Forms
- Authorize For Release of Information Form
- Beneficiary Form for Bereavement Benefit
- Beneficiary Form for Metlife (Active)
- Beneficiary Form for Metlife (Retired)
- Beneficiary Form for Metlife Voluntary Life
- Beneficiary Form for Survivors Benefit
- Change of Address Form
- Check Replacement Affidavit
- COBRA Coverage Application (2023 Rates)
- COBRA Coverage Pre-Payment Application
- Dental Claim Form
- Disability Claim Form – Short Term (Metlife)
- Domestic Partner Application
- Domestic Partner Renewal Affidavit
- Domestic Partner Termination
- Health Insurance Assistance Claim Form
- Hearing Aid Medical Out-of-Network Claim Form (Empire BC/BS)
- Opt-Out, Opt-Back-In Form
- Prescription Claim Form
- “Self-Pay” Enhanced Retiree Plan Enrollment Packet (2023-24 Rates)
- “Self-Pay” Enhanced Retiree Plan Enrollment Form (2023-24 Rates)
- Specialist Co-pay Reimbursement Claim Form
- Statement of Dependence Form – Custodial
- Statement of Dependence Form – Medical