Forms

Overview

The Forms Library will serve as the central hosting and retrieval application for all LACERS forms and documentations. The Forms Library will allow external users to search and filter across a variety of categories with all forms/documentation available for download.

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Health Benefit Forms*


2020 Medical Plan Enrollment Form (Non-Kaiser)
2020 Medical Plan Enrollment Form (Kaiser)
2020 Dental Plan Enrollment Form
2020 Medical/Dental Cancellation Form
Certification of Dependent or Survivor Status for Health Coverage

*Contact LACERS if you need enrollment forms for the following plans:

  • Anthem Blue Cross Life and Health
  • Kaiser Permanente Senior Advantage
  • UnitedHealthCare Medicare Advantage
  • SCAN Medicare Advantage

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