SLPS-Sponsored Base-BuyUp Plans Creditable Prescription Drug Coverage Disclosure Notice

2025 Bonus Drug List

You can check your medication tiers on these databases so we can ensure you are in the correct insurance plan. 

Dependent Eligibility for Medical, Dental and Vision Coverage

Provides dependent eligibility guidelines for PSRSSTL insurance Coverage 

Drug Formulary for All Medicare Advantage Plans

You can check your medication tiers on these databases so we can ensure you are in the correct insurance plan. 

Disability Pension Application Form

Direct Deposit Cancellation Form

Direct Deposit Authorization Form

Retired members are encouraged to sign up for deposit of their benefit into their bank account.  This form along with documentation from the bank is needed to request direct deposit of the monthly retirement benefit into the Member’s bank account. 

Delta Dental Out of Network Claim Form