Click on the links below to access a variety of forms, documents and other tools and resources. Please note that plan changes and/or new rules and regulations may result in modifications to the forms and/or documents listed below.
COVID-19 What You Need to Know
Anthem PPO Medicare Part D Enrollment Form
Anthem HMO Medicare Part D Enrollment Form
Anthem Medicare Part D Disenrollment Form
City of Los Angeles Cash-in-Leu Affidavit Form
City of Los Angeles Declaration of Domestic Partnership Form
Kaiser Senior Advantage Enrollment Form
Kaiser Senior Advantage Disenrollment Form
Personal Information Change Form
Verification of Dependents Form
Member Deduction Authorization
Life Insurance Cash Surrender Form
Los Angeles Police Relief and Assistance Foundation Donation Form
Access the Anthem Web Portal or Sydney Care Mobile App
Anthem Web Portal or Sydney Care Mobile App Registration
LAPRA 2023-2024 Benefits Guide for Active Members
LAPRA 2023-2024 Benefits Guide for Retired Members
LAPRA 2023-2024 Retiree Medical/Dental Premiums
Anthem Blue Cross PPO Medical Evidence of Coverage
Anthem Blue Cross HMO Medical Evidence of Coverage
Anthem Blue Cross PPO Dental Evidence of Coverage
Anthem Blue Cross HMO Dental Evidence of Coverage
Anthem Blue Cross PPO Medical Plan Carrier Summary
Anthem Blue Cross PPO Medical Plan Rx Summary
Anthem Blue Cross HMO Medical Plan Carrier Summary
Anthem Blue Cross HMO Medical Plan Rx Summary
Anthem Blue Cross Medicare Part D Medical Plan Rx Summary
Anthem Blue Cross PPO Dental Plan Carrier Summary
Anthem Blue Cross HMO Dental Plan Carrier Summary
Kaiser HMO Evidence of Coverage (active members)
Kaiser HMO Benefits Summary (active members)
Kaiser HMO Evidence of Coverage (early retiree members)
Kaiser Senior Advantage HMO Evidence of Coverage (retired members)
Kaiser Senior Advantage Benefits Summary
Kaiser Chiropractic Benefits Summary
LAPRA Eligibility Guide for Active Members
LAPRA Eligibility Guide for Retired Members
Life and AD&D Certificate of Coverage (active members)
Life and AD&D Certificate of Coverage (retired members)
Death Notification Assistance for Active Members
Death Notification Assistance for Retired Members
Death Notification Assistance for Spouses of Members
Long-term Care Insurance Certificate of Coverage (active members)
Long-term Care Insurance Certificate of Coverage (retired members)
Long Term Disability Certificate of Coverage (active members)
Vision Service Plan (VSP) Grievance Process
LAPPL Member Assistance Program Flyer
2023 Legally Required Notices Booklet
2024 Legally Required Notices Booklet
Women's Health and Cancer Rights Act of 1998 Notice
Anthem Blue Cross PPO Summary of Benefits and Coverage
Anthem Blue Cross HMO Summary of Benefits and Coverage
Kaiser HMO Traditional Plan Summary of Benefits and Coverage
Kaiser HMO Senior Advantage Summary of Benefits and Coverage (Medicare eligible retired members)