HCTC AMP Payment Coupons
Benistar will be sending pre-filled HCTC AMP Payment Coupons, IRS form #13973, to each HCTC AMP participant. These payment coupons must be included with the monthly premium payment to the IRS for each participant. If you have not received the pre-filled payment coupons in time to make your March premium payment to the IRS, due by March 10th, you should have them in time to make your April premium payment. For HCTC AMP participants who have not received the pre-filled payment coupons and have not made your March premium payment, please print form #13973 from www.IRS.gov and complete the payment coupon to include with your HCTC AMP premium payment. HCTC AMP participants who have been re-enrolled and have received the HCTC Welcome letter must make their March premium payment by March 10th.
You may have received a second invoice from Benistar for the February premium payment. If you were re-enrolled in the HCTC AMP program, have received the Welcome letter from the IRS/HCTC and have made the 27.5% February premium payment to the IRS, please disregard the Benistar invoice. If you are not an HCTC AMP participant and received a second invoice from Benistar but have previously sent your 100% February premium payment to Benistar, please contact the Benistar Retiree Call Center 1-888-588-6682 to verify they have received your February premium payment.
Effective Monday, February 24, 2020 all EFT (Electronic Funds Transfer) forms received by February 14th have been processed by Benistar. DSRA Benefit Trust members who have chosen to use EFT for monthly premium payments should receive notification of their EFT enrollment and should expect to have those funds automatically drafted from their bank accounts between the 7th and 10th of each month apart from any Holiday delay. If you see any irregularities in the EFT from your bank account, please call Benistar Retiree Call Center 1-888-588-6682.
After you have been re-enrolled in the HCTC AMP and after you have made one month’s premium payment of 27.5%, you can use IRS form #14095 to request a timelier reimbursement of the 72.5% for the months you pay 100%. If you would prefer to wait and request the reimbursement when filing your 2020 Federal Tax Return, you will use IRS form #8885. Any participants who age up to Medicare before the ability to make a 27.5% premium payment in 2020, will have to wait to file form #8885 with their 2020 Federal Tax Return for the 72.5% reimbursement. Benistar can provide a detailed invoice to assist with your 72.5% reimbursement when submitting form #14095 or form #8885. Contact the Benistar Retiree Call Center 1-888-588-6682 to request the reimbursement invoice.
DSRA-Benefit Trust Board of Directors