LACERA - The Los Angeles County Employees Retirement Association LACERA Home Disclaimer Links My LACERA FAQs Contact Us LACERA Home


Search by Topic

Brochures & Forms

COMMUNICATIONS

LACERA BROCHURES & FORMS

INSTRUCTIONS FOR ORDERING OR DOWNLOADING MATERIALS

TO ORDER A BROCHURE OR FORM

  1. Click on the box next to the item(s) you wish to order.
  2. Scroll down to the bottom of the page and complete the order form.
  3. LACERA will mail the ordered item(s) to you.

TO DOWNLOAD A BROCHURE OR FORM
Get the Free Adobe ReaderTo download (or print) a PDF of a document shown on this page, click on the link under the item. NOTE: If you are having difficulty accessing a PDF, you may need to upgrade to the most recent version of Adobe Reader; it's free.

PLAN BOOKS PLAN TRANSFERS DISABILITY RETIREE HEALTHCARE
NEW MEMBER OTHER BROCHURES FORMS LEGAL

BROCHURES and APPLICATIONS

SUMMARY PLAN DESCRIPTION BOOKS:

Retirement Plans A, B & C for General Members Retirement Plan D for General Members Retirement Plan E for General Members Retirement Plans A & B for Safety Members

Retirement
Plans A, B & C for General Members
(ASD 545) PRINTED 6/10

Retirement
Plan D for
General Members
(ASD 541) PRINTED 6/09
PDF update 4-8-10

Retirement
Plan E for
General Members
(ASD 543) PRINTED 6/09
PDF update 4-8-10

Retirement
Plans A & B for Safety Members
(ASD 544) PRINTED 6/09
PDF update 4-8-10
Ready To Order

NEW MEMBER INFORMATION:

New Member Guide Package New Member Guide (brochure only)

New Member Guide Package
(Includes Sworn Statement, Beneficiary form, Plan D and Plan E brochures)

New General Member Interactive Workshop Online

New General Member Workshop Schedule

New Member Guide
(ASD 683) PRINTED 3/08
DOWNLOAD BROCHURE ONLY

PLAN TRANSFER INFORMATION:

Open Window Transfer - Plan E to Plan D Prospective Transfer to Plan D Prospective Transfer to Plan E

Open Window Transfer - Plan E to Plan D (ASD 684) PRINTED 1/08
DOWNLOAD ONLY

Additional Open Window Plan Transfer information

Prospective Transfer to Plan D (RSD 1511) PRINTED 11/04
DOWNLOAD BROCHURE ONLY

Prospective Transfer to Plan E
(RSD 1512) PRINTED 6/11
DOWNLOAD BROCHURE ONLY

Additional Plan Transfer information

To request a Prospective Plan Transfer package and application, call 1-800-786-6464.
Ready To Order

OTHER BROCHURES:

Pre-Retirement Guide LACERA's Special Durable Power Of Attorney Q&A Survivorship Brochure

Pre-Retirement Guide
(OUT 414) PRINTED 2/08

Pre-Retirement Workshop Schedule

Survivor & Death Benefits Information Card
(RSD 2005) PRINTED 7/10
DOWNLOAD ONLY

Survivor & Death Benefits Q&A
(RSD 1589) PRINTED 7/10

Get the Free Adobe Reader
PDF Problem?
Upgrade your Free Adobe Reader
7-Steps to a Successful Retirement Direct Deposit Withdrawal/Reciprocity

Introduction to Retirement:
7-Step Reference Card
(OUT 2000) PRINTED 6/11
DOWNLOAD ONLY

Direct Deposit includes application
(ASD 611) PRINTED 1/09

Make your change over the phone — 1-800-786-6464

Withdrawal/Reciprocity
(RSD 562) PRINTED 9/00
DOWNLOAD ONLY

Additional Reciprocity information

Q&A: Purchasing Service Credit Q&A: Purchasing Additional Retirement Credit (ARC) Q&A: Prospective Plan Transfer: Purchasing & Converting Plan E Service Credit

Q&A: Purchasing Service Credit includes Service Credit Category List & application form
(RSD 1589 & RSD 509) PRINTED 9/09

Additional Purchasing Service Credit information

Q&A: Purchasing Additional Retirement Credit (ARC)
(RSD 1540) PRINTED 2/11

Additional ARC information

Q&A: Prospective Plan Transfer: Purchasing & Converting Plan E Service Credit
(RSD 1521) PRINTED 4/10
Ready To Order

LEGAL

LACERA's Special Durable Power Of Attorney Q&A Direct Deposit  

LACERA's Special Durable Power Of Attorney Q&A includes application form
(LEG 401 PRINTED 6/08, LEG 402 PRINTED 9/11)

Special Durable Power of Attorney Form
(LEG 402) PRINTED 9/11
DOWNLOAD ONLY

Community Property
(LEG 2000) PRINTED 7/11

 

2011 Edition: County Employees Retirement Law (CERL) of 1937 (4-19-11)
(The printed version of the 2011 edition of the CERL is currently in production.)

This PDF contains the complete law book; it is a large file which may take a long time to download. For your convenience, we divided the law book into three separate PDF documents. For ease of use, the Table of Contents page is linked.
Part One: Sections 31450 - 31607
Part Two: Sections 31610 - 31699.10
Part Three: Sections 31700 - 31899.10

DISABILITY EDUCATIONAL MATERIAL – Download only

Disability Retirement Law Resource (Second Edition) (10-19-11)
A comprehensive review of both the related statutes and case law.

