Resources

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.

NEWS & ANNOUNCEMENTs



Coronavirus What You Need to Know

2020 LAPRA Fitness Challenge is Going on Now

Apply Now for a 2020 LAPRAF Academic Scholarship

Use LAPRALive to Keep Your Personal Information and Beneficiary Designations Up-to-Date, View Current Benefits, Access Forms and More

Forms



Medical/Dental Enrollment/Change Form

Anthem Blue Cross PPO Medicare Part D Enrollment Form

Anthem Blue Cross HMO Medicare Part D Enrollment Form

Anthem Blue Cross Medicare Part D Disenrollment Form

Kaiser Senior Advantage Enrollment Form

Kaiser Senior Advantage Disenrollment Form

Medical & Dental Declination Form

Personal Information Change Form

Verification of Dependents Form

Beneficiary Change Form

Active Member Deduction Authorization

Retiree Deduction Authorization

ANTHEM SELF-SERVICE TOOLS



Access the Anthem Web Portal or Sydney Care Mobile App

Anthem Web Portal or Sydney Care Mobile App Registration

Anthem Find a Doctor Flyer

Documents



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 HMO Medical Plan Carrier Summary

Anthem Blue Cross HMO Dental Plan Carrier Summary

Kaiser HMO Evidence of Coverage (active members)

Kaiser HMO Evidence of Coverage (retired members)

Kaiser Senior Advantage HMO Evidence of Coverage (retired members)

Kaiser Chiropractic Benefits Summary

LAPRA 2018-2019 Benefits Guide for Active Members

LAPRA 2018-2019 Benefits Guide for Retired Members

LAPRA 2019-2020 Benefits Guide for Active Members

LAPRA 2019-2020 Benefits Guide for Retired Members

LAPRA Vision Plan Overview

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

LAPRA Bylaws

 

Required Notices



Medicare Part D

2019 Legally Required Notices Booklet

Women's Health and Cancer Rights Act of 1998 Notice

Privacy 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)