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

CIGNA Claim Form for Hospital/Medical (PDF)
CPS - Claim Form for In-Network Vision
CPS - Claim Form for Out-of-Network Vision
Retiree Health Program Enrollment/Change Form (PDF)
Caremark – Prescription Reimbursement Claim Form (PDF)
Caremark – Prescription Order Form (PDF)
Met Life – Dental Claim Form (PDF)

Insurance & Pension

Met Life – Beneficiary Designation Form (PDF)
Met Life – GUL Beneficiary Designation Form (PDF)
Direct Deposit Form for Retired Employees (PDF)
Federal Tax Withholding Form (PDF)
New York State Tax Withholding Form (PDF)