Benistar Retiree Services, our plan administrator, is here to assist DSRA Benefit Trust members participating in the HCTC Advanced Monthly Payment (AMP) program with the re-enrollment process.  Below are a few IMPORTANT items to ensure you have a smooth transition back into the HCTC AMP program.  Please contact Benistar with any questions at 1-888-588-6682.

  1. NEW! A newly completed IRS 13441-A form is required by all participants to re-enroll in the HCTC AMP program for 2020.  If you have been enrolled in the HCTC AMP in past years, please include the HCTC Participant Identification Number (PIN) you were assigned by the IRS/HCTC at that time on the top of the 13441-A form. 
  2. NEW! All completed 13441-A forms should be sent to Benistar by fax 1-860-408-7025 or email to This email address is being protected from spambots. You need JavaScript enabled to view it. for review.  Benistar will then forward your 13441-A form along with proof of your BCBSM insurance enrollment to the IRS/HCTC department.  DO NOT SEND 13441-A FORMS DIRECTLY TO THE IRS.
  3. NEW! ALL DSRA Benefit Trust HCTC AMP participants must call Benistar to provide them with your HCTC PIN . If you were previously enrolled in the HCTC AMP program you already have a PIN, please call 1-888-588-6682 today and provide the PIN to Benistar if you have not already done so.  If you are enrolling in the HCTC AMP for the first time, please contact Benistar with your HCTC PIN once you receive the HCTC Welcome Letter.
  4. NEW! Benistar will send pre-filled HCTC payment vouchers to each DSRA Benefit Trust member enrolled in the HCTC AMP program once they have received your HCTC PIN. In the event you do not receive the pre-filled payment vouchers from Benistar in time to make your next monthly payment, print and complete the Form 13973 - HCTC Blank Payment Coupon available on the website and follow the instructions on that form for mailing your monthly payment directly to the U.S. Treasury. 
DSRA-Benefit Trust Board of Directors

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