Tools & 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



Consumer Watchdog Anthem Blue Cross Lawsuit

2016 Anthem Blue Cross Mental Health and Substance Use Disorder HMO Update

2016 Anthem Blue Cross Mental Health and Substance Use Disorder PPO Update

Forms



LAPRA 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

LAPRA Medical & Dental Declination Form

LAPRA Verification of Address Form

Beneficiary Change Form

Active Member Deduction Authorization

Retiree Deduction Authorization

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 Carrier Brochure

Anthem Blue Cross CaliforniaCare HMO Carrier Brochure

Healthy Lifestyles Overview

Healthy Lifestyles FAQs

Healthy Lifestyles Reward Points Flyer

Healthy Lifestyles Website Registration Flyer

Kaiser HMO Evidence of Coverage (active members)

Kaiser HMO Evidence of Coverage (retired members)

Kaiser Chiropractic Benefits Summary

LAPRA 2017-2018 Benefits Guide for Active Members

LAPRA 2017-2018 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

Required Notices



Medicare Part D

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)