Forms and Documents

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MSK Direct FAQs

Retirement Savings Plan Prospectus

LTD Certificate

Cigna Dental Health Maintenance Organization (HMO) Patient Charge Schedule

Cigna Dental HMO Patient Charge Schedule (Arizona)

Cigna Dental HMO Patient Charge Schedule (California)

Cigna Dental HMO Patient Charge Schedule (Illinois)

Cigna Dental HMO Patient Charge Schedule (Texas)

Leaving Citi (U.S.)

Leaving Citi (Puerto Rico)

MetLife TakeAlong Dental Overview

Survivor Guide: Citi Programs and U.S. Benefits

Letter of Medical Necessity

2020-2022 Illinois Essential Health Benefit (EHB) Listing

U.S. Legal Notices

Nondiscrimination and Accessibility Notice

Family Planning FAQs

International SOS Brochure

International SOS FAQs

International SOS LiveChat Brochure

Cigna Dental HMO State Legislation SPD

Your Retirement Guide (U.S.)

Your Retirement Guide (Puerto Rico)

Tips to Keep Accounts Safe from Fraud

Live Well at Citi Program User Guide

Live Well at Citi Rewards

Anthem Fertility Support Program

Making Sense of Menopause

Breast Cancer Awareness

MetLife Legal Plans Overview

Aetna Medical Benefits Request Form

Aetna SNOO Claim Form

Aetna Vision Claim Form

Anthem BlueCross BlueShield Claims Form

Anthem SNOO Claim Form

CVS Mail Order Form

CVS Prescription Reimbursement Claim Form

Dependent Care Spending Account Claim Form

HCSA and LPSA Claim Form

MetLife AD&D Beneficiary Designation Form

MetLife AD&D Enrollment Form

MetLife Dental Claim Form

MetLife GUL Enrollment Form for Expatriate Employees

MetLife GUL Enrollment Form for U.S. Employees

MetLife GUL Beneficiary Designation Form

Power of Attorney Form Instructions

Retirement Savings Plan Disclaimer of Beneficiary Form

Retirement Savings Plan Marital Status Verification Form

Retirement Savings Plan Unidentified Beneficiary Affidavit Form

Tobacco Certification Form

Transportation Reimbursement Incentive Program (TRIP) Claim Form

Aetna Choice Plan SBC

Aetna High Deductible Plan with HSA SBC

Aetna In-network Only Plan SBC

Aetna International Medical Fact Sheet

Aetna International Dental Fact Sheet

Aetna Vision Fact Sheet

Anthem BlueCross BlueShield Choice Plan SBC

Anthem BlueCross BlueShield High Deductible Plan with HSA SBC

Anthem BlueCross BlueShield In-network Only Plan SBC

Be Well Program (Telus) SBC

Chubb Business Travel Medical and Accident SBC

Cigna Dental Fact Sheet

Kaiser California SBC

MetLife Dental Fact Sheet

Puerto Rico Enrollment Guide - English

Puerto Rico Enrollment Guide - Spanish

Summary of 2025 Benefit Changes

Triple-S SBC - English (For coverage until June 1)

Triple-S SBC - Spanish (For coverage until June 1)

Triple-S SBC - English (For coverage June 1 and later)

Triple-S SBC - Spanish (For coverage June 1 and later)

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