The HCTC program has been reauthorized for 2020 and the HCTC AMP program will begin providing the MONTHY 72.5% subsidy to eligible participants that have returned a newly completed 13441-A form to Benistar, the DSRA-BT Plan Administrator.  The monthly program begins again on February 01, 2020, following a brief termination.  The recent reauthorization of the program by Congress is for 1 year and now set to expire December 31, 2020.  As the AMP program begins, the IRS/HCTC has informed us they will be requiring ALL HCTC AMP participants to complete a new 13441-A form.  This is a mandatory action each individual and each family must take, in order to participate in the AMP program for 2020.

     *  If you fail to complete and return a New 13441-A form to Benistar, the Plan Administrator, you will not be eligible to participate in the AMP program. 

     *  The Special Open Enrollment Period is now available and will run until January 31, 2020.  If you intend on making a change to your 2020 BCBSM plan level or if you terminated your BCBSM insurance at the end of 2019 and would like to re-enroll, please complete the DSRA Benefit Trust BCBSM Enrollment form and check “Change”, “Other” and write “Plan Level Change” or “Re-Enrollment”.  It would be helpful to also write “Plan Level Change” or “Re-Enrollment” on the top of the form.  It is not necessary to check any other boxes in Part I of the form.  If you do not wish to make any plan changes for 2020 during this Special Open Enrollment Period, you do not need to complete the DSRA-BT BCBSM Enrollment Form.

     *  Prior to receiving this email, if you have sent a re-enrollment 13441-A form to Benistar and do not need to update your 2020 plan selection or if you have sent the re-enrollment 13441-A form and have confirmed with Benistar of your plan change for 2020, you do not need to send another 13441-A form or BCBSM Enrollment form.  If you have sent the 13441-A form but would like to change your plan level for 2020, please complete the 13441-A form as an update and complete the BCBSM Enrollment form and send both to Benistar as quickly as possible.

     *  It is also important to remember, the IRS/HCTC will not accept 13441-A forms directly from DSRA Benefit Trust members, as they have in the past, you must send the completed 13441-A form to Benistar.  Benistar will review the forms for mistakes and will work with you to correct the information if necessary.  Benistar will forward your form to the IRS/HCTC on your behalf along with your updated insurance information.

     *  Once the IRS/HCTC AMP program receives and approves your enrollment/re-enrollment into the AMP program, they will send you a re-enrollment letter, welcoming you back into the program.  You will then be able to make your 27.5% monthly premium payment directly to the IRS.  You must include the voucher with your check when sending in your premium payment.

     *  To ensure you receive the HCTC AMP for February, Benistar should receive your 13441-A form by January 17th.  After January 17th, the IRS may not have time to process your form in time for a February AMP start.  It is recommended that you fax or email your forms to Benistar.  The updated 13441-A sample forms as well as the 13441-A form are available at  If you have any questions, please call the Benistar DSRA Call Center at 1-888-588-6682.

Please remember, you must send your 13441-A form to Benistar.


By mail:                    Benistar DSRA-BT Client Service Center

                               10 Tower Lane, Suite 100

                               Avon, CT 06001


By fax:                     1-860-408-7025                 By email:          This email address is being protected from spambots. You need JavaScript enabled to view it. 


The IRS/HCTC will accept the HCTC Reimbursement Form #14095 for any months in 2020 you pay 100% of the monthly premium.  This form is in lieu of form #8885 filed with your 2020 Federal Tax Return.  By using form #14095, you will receive the 72.5% reimbursement for the months you have paid 100%, faster than waiting to file form #8885 with your 2020 Federal Tax Return in 2021.  To file form #14095:

  • You must be re-enrolled in the HCTC AMP program
  • You must have paid the 27.5% monthly premium for at least one month (e.g. if you are enrolled for February, you can submit form #14095 in March for the 72.5% premium reimbursement of your January 2020 100% premium payment). Please do not send your #14095 form request in prior to the completion of your first month of paying 27.5% of the cost in order to allow the IRS/HCTC program to process your application in a timely manner.  Form #14095 should not be sent to Benistar.  This form and any required supporting documents should be mailed directly to the IRS.  
DSRA-Benefit Trust Board of Directors

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