library

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

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COVID-19 Testing Information

COVID-19 What You Need to Know

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

Forms

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Anthem PPO Medicare Part D Enrollment Form

Anthem HMO Medicare Part D Enrollment Form

Anthem Medicare Part D Disenrollment Form

Anthem Medical PHI Authorization Form

Anthem Dental PHI Authorization 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

Kaiser PHI Authorization Form

Personal Information Change Form

Verification of Dependents Form

Beneficiary Change Form

Member Deduction Authorization

Death Benefit Claim Form

Life Insurance Cash Surrender Form

LAPRA PHI Authorization Form

Los Angeles Police Relief and Assistance Foundation Donation Form

SUMMARY OF BENEFITS AND COVERAGE

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Anthem PPO SBC

Anthem HMO SBC

Kaiser HMO SBC

ANTHEM SELF-SERVICE TOOLS

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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

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LAPRA 2024-2025 Benefits Guide for Active Members

LAPRA 2024-2025 Benefits Guide for Retired Members

LAPRA 2024-2025 Retiree Medical/Dental Premiums

LAPRA Key Contacts Flyer

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 Vision Plan Overview

LAPRA Eligibility Guide for Active Members

LAPRA Eligibility Guide for Retired Members

LAPRA Retirement Guide

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

LAPPL Member Assistance Program Flyer

Required Notices

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Medicare Part D

2023 Legally Required Notices Booklet

2024 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)