Retirement Forms & Publications (PDF format)
Frequently Used Forms
Name/Address Change Form
Retirement Benefits Estimate Request (DryRun) Form
Beneficiary Designation Form
Beneficiary Designation for Temporary Employee Form
Retirement Notification and Instructions Form
W4P Withholding for Pension or Annuity Form
Plan Guides & Summaries
The Plan Guide is the ultimate source of comprehensive information about City retirement benefits. The plan guide provides detailed information about retirement benefits including:
- General Plan Information
- Eligibility and Membership
- When You Can Retire
- Your Benefit Amount
- How Your Benefit is Paid
- Benefits Payable Upon Your Death
- Termination of Employment
Plan Guide - General Employees
Plan Guide - Firefighters
Plan Guide - Police Officers
Plan Highlights for Firefighters
Plan Highlights for General Employees
Plan Highlights for Police Officers
Pre-Retirement Survivor Annuity Information
Qualified Domestic Relations and Income Deduction Orders (QDRO/IDO)
Summary Plan Modification for General Employees
Guides to Retiring
Guide to Retiring - General Employees
Guide to Retiring - Police Officers & Firefighters
Guide to Retiring for Vested Employees
Retirement Notification and Instructions Form
Payment Options for 401(k) MAP
Payment Options for 457 RSVP, 175/185 Supplemental Share, and DROP
Pension Calculation Worksheet
Pension Calculator for General, Police and Fire
401 (k) MAP and 457 RSVP
MAP vs RSVP Comparison Chart
MAP/RSVP Contribution Limits Info Sheet
401 (k) MAP Contribution Change Form: General Employees
401 (k) MAP Contribution Change Form: Police and Fire
401 (k) MAP Enrollment Form
401 (k) MAP Options at Retirement
457 RSVP Contribution Change Form
457 RSVP Enrollment Form
457 RSVP Options at Retirement
175/185 Supplemental Share Plan (Firefighters and Police Officers)
175 Supplemental Share Plan for Firefighters Information Sheet
185 Supplemental Share Plan for Police Officers Information Sheet
Deferred Retirement Option Plan (DROP)
DROP Enrollment Instructions and Form
DROP-to-Retirement Notification and Instructions Form
DROP Information Sheet For General Employees
DROP Information Sheet for Firefighters
DROP Information Sheet for Police Officers
DROP Begin and End Dates
DROP Account Value Estimator (to estimated amount that can be accumulated)
BuyBack Program
175 Firefighter Buyback Rollover Form
185 Police Buyback Rollover Form
401 (k) MAP Buyback Rollover Form
457 RSVP Buyback Rollover Form
Out of City Public Service Verification Form
Insurance
BCBS/CHP Rates and Benefits
Health Care Premiums for BCBS/CHP
Health Care Premiums for BCBS/CHP With Rates For Overage Dependents
Changes to Coverage Outside of Open Enrollment: BCBS/CHP
Discontinue Retiree Health Form
BCBS
BCBS Enrollment Form
BCBS Status Change Form
BCBS Dependent Verification Form
BCBS PrimeMail Pharmacy Mail Order Form
BCBS Schedule of Benefits
BCBS Find A Provider
BCBS HIPAA Authorization Form
BCBS Notice of Special Enrollment Rights
Domestic Partner Information
Domestic Partnership For Retirees Affidavit
Domestic Partnership Termination Affidavit
BCBS Prior/Concurrent Coverage Affidavit
BCBS Prior/Concurrent Coverage Info
BCBS Prior Authorization
BCBS Prescription Program
BCBS Medicare
Blue Options Enrollment Guide
Blue Options Medicare Mail Order Brochure
Blue Options Medicare PirmeMail Pharmacy Mail Order Form
CHP
CHP Enrollment Form
CHP Dependent Eligibility Verification Form
CHP Member Status Change Form
CHP Caremark Mail Order Form
CHP Understanding How CHP Works
CHP Schedule of Benefits
CHP Physician List
CHP Away From Home Brochure
CHP Caremark Brochure
CHP Connect (Access to Online Medical Records)
CHP Drug Endorsement $15 $30 $50
CHP Overage Dependent Enrollment Form
CHP Personal Health Assessment
CHP Prescription Program
CHP Medicare
CHP Medicare Enrollment Form
CHP Medicare Made Easy Brochure for Retiree Advantage
CHP Medicare Schedule of Benefits for Retiee Advantage Copayments
CHP Medicare Summary of Benefits for Retiree Advantage
ARAG
ARAG Legal Insurance Brochure
ARAG Legal Insurance Plan Summary
ARAG Rate Schedule
CNA
CNA Long Term Care Change/Term Form
CNA Insurance Detailed Plan Information
CNA Rate Schedule
Humana-CompBenefits
Humana CompBenefits Change Request Form
Humana CompBenefits Dental Claim Form
Humana CompBenefits Rate Schedule
MetLife
MetLife Beneficiary Designation Form
MetLife Change Request Form
MetLife Beneficiary Claim Form
MetLife Disclaimer Form
MetLife Rate Schedule
MetLife Plan Guide
MetLife Direct Deposit Form
MetLife Rate Schedule 2012
MetLife Plan Booklet 2012
Forms for Retirees
Name/Address Change Form
W4P Withholding for Pension or Annuity Form
Direct Deposit 175 Firefighter Form
Direct Deposit 185 Police Form
Direct Deposit 401(k) Form
Direct Deposit 457 RSVP Form
Direct Deposit DROP Form
Direct Deposit Pension Form
MetLife Direct Deposit Form
Termination Distribution Forms (for Terminating/Retiring Employees only)
175 Firefigther Supplemental Share Termination Distribution Form
185 Police Supplemental Share Termination Distribution Form
401(k) MAP Termination Distribution Form
457 RSVP Termination Distribution Form
DROP Termination Distribution Form
Special Tax Notice regarding plan payments: 401(k) Map
Special Tax Notice regarding plan payments: 457 RSVP
Social Security Notice
Social Security Notice
Windfall Elimination Provision (Reduction of Social Security Benefit)
Government Pension Offset
Temporary Employees Information
Beneficiary Designation for Temporary Employee Form
Temporary Employees Information Sheet