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Our outage map is down temporarily. We’ll post updated information shortly. We have approximately 3,500 customers out from the heat and last night’s storm.

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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/Vision (PDF)
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)