Benefits Forms
Download claim forms for medical, dental, vision care, and prescription services. Print out what you need, fill it out, and send it to the appropriate vendor.
Medical, Vision & Dental
Anthem BCBS Claim Form for Hospital/Medical (PDF)
CPS - Claim Form for In-Network Vision
CPS - Claim Form for Out-of-Network Vision
Caremark – Prescription Reimbursement Claim Form (PDF)
Caremark – Prescription Order Form (PDF)
SilverScript prescription claim form for Medicare retirees (PDF)
MetLife – Dental Claim Form (PDF)
Insurance & Pension
MetLife – Beneficiary Designation Form (PDF)
MetLife – GUL Beneficiary Designation Form (PDF)
Federal Tax Withholding Form (PDF) Please email your W4 to Con Edison Payroll
New York State Tax Withholding Form (PDF)