in The Harford medical/prescription plan – OR – are changing your existing coverage with The Hartford, you must complete The Hartford Enrollment form in addition to the benefit enrollment form.

 

3.     Return all forms to either Mercer and/or BCBSM – depending on line of coverage – as outlined below.

 

4.     If you are interested in exploring and enrolling in an “individual” Medicare supplement, Medicare Advantage or Part D prescription plan in your area, please contact Mercer at (877) 336-DSRA (3772) and choose the SelectQuote option from the menu to speak to a SelectQuote agent. You can also visit www.dsrabenefittrust.net to review your individual medical and prescription drug coverage options and get other valuable information.

 

WHERE DO I RETURN MY FORMS?

PRE-65 & PRE-65 MEDICARE DISABLED

POST-65

 

Please note that forms will be returned to two different places depending on the line of coverage, as outlined below.

Return all medical, dental, and vision forms to BCBSM as indicated below.

Mail:

BCBSM
DSRA-BT Plan Administrator
600 E. Lafayette Blvd, MC 610G
Detroit, MI 48226-9942

 

 

Email:

This email address is being protected from spambots. You need JavaScript enabled to view it.

 

 

Fax:

(877) 318-6295

Advanced Monthly Payment Program (AMP)

If you are enrolling in the HCTC AMP for the first time for 2019, return the completed IRS Form 13441-A along with a copy of your invoice from the last 60 days to the IRS as indicated below.

 

Mail:

 

Email:

Internal Revenue Service
Stop 6098 AUSC
Austin, TX 78741

 

This email address is being protected from spambots. You need JavaScript enabled to view it.

  Return all voluntary life forms to Mercer as indicated below.

 

Mail:

Mercer
PO Box 14464
Des Moines, IA 50306

 

 

Overnight Mail:

Mercer
ATTN: Application Processing
12421 Meredith Dr.
Urbandale, IA 50398

 

 

Email:

This email address is being protected from spambots. You need JavaScript enabled to view it.

 

 

Fax:

(515) 365-1520

 

 

Please note that forms will be returned to two different places depending on the line of coverage, as outlined below.

 Return all medical and voluntary life forms and the first month’s premium payment (made payable to DSRA Benefit Trust) to Mercer as indicated below.

 

Mail:

Mercer
PO Box 14464
Des Moines, IA 50306

 

 

Overnight Mail:

Mercer
ATTN: Application Processing
12421 Meredith Dr.
Urbandale, IA 50398

 

 

Email:

This email address is being protected from spambots. You need JavaScript enabled to view it.

 

 

Fax:

(515) 365-1520

 Return all dental or vision forms to BCBSM as indicated below.

Mail:

BCBSM
DSRA-BT Plan Administrator
600 E. Lafayette Blvd, MC 610G
Detroit, MI 48226-9942

 

 

Email:

This email address is being protected from spambots. You need JavaScript enabled to view it.

 

 

Fax:

(877) 318-6295

 

 

WHAT IS THE DEADLINE?

Don’t delay! All enrollment materials must be received by the election deadline:

 

PRE-65 & PRE-65 MEDICARE DISABLED

POST-65

 

Completed forms must be returned to BCBSM (medical, dental, vision), our pre-65 plan administrator – via mail, fax, or email no later than TUESDAY, NOVEMBER 13th.

 

Completed voluntary life forms must be returned to Mercer.

 

 

Completed forms for dental and vision coverage must be returned to BCBSM via mail, fax, or email by TUESDAY, NOVEMBER 13h.

 

Completed forms for medical and voluntary life coverage must be returned to Mercer via mail, fax, or email no later than FRIDAY, DECEMBER 7th.

 

 

QUESTIONS?

If you have questions about the benefit plans or the enrollment process, please contact our plan administrators:

 

BCBSM

Mercer

 

Contact BCBSM for enrollment questions regarding

pre-65 and Medicare disabled medical as well as dental and vision

 

1-877-354-2583

 

Contact Mercer for enrollment questions regarding

post-65 medical as well as voluntary life

1-877-336-DSRA (3772)

 

-----

DSRA-Benefit Trust Board of Directors

 

 

The open enrollment period will depend on your age as follows:

 

PRE-65 &
PRE-65 MEDICARE DISABLED

POST-65

October 15th – November 13th

October 15th – November 13th
(dental & vision)

 

October 15th – December 7th
(medical – the deadline aligns with the official Medicare
open enrollment period)

 


Also has the HCTC FAQ's

Go to top