Click on the links below to access a variety of forms, documents and other tools and
resources.
Anthem Blue Cross Medical Enrollment Form
Anthem Blue Cross Dental Enrollment Form
Anthem Blue Cross Medical/Dental Change Form
Anthem Blue Cross Medicare Part D Enrollment Form
Anthem Blue Cross Medicare Part D Disenrollment Form
Kaiser HMO Enrollment/Change Form
Kaiser Senior Advantage Enrollment Form
Kaiser Senior Advantage Disenrollment Form
LAPRA Medical Declination Form
LAPRA Verification of Address Form
Retiree Deduction Authorization
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 Carrier Brochure
Anthem Blue Cross CaliforniaCare HMO Carrier Brochure
Kaiser HMO Evidence of Coverage (active members)
Kaiser HMO Non Medicare Eligible Evidence of Coverage (retired members)
Kaiser HMO Senior Advantage Evidence of Coverage (retired members)
LAPRA 2013-2014 Open Enrollment Guide for Active Members
LAPRA 2013-2014 Open Enrollment Guide for Retired Members
LAPRA Medical Plans Comparison
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)
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
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 Summary of Benefits and Coverage (active and non-Medicare eligible retired members)
Kaiser HMO Senior Advantage Summary of Benefits and Coverage (Medicare eligible retired members)