To download (or print) a PDF of a document shown on this page, click on the link under the item. NOTE: If you are having difficulty accessing a PDF, you may need to upgrade to the most recent version of Adobe Reader; it's free.
Enrollment/Change Forms:
- Dental and Vision Plan - New Enrollment, Change, Cancellation (Form DCD)
- Medical Plan New Enrollment, Change, Cancellation (Form NC)
- Medicare Advantage Prescription Drug Plan Enrollment Form
- Kaiser Permanente Hawaii Arbitration Agreement
Please note, the three forms above are interactive but cannot be submitted electronically as each requires your signature. You may fax the completed form at 626-564-6155, or mail to LACERA at PO Box 7060, Pasadena, CA 91109-7060.
Brochures & Rate Tables
- Medical & Dental/Vision Premium Rates
- Medical Premium Rates - Out of Area
- Dental Vision Chart
- Plan Comparison
- Plan Comparison - Medicare
- Plan Comparison - Out of Area
- Medicare Benefits Chart
- How Your Anthem Blue Cross Plans I, II, and III Coordinate with Medicare
- Changing Medical Plans
New Retiree Healthcare Packet
- Exploring Your Healthcare Benefits Through LACERA
- Contact Information
- Decision Guide
- Dental/Vision Plans
- Medical Plans Overview
- When You Travel
- Request Enrollment Forms
Annual Retiree Healthcare Packet
To order healthcare forms and packets, call 800-786-6464, and press 1 for Retiree Healthcare.
To order other retirement information, visit the Brochures & Forms page.