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    • Retirement System

    Retiree Documents, Forms, Health Care Links

     

    Forms are opened using Adobe Acrobat which is available for free download here.  All links below will open in a new window.  If you don't find what you need please contact the Benefits Customer Service Team by e-mail or at 703/228-3500 (press 1 when you hear the message begin).

    General

    Arlington Retirement System Refund Packet
    Cancellation Form (Cancel health and dental coverage.)
    Change of Address/Name Change Packet
    Designation of Beneficiary - Arlington Retirement Account
    Dependent Verification for CIGNA and Delta Dental Form
    Direct Deposit Form
    Estimate Request Form
    Retiree Medical and Dental Plan Monthly Premiums (retired before 1/16/2012)
    Retiree Medical and Dental Plan Monthly Premiums (retired after 1/16/2012)
    Policy on Returning to Health Plan
    Tax Withholding Request (Federal and State)
    HIPAA Notice of Privacy Practices    		Life Insurance

    Designation of Beneficiary Form - Hartford Life Insurance
    Hartford Life and Supplemental Life Insurance Booklet
    FY13 Supplemental Life Insurance Rates
    Designation of Beneficiary- Aetna

    Delta Dental

    Enrollment/Change Form
    Delta Dental Member Guide
    Summary of Benefits- PPO Plus Premier 

    CIGNA

    CIGNA Preventive Care Guidelines
     Enrollment/Change Form
    Guide to myCIGNA.com (check claim status, get a replacement card, etc.)
    Link to CIGNA Site
    Summary of Benefits- Network Open Access Plan (HMO)
    Summary of Benefits- Point of Service Plan Open Access Plan

    CIGNA Medicare Surround and CIGNA Medicare Rx (PDP) Coverage is effective January 1, 2011

    Summary of Benefits
    Frequently Asked Questions

    		Kaiser Permanente

    Enrollment /Change Form
    Link to Kaiser Website
    Medicare Summary of Benefits
    Summary of Benefits

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    Quick Links for Retirees:  Retiree Information | Pension Gold (Retiree Payment Online System) | HealthSmart Program| ACREA(Arlington County Retired Employee Association) | Retiree Link Newsletter

    GET IT DONE ONLINE

    Retiree Payment Online System
    Explore your personal retirement information online.
    Subscribe to Retirement Benefits Updates by E-mail
    Please include the member's full name in the body of your message. 
    RETIREE LINK eNEWSLETTER
    Read the latest issue  here.
    HealthSmart for Retirees
    Many of the services and programs are available to retirees.
    HealthSmart Wellness Survey
    Help us find out what health topics and programs are important to you.
    Arlington County Retired Employee Association (ACREA) :  Keep up with what is going on with your fellow retirees.  Click here for more information about the organization and membership.
    How to Live Healthfully Info - CDC
    Great information source for healthy living.

    CONTACT US

    Retirement Benefits Office
    2100 Clarendon Boulevard, Suite 511 (Human Resources Department)
    Arlington, VA 22201
    (Orange Line Metro - Courthouse Station)

    TEL 703-228-3500
    FAX 703-228-3265
    1-800-818-4910
    Benefits Customer Service Team

     

    Last Modified: May 21, 2012
    2100 Clarendon Blvd. Arlington, VA 22201 Tel: 703-228-3000 TTY: 703-228-4611