The Family Member Registration Form (IRS/HCTC Form 14117) is now available. Family members who are currently enrolled or were recently cancelled from the program can download the form and send it in now.  The retiree should use this form for their family members if they are already Medicare eligible and/or the Medicare status occurred within the last 24 months; due to turning 65 or disability, or the divorce or death of the retiree.  This is the form to use for the new law that went into effect January 1st, 2010.

Click here for the IRS page related to this information
Click here for Form 14117
Click here for Step-by-Step instructions for Form 14117