Document Library
Find forms, plan documents, and important resources
49 document(s) found
Archives
Post-65 Plan Summary 2023 (Archived)
Archived Post-65/Medicare plan documentation from 2023Post-65 / Medicare2023
Pre-65 Plan Summary 2023 (Archived)
Archived Pre-65 plan documentation from 2023Pre-652023
Post-65 Plan Summary 2022 (Archived)
Archived Post-65/Medicare plan documentation from 2022Post-65 / Medicare2022
Pre-65 Plan Summary 2022 (Archived)
Archived Pre-65 plan documentation from 2022Pre-652022
Post-65 Plan Summary 2021 (Archived)
Archived Post-65/Medicare plan documentation from 2021Post-65 / Medicare2021
Pre-65 Plan Summary 2021 (Archived)
Archived Pre-65 plan documentation from 2021Pre-652021
Post-65 Plan Summary 2020 (Archived)
Archived Post-65/Medicare plan documentation from 2020Post-65 / Medicare2020
Pre-65 Plan Summary 2020 (Archived)
Archived Pre-65 plan documentation from 2020Pre-652020
Billing & Payments
Enrollment
Life Insurance
Life Insurance Beneficiary Designation Form
Form to designate or update life insurance beneficiariesAll Members
Life Insurance Claim Instructions
How to file a life insurance claimAll Members
Life Insurance Plan Overview
Comprehensive guide to DSRA life insurance benefitsAll Members
MetLife Contact Information
Contact information for MetLife life insurance administrationAll Members
Plans & Rates
Medicare Part D Prescription Drug Plan 2026
Part D prescription drug coverage details for 2026Post-65 / Medicare2026
Post-65 Benefit Comparison Chart 2026
Side-by-side comparison of Medicare supplement options for 2026Post-65 / Medicare2026
Post-65 Dental & Vision Summary 2026
Dental and vision coverage for Medicare-eligible retirees in 2026Post-65 / Medicare2026
Post-65 Medicare Supplement Plan Summary 2026New
Medicare supplement coverage overview for 2026Post-65 / Medicare2026
Post-65 Premium Rate Sheet 2026
Monthly premium rates for Post-65/Medicare coverage in 2026Post-65 / Medicare2026
Pre-65 Benefit Comparison Chart 2026
Side-by-side comparison of Pre-65 plan options for 2026Pre-652026
Pre-65 Dental & Vision Summary 2026
Dental and vision coverage details for 2026Pre-652026
Pre-65 Medical Plan Summary 2026New
Complete medical plan overview for Pre-65 retirees in 2026Pre-652026
Pre-65 Premium Rate Sheet 2026
Monthly premium rates for Pre-65 coverage in 2026Pre-652026
Medicare Part D Prescription Drug Plan 2025
Part D prescription drug coverage details for 2025Post-65 / Medicare2025
Post-65 Benefit Comparison Chart 2025
Side-by-side comparison of Medicare supplement options for 2025Post-65 / Medicare2025
Post-65 Dental & Vision Summary 2025
Dental and vision coverage for Medicare-eligible retirees in 2025Post-65 / Medicare2025
Post-65 Medicare Supplement Plan Summary 2025
Medicare supplement coverage overview for 2025Post-65 / Medicare2025
Post-65 Premium Rate Sheet 2025
Monthly premium rates for Post-65/Medicare coverage in 2025Post-65 / Medicare2025
Pre-65 Benefit Comparison Chart 2025
Side-by-side comparison of Pre-65 plan options for 2025Pre-652025
Pre-65 Dental & Vision Summary 2025
Dental and vision coverage details for 2025Pre-652025
Pre-65 Medical Plan Summary 2025
Complete medical plan overview for Pre-65 retirees in 2025Pre-652025
Pre-65 Premium Rate Sheet 2025
Monthly premium rates for Pre-65 coverage in 2025Pre-652025
Medicare Part D Prescription Drug Plan 2024
Part D prescription drug coverage details for 2024Post-65 / Medicare2024
Post-65 Benefit Comparison Chart 2024
Side-by-side comparison of Medicare supplement options for 2024Post-65 / Medicare2024
Post-65 Dental & Vision Summary 2024
Dental and vision coverage for Medicare-eligible retirees in 2024Post-65 / Medicare2024
Post-65 Medicare Supplement Plan Summary 2024
Medicare supplement coverage overview for 2024Post-65 / Medicare2024
Post-65 Premium Rate Sheet 2024
Monthly premium rates for Post-65/Medicare coverage in 2024Post-65 / Medicare2024
Pre-65 Benefit Comparison Chart 2024
Side-by-side comparison of Pre-65 plan options for 2024Pre-652024
Pre-65 Dental & Vision Summary 2024
Dental and vision coverage details for 2024Pre-652024
Pre-65 Medical Plan Summary 2024
Complete medical plan overview for Pre-65 retirees in 2024Pre-652024
Pre-65 Premium Rate Sheet 2024
Monthly premium rates for Pre-65 coverage in 2024Pre-652024
VEBA Documents
Board Election Procedures
Procedures for DSRA VEBA board electionsAll Members
DSRA VEBA Bylaws
DSRA VEBA organizational bylawsAll Members
DSRA VEBA Trust Agreement
Official DSRA VEBA Trust Agreement documentAll Members
HIPAA Notice of Privacy Practices
HIPAA privacy notice for health plan participantsAll Members
Privacy Policy
DSRA VEBA privacy policy and data handling practicesAll Members
Can't Find What You're Looking For?
Contact Benistar for assistance locating specific documents or forms.