How to Complete and Submit Retiree Healthcare Forms | LACERA

In these videos, we will guide you through the process of completing and submitting your retiree healthcare forms. Whether you need to enroll, change, or cancