The IRS/HCTC department is currently processing 13441-A forms submitted after the extension of the HCTC program this year.  You may have recently received a letter from the IRS telling you to send your 13441-A form to them.  Please ignore this request. All DSRA HCTC Advanced Monthly Payment (AMP) members should have submitted a 13441-A form to Benistar in order to re-enroll in the HCTC AMP program for 2020.  Once your form has been reviewed by Benistar and processed by the HCTC department, you will receive the IRS/HCTC Welcome letter with payment instructions and your PIN.  When you receive the IRS letter or if you know your PIN from 2019, contact Benistar and provide your PIN to them.  Benistar will send prefilled IRS form #13973 Payment Coupons to each member once you have been re-enrolled in the AMP program.

If you have received the IRS/HCTC Welcome letter, you are re-enrolled and can now make your February 27.5% payment.  Do not wait to receive the prefilled coupons from Benistar for the February payment.  Print the IRS form #13973 HCTC Payment Coupon (available at and complete for your February payment.  The deadline for the February enrollment notification and for sending your February payment by regular mail is February 7th.  Any participants who have not received the IRS/HCTC Welcome letter by this date should be prepared to make the 100% premium payment to Benistar for the month of February.  After you have been re-enrolled in the HCTC AMP and after you have made one month’s 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.

If you are delayed in sending the February 27.5% payment to the IRS due to late notification, the HCTC department requests you overnight the payment, return receipt requested, no later than February 15th via the USPS to:

U.S. Treasury – HCTC
P.O. Box 970023
St. Louis, MO 63197-0023

FedEx and UPS are not accepted.  Due to the February 17th President’s Day Holiday, if you are unable to overnight the 27.5% February payment by February 15th, you will need to make the 100% payment to Benistar for the month of February even if you receive your HCTC Welcome letter after that date.  Do not make a payment to Benistar and a payment to the IRS/HCTC for February.  If you have already sent your February payment to Benistar, your premium will be paid, and you will start making 27.5% payments to the IRS/HCTC in March.

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 form #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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