Retiree Forms & Resources

Life Insurance Beneficiary Forms

Enter and update beneficiary information any time, day or night, at http://mybenefits.metlife.com. To enter your beneficiary information for the first time, please follow the steps below. Once you are registered, you may access MyBenefits for future updates to your beneficiary information. Enhanced security is a priority at MetLife. During the log on process, you may be asked to verify a validation code and password for Multi-Factor Authentication.

• How to register for MetLife MyBenefits site
• If you would like to complete and mail a hardcopy beneficiary form, please click here

If you have questions about MetLife’s MyBenefits website, your user profile or you need additional assistance, contact MetLife Customer Service at 866-492-6983, Monday-Friday, 8:00 am – 11:00 pm (EST).

To file a Death Claim, contact:

Retiree Service Center
(800) 344-0661

Voluntary Group Accident Insurance Conversion

• VGA (AD&D) Conversion Form

• Change your Address
  • Update by Mail - Form
  • Update online - Benefits Website
  • If you hold Dow Stock, you need to notify your stockbroker or Computershare
• Direct Deposit Authorization
• W-4P Combo
• W-4
  Please return the completed form to:
  Dow North America Benefits
  DEPT: Dow
  P.O. Box 981901
  El Paso, TX 79998

• 2023 Notice of Creditable Coverage
• 2022 Notice of Creditable Coverage
• Aetna/CVS Caremark Mail Order Form (Pre-Medicare Retirees)
  If you are a pre-Medicare retiree and participate in the Low Deductible Plan or the High Deductible Plan, this is your mail order drug enrollment form.
• Aetna Medical Claim Form
  When making a claim for medical benefits reimbursement, this form must accompany itemized bills from your health care provider.
• Spouse/Domestic Partner Insurance Rules
• Aetna Transition of Care Form
• RHCAP Manual Claim Form
  
• Aetna/CVS Caremark Mail Order Form (Medicare Retirees)
  If you are a Medicare retiree and participate in Low Deductible Plan, Old Plan (Dow only), New Plan (Dow Only), Medicare Supplement Plan Options A – D (UCC only), Medicare Advantage PPO, this is your mail order drug enrollment form.
• Monthly Automated Payment Form
  For retirees who receive a monthly benefits invoice and want to set up automatic withdrawals from a bank account
• Authorized Representative Form
• Documentation Needed for Dependent Eligibility
• Your Rights and Protections Against Surprise Medical Bills
• CVS Prescription Drug Coverage Details
• CVS Prescription Specialty Drug Coverage Details
• CVS Pharmacy Locator

• Statement of Domestic Partner Relationship
  If you are commencing your pension and wish to add a Domestic Partner as your surviving spouse, complete this form, attaching all required documentation. You will receive a confirmation email from Dow Benefits once approved.

• DEPP Beneficiary Designation Form for Preretirement Death Benefits
• ROH Beneficiary Designation Form for Preretirement Death Benefits
• UCEPP Beneficiary Designation Form for Preretirement Death Benefits

COBRA

For plan year 2020

Building Materials

O'Leary Paint

20% off Retail Sales Price for Employees, Contractors, Retirees, Friends and Family

For more information please visit this webpage.

Vehicle Rental and Purchase Discounts

Avis

Dow retirees are eligible for Avis corporate rental car rates. As a Dow retiree, you do receive a corporate rate, but you would not get insurance coverage. If you decide to rent a vehicle, please use discount number A333300.

Chrysler

Company Code: S50326
Phone Number: 888-444-4321
Website: https://www.CHRYSLERaffiliates.com

Process:

1. Reference Company Code: S50326
2. Log onto: https://www.CHRYSLERaffiliates.com/JSP/ or call Program Headquarters at 888- 444-4321 and provide name, address, telephone number, company name, Social Security Number and Company Code in order to receive a unique Control Number.
3. Take Control Number, along with company photo ID badge, to any participating U.S. CHRYSLER, Jeep or Dodge dealership.
4. Once the dealership verifies the Control Number, the employee or spouse can choose from any eligible new CHRYSLER, Jeep or Dodge vehicle and receive the Preferred Price.

Eligibility:

Chrysler U.S. – All U.S. employees, retirees and spouses of Dow Automotive and its affiliated companies can participate.

Chrysler Canada – Active employees only, spouse not eligible but can be added as a joint owner.

Ford

Company Code: XG749
Phone Number: US: 877-975-2600; CANADA: 877-294-7554
Website: https://www.fordpartner.com/login/login.asp

Process:

• Log onto https://www.fordpartner.com/login/login.asp or call program headquarters at: 877-975-2600; CANADA: 877-294-7554.
• Provide Partner Recognition Code: XG749
• Click on “Get your PIN today!” You will be asked to provide the last 4 digits of your Social Security Number (SSN), name and contact information to generate a PIN number.

Eligibility:

Active employees (salaried, hourly and contract), retirees, members of organizations and their households who reside within the U.S. Proof of employment or membership by an organization or company eligible for Partner Recognition benefits are required at time of vehicle delivery. See the X-Plan Eligibility section for details. Driver’s licenses will be required for proof of residence for the Partner Company employee and household member.

Discount:

You can take advantage of special discount prices on FORD and LINCOLN vehicles. Discount varies depending upon vehicle selected based on X-Plan pricing. Dow identification required. Business cards not accepted.

Mitsubishi - Canada

Website for details:

• VIP Website
• Select Mitsubishi Canada/Partners and create your username and password
• VIP Documents

Supplier Contact: Nicole Simpson - 905.214.9065

Who is eligible: Active Employees only are eligible but may sponsor a friend or family member for VIP pricing.

Process: Print out Eligibility Certificate from website and take to the dealership. Proof of employment must be presented, i.e. Dow badge or pay stub.