Health Plan Enrollment Information


When to Enroll

Generally, you may enroll in, or change your LACERS-sponsored medical/vision and dental plan coverage or your participation in the Medical Premium Reimbursement Program (MPRP) within:

  • 60 days of your effective retirement date
  • LACERS’ annual Open Enrollment period (October 15 – November 15)
  • The specified amount of days from the following Qualifying Events:
  • 30 days of a family status change (marriage, domestic partnership, birth, adoption)
  • 60 days of turning age 55 
  • 90 days of turning age 65 (based on your Medicare eligibility) 
  • 30 days of relocation out of or into a LACERS HMO plan zip code service area
  • 30 days of a LACERS HMO plan zip code service area becoming available or unavailable
  • 30 days of being involuntarily terminated from a non-LACERS medical plan (LACERS requires proof of termination)

How to Enroll

To enroll in a LACERS health plan:

  1. Review the Health Benefits Guide 2020 for health plan premiums, subsidies, deductions and benefits to understand how the plans work, and any out-of-pocket costs you may have and make your medical and/or dental plan selections
  2. Complete relevant health plan enrollment forms:
    2020 Medical Enrollment Form (non-Kaiser)
    2020 Medical Enrollment Form (Kaiser)
    2020 Dental Enrollment Form
  3. Submit your completed form(s) to:

202 W. First Street, Suite 500
Los Angeles, CA 90012-4401

If you are enrolled in a health plan and do not want to make changes, no action is necessary and your health plan will remain in effect for the next plan year.

Making Changes

If you’d like to make changes to your coverage or dependents, see the following forms:

2020 Medical and Dental Cancellation Form

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