Dear Delphi Retiree or Eligible Dependent:

 

In a recent email blast, we mentioned that if you are currently enrolled in the HCTC AMP program and you changed/updated your mailing address with BCBSM through a new enrollment form, you MUST verify that your address matches what the IRS currently has. If the address is different, you MUST submit a new 13441-A form to the IRS. While this information is still true, you DO NOT need to completely fill out the 13441-A form as previously stated. Please reference the sample 13441-A form located at https://www.dsrabenefittrust.net/dsrabene/index.php/document-center/Health-Coverage-Tax-Credit-(HCTC)/Sample-Documents/ for the sections that you do need to fill out when submitting your new address to the IRS.

Visit our website at www.dsrabenefittrust.net or download the form at https://www.irs.gov/pub/irs-pdf/f13441a.pdf when submitting a new form to the IRS.

On behalf of the DSRA Benefit Trust Committee, we thank you for your participation in the DSRA Benefit Trust benefit plans and your ongoing support. We appreciate the opportunity to continue to serve you!

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DSRA-Benefit Trust Board of Directors

 

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