Dear Delphi Retiree or Eligible Dependent:
The Advance Monthly Payment Program (AMP)
If you are currently enrolled in the AMP program and are not changing anything other than the rate, you do not need to submit a new 13441-A form to the IRS. The IRS will work directly with BCBSM to update premiums. If you wish to change your current plan (e.g. from Bronze to Gold), you must submit an updated 13441-A form.
If you are electing 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 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. (Visit our website at www.dsrabenefittrust.net or go to the IRS website at 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.
For those people who are not currently in our DSRA-BT plans and want to enroll in both the DSRA-BT healthcare with BCBSM and want to take advantage of the HCTC AMP program, you must first submit an enrollment form to BCBSM requesting the coverage tier you want (Gold, Silver, Bronze or Copper) with no mention of the HCTC. Wait at least FIVE business days and then call BCBSM customer service and request a letter from them indicating you will have healthcare coverage with them effective January 1, 2019. Once you receive this letter, fill out IRS Form 13441-A Monthly Health Coverage Tax Credit Group Registration and attach the BCBSM letter. If all your paperwork is filled out correctly, the IRS will send you a confirmation letter indicating you have been approved for the HCTC AMP. Your final step is to fill out another BCBSM enrollment form indicating you want to enroll for the HCTC AMP and attach the confirmation letter from the IRS. Refer to the HCTC FAQs à 2019 Open Enrollment section à FAQ #3 for more details. This document is posted at our website.
Sample of IRS Form13441-A for various situations can be found at the following link: www.dsrabenefittrust.net/dsrabene/index.php/document-center/Health-Coverage-Tax-Credit-(HCTC)/Sample-Documents/.
-----DSRA-Benefit Trust Board of Directors