Forms to Submit for Enrollment

This section will help you determine which forms below are needed to submit to enroll in the LACERS Health Plan of your choice, add or delete dependents from your plan, or cancel your coverage. You must submit the appropriate forms to LACERS to process your health plan selection. Health plan enrollment and family account change forms are available on this page as well as the Forms section, upon request by emailing LACERS.Health@lacers.org or calling LACERS at (800) 779-8328.

Outside of Open Enrollment period: Completed forms with applicable supporting documents must be received by the 10th of the month in order for the transaction to be effective the first of the following month.

If you are not adding/changing plans nor adding/deleting dependents, no action is needed on your part.

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