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HCTC Forms & Brochures

HCTC - (HEALTH COVERAGE TAX CREDIT)

HCTC AIRLINE ENROLLMENT FORM

13441A Form - IRS Enrollment Form

completed sample forms available at bottom of this page for 13441-A form

2020 AIRLINE TRUST HCTC ENROLLMENT BOOK

SUMMARY PLAN DESCRIPTIONS FOR HCTC PLANS

GOLD PLAN SPD

SILVER PLAN SPD

BRONZE PLAN SPD

Medicare Forms & Brochures

MEDICARE

Aetna/BCBSM MEDICARE ENROLLMENT FORM

HARTFORD MEDICARE ENROLLMENT FORM

The Enrollment form is for all States, with the exception of Florida.

PLEASE CONTACT BENISTAR CALL CENTER IF YOU ARE ENRO:LLING AND LIVE IN FLORIDA.

2020 MEDICARE Enrollment Book

Aetna Formulary

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN.

SUMMARY PLAN DESCRIPTIONS FOR HARTFORD MEDICARE PLANS

PREMIUM CHOICE PLAN ( PLAN F )

PREMIUM PLAN ( PLAN G w/ COPAY )

Brochures, Enrollment Information & Forms

HCTC Forms & Brochures

HCTC - (HEALTH COVERAGE TAX CREDIT)

completed sample forms available at bottom of this page for 13441-A form

2020 AUTO TRUST HCTC ENROLLMENT BOOK

SUMMARY PLAN DESCRIPTIONS FOR HCTC PLANS

GOLD PLAN SPD

SILVER PLAN SPD

BRONZE PLAN SPD

HCTC AUTO ENROLLMENT FORM

Medicare Forms & Brochures

MEDICARE

Aetna/BCBSM MEDICARE ENROLLMENT FORM

HARTFORD MEDICARE ENROLLMENT FORM

The Enrollment form is for all States, with the exception of Florida.

PLEASE CONTACT BENISTAR CALL CENTER IF YOU ARE ENRO:LLING AND LIVE IN FLORIDA.

2020 AUTO MEDICARE ENROLLMENT BOOK

Aetna Formulary

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN.

SUMMARY PLAN DESCRIPTIONS FOR HARTFORD MEDICARE PLANS

PREMIUM CHOICE PLAN ( PLAN F )

PREMIUM PLAN ( PLAN G w/ COPAY )

Brochures, Enrollment Information & Forms

HCTC Forms & Brochures

HCTC - (HEALTH COVERAGE TAX CREDIT)

HCTC STEEL ENROLLMENT FORM

13441A Form - IRS Enrollment Form

completed sample forms available at bottom of this page for 13441-A form

2020 STEEL TRUST HCTC ENROLLMENT BOOK

SUMMARY PLAN DESCRIPTIONS FOR HCTC PLANS

GOLD PLAN SPD

SILVER PLAN SPD

BRONZE PLAN SPD

Medicare Forms & Brochures

MEDICARE

Aetna/BCBSM MEDICARE ENROLLMENT FORM

HARTFORD MEDICARE ENROLLMENT FORM

The Enrollment form is for all States, with the exception of Florida.

PLEASE CONTACT BENISTAR CALL CENTER IF YOU ARE ENRO:LLING AND LIVE IN FLORIDA.

2020 MEDICARE Enrollment Book

Aetna Formulary

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN.

SUMMARY PLAN DESCRIPTIONS FOR HARTFORD MEDICARE PLANS

PREMIUM CHOICE PLAN ( PLAN F )

PREMIUM PLAN ( PLAN G w/ COPAY )

SAMPLE 13441A Enrollment Forms

Sample 13441-A (IRS) Enrollment Form

Call Center

FORMS

Brochures, Enrollment Information & Forms

HCTC Forms & Brochures

HCTC - (HEALTH COVERAGE TAX CREDIT)

completed sample forms available at bottom of this page for 13441-A form

SUMMARY PLAN DESCRIPTIONS FOR HCTC PLANS

Medicare Forms & Brochures

MEDICARE

The Enrollment form is for all States, with the exception of Florida.

PLEASE CONTACT BENISTAR CALL CENTER IF YOU ARE ENRO:LLING AND LIVE IN FLORIDA.

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN.

Brochures, Enrollment Information & Forms

HCTC Forms & Brochures

HCTC - (HEALTH COVERAGE TAX CREDIT)

completed sample forms available at bottom of this page for 13441-A form

SUMMARY PLAN DESCRIPTIONS FOR HCTC PLANS

Medicare Forms & Brochures

MEDICARE

The Enrollment form is for all States, with the exception of Florida.

PLEASE CONTACT BENISTAR CALL CENTER IF YOU ARE ENRO:LLING AND LIVE IN FLORIDA.

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN.

Brochures, Enrollment Information & Forms

HCTC Forms & Brochures

HCTC - (HEALTH COVERAGE TAX CREDIT)

completed sample forms available at bottom of this page for 13441-A form

SUMMARY PLAN DESCRIPTIONS FOR HCTC PLANS

Medicare Forms & Brochures

MEDICARE

The Enrollment form is for all States, with the exception of Florida.

PLEASE CONTACT BENISTAR CALL CENTER IF YOU ARE ENRO:LLING AND LIVE IN FLORIDA.

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN.

SAMPLE 13441A Enrollment Forms

(RETIREE ENROLLING)

(SINGLE PERSON ENROLLING)

(FAMILY ENROLLING)

(QUALIFIED FAMILY MEMBER ENROLLING)

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