Welcome to the CalSTRS Medicare Benefits Program forms online. You can now download and print the Medicare Benefits Program form. The available version of Adobe Acrobat Reader enables you to fill out a form on your computer and print it, and we have enabled the on-line form with this feature. You should print a test page (first page or portion of first page partially filled out if you intend to fill out the entire form on your computer and print it), to determine that your printer can successfully print the information before spending a lot of time on it.

• Once you have completed the appropriate form, you will need to print it before closing your form. Acrobat Reader does not allow you to save a filled out document for later retrieval and/or revision.
• If you would like to fill out and print the CalSTRS Medicare Authorization Form (HB - 0986) only, please click below on the second link. If you prefer to print the entire CalSTRS Medicare Information Packet, please click below on the first link.
• You cannot submit the form electronically at this time. We hope to offer this feature to you at a future date.

CalSTRS Medicare Information Packet (Includes Cover Letter, CalSTRS & Medicare Information, and CalSTRS Medicare Authorization Form HB - 0986)

CalSTRS Medicare Authorization HB - 0986 Only