The links below provide you with the forms necessary to maintain your Personal, Payroll, and Benefits data at Dow. Do you want to view your data and make immediate changes? If so, please visit My Retiree Data, the easiest way to view and maintain all of your important Dow information. Are you a Canada Retiree? Please see the Retirees in Canada page for all of the necessary forms. If you have a question on any of these services, please contact the HR Service Center.
Personal Data and Payroll
- Address Change Form
- Direct Deposit Authorization (108K PDF)
- State Forms
- W-4 General(PDF, 632KB)
- W-4P Combo(PDF, 13KB)
|Aetna/CVS Caremark Mail Order Form (Pre-Medicare Retirees) (PDF, 903KB)||If you are a pre-Medicare retiree and participate in the MAP Plus Option 1 Low Deductible Plan or the MAP Plus Option 2 High Deductible Plan, this is your mail order drug enrollment form.|
|Aetna Medical Claim Form (PDF, 479KB)||When making a claim for medical benefits reimbursement, this form must accompany itemized bills from your health care provider.|
|Spouse/Domestic Partner Insurance Rules (PDF, 69KB)|
|Aetna Transition of Care Form (PDF, 373KB)|
|RHCAP Manual Claim Form (PDF, 90KB)||Click on this link for the RHCAP Manual Claim Form.|
|Aetna/CVS Caremark Mail Order Form (Medicare Retirees) (PDF, 903KB)||If you are a Medicare retiree and participate in MAP Plus Option 1 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.|
|Blue Care Network 2017 Employer Group/union Enrollment Form (PDF, 235KB)|
Monthly Automated Payment Form |
|For retirees who receive a monthly benefits invoice and want to set up automatic withdrawals from a bank account|
|VGA (AD&D) Conversion Form (PDF, 731KB)|
- DEPP Beneficiary Form (228K PDF)
- ROH - Unmarried Preretirement Death Benefit Beneficiary Designation (225K PDF)
- UCEPP Beneficiary Form
|Statement of Domestic Partner Relationship (PDF, 239KB)||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.|
You can now enter and update beneficiary information any time, day or night, via the Internet at www.MetLife.com/MyBenefits. 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.
- Log on and select your employer’s name: "The Dow Chemical Company."
- Register by clicking the "Register here" highlighted text, or by clicking "Register Now" on the left hand side of the web page.
- Enter your personal information: Your first and last name, Dow ID number preceded by three zeros (e.g. 000123456) and date of birth. E-mail address is optional.
- Create a User Name and Password: Be sure to use the correct number of characters noted.
- Security Verification Questions: You will need to answer three security verification questions in the event you forget your Username and Password.
- Select the Group Life Insurance link to enter the beneficiary designation page. (Note that you will need birth dates and current addresses for your beneficiaries so have this information available before starting the process.)
If you assigned ownership of your policy(ies) to a trust or a third party, only the Policy Owner can designate/update beneficiary information, and you will not have access to the MetLife web site. MetLife already has your current assignment on file. If the Policy Owner wants to update the assignment, they must contact MetLife directly at 866-492-6983 (domestic and international calls), and request the appropriate forms.
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).
Who to Contact
To file a Death Claim, contact:Retiree Service Center
Toll Free: (800) 344-0661
Phone: (989) 636-0977
Dow Matching Gift Program
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