Required Forms
LACERS Enrollment Forms
Forms to enroll, add/delete dependents or change Health Plans can be found in your Benefits Guide and are also available online.
* For dependents between the age of 19 and 25, completing the Student Verification portion of the enrollment form is the first step. Members still must submit additional documents - Proof from school and for Kaiser members the Kaiser Student Certification form.
Medicare Enrollment Forms
Any forms necessary to enroll or make changes to your Medicare Benefits must be acquired from your local Social Security office.
Medicare Advantage Forms
If you and/or your dependent(s) have Medicare Parts
A and B, an additional Senior form (Medicare + Advantage
form) must be completed if selecting Kaiser Senior Advantage,
Secure Horizons or SCAN.
These forms should be included in your packet if you
have already attended a retirement counseling session.
If not, please call LACERS and the forms will be mailed
to you.
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