DISABILITY INFORMATION

EMPLOYEE

DISABILITY FORMS – Download Only
(To order the forms, you must order the full package)

Employee Disability Retirement Package

Employee Disability Retirement Package
(DIS 101, DIS 104, DIS 105, DIS 107, DIS 108, DIS 117, RSD 1580) PRINTED 12/09

Click here to read the individual forms and brochure included in the Employee Package
Employee Application for Disability Retirement

(DIS 101) PRINTED 12/09

• Authorization to Obtain and Release Records & Information (DIS 104)

 PRINTED 10/10

• Physician Statement for Disability Retirement (DIS 107)

 PRINTED 12/09

• Claims Against Third Party (DIS 117)

PRINTED 12/09

• Taxability of a LACERA Disability Retirement Allowance (RSD 1580)

 PRINTED 12/09

SURVIVOR

Survivor (Service-Connected Death) Package

Survivor (Service-Connected Death) Package (DIS 119, DIS 2000, DIS 2004) PRINTED 12/09

Click here to read the individual forms included in the Survivor Package
Application for Survivor Benefits

(Service-Connected Death)
(DIS 119) PRINTED 12/09

• Authorization to Obtain and Release Records & Information (Service-Connected Death) (DIS 2000)

 PRINTED 12/09

• Claims Against Third Parties (Service-Connected Death) (DIS 2004)

 PRINTED 12/09

EMPLOYER

Employer Disability Retirement Package

Employer Disability Retirement Package
(DIS 108, DIS 121, DIS 122) PRINTED12/09

Click here to read the individual forms and brochure included in the Employer Package

Employer Application for Disability Retirement

(DIS 121) PRINTED 12/09

• Disability Retirement Eligibility Application Instructions (DIS 122)

 PRINTED 12/09

Additional Disability Retirement information

Disability Policies & Procedures Procedures for Disability Retirement Hearings

Disability Retirement Plans A, B, C & D
(DIS 108) PRINTED 12/09

Disability Policies & Procedures
(DIS 124) PRINTED 12/09

Procedures for Disability Retirement Hearings
(DIS 112) PRINTED 9/06

FORMS

Forms with this icon Interactive are saveable interactive PDF documents. You can type directly into the fields of the document and save your changes.

Affidavit Public Safety Officer (PSO) Status and Election Form: Retired PSO $3,000 Healthcare Tax Benefits

 PRINTED 7/09

Federal & CA Tax Withholding Cert. For Pension/Annuity Payments* (RSD 510)
(Forms W-4P and DE-4P)

PRINTED 9/09

Address Change** (RSD 583)  

 PRINTED 10/08

Name Change** (RSD 582)

 PRINTED 8/07

Beneficiary Designation** (RSD 504)

 PRINTED 6/09

Beneficiary Designation For Ex-Spouse (RSD 578)

 PRINTED 3/10
Rollover/Transfer Certification Form (RSD 1539) PRINTED 3/08
Request to Rescind or Change Retirement Date (RSD 2003) PRINTED 2/09

*You can make this change and submit it on MyLACERA
**You can make this change over the phone — call 1-800-786-6464

Ready To Order

RETIREE INFORMATION


2011 COLA insert mailed with retiree paystub.
2011 COLA insert mailed with retiree paystub.		    

Payday Planning Calendar
MAILED 12/11

2011 COLA
MAILED 3/11

 

 

RETIREE HEALTHCARE

You may request to have a copy of the Exploring Your Healthcare Benefits Through LACERA brochure mailed to you or you may download a copy. All other Retiree Healthcare materials are available for download only.

ENROLLMENT/CHANGE FORMS

• Dental and Vision Plan - New Enrollment, Change, Cancellation (Form DCD)

 PRINTED 6/08

• Medical Plan New Enrollment, Change, Cancellation (Form NC)

 PRINTED 11/11

• Medicare Advantage Prescription Drug Plan Enrollment Form

 PRINTED 6/08

BROCHURES/RATE TABLES

• 2011-2012 Dental Vision Chart

 PRINTED 6/11

• 2011–2012 Medical & Dental/Vision Premium Rates

 PRINTED 6/11

• 2011-2012 Medical Premium Rates - Out of Area

 PRINTED 6/11

• 2011-2012 Plan Comparison

 PRINTED 6/11

• 2011-2012 Plan Comparison - Medicare

 PRINTED 6/11

• 2011-2012 Plan Comparison - Out of Area

 PRINTED 6/11

• 2011 Medicare Benefits Chart

 PRINTED 12/11

• How Your Anthem Blue Cross Plans I, II, and III Coordinate with Medicare

 PRINTED 12/11

• Changing Medical Plans

 PRINTED 12/11

NEW RETIREE HEALTHCARE PACKET

Exploring Your Healthcare Benefits Through LACERA

 PRINTED 7/11

• Contact Information

 PRINTED 7/11

• Decision Guide

 PRINTED 7/11

• Dental/Vision Plans

 PRINTED 7/11

• Medical Plans Overview

 PRINTED 7/11

• When You Travel

 PRINTED 7/11

• Request Enrollment Forms

 PRINTED 7/11

2011–2012 ANNUAL HEALTHCARE PACKET

• 2011–2012 Annual Healthcare Letter

• Benefits Guide

• Benefits Update

• Notice of Creditable Coverage PRINTED 10/11
Ready To Order

PLACE YOUR ORDER NOW

Name:

Address:

City:

State:

Zip:

Country:

Email:

Please review your order. If everything is accurate click on the “Send Order Now” button. Your order will be processed by the end of the next business day, and mailed to you free of charge.

12/30/11