Health Benefit Forms
Caremark Mail Order Form
Caremark Prescription Reimbursement Form
SilverScript prescription claim form for Medicare retirees (PDF)
CIGNA Claim Form
Vision Care Claim Form
Vision Provider List
Metlife Dental Form
Retiree Health Program Enrollment/Change Form
Direct Deposit Form for Retired Employees (PDF) or Surviving Spouses, Qualified Domestic Relation Order (QDRO), and Beneficiary Accounts (PDF)
W-4P – Withholding Certificate for Pension or Annuity Payments Please email your W4 to Con Edison Payroll.
NY State Tax Withholding Explanation and Election Form
Address Change - Contact Employee Benefits at 800-582-5056 or email email@example.com or logon to retiree self service in HR Payroll.
Retiree Self Service
Once enrolled in Retiree Self Service, you can view and print your pension verification letter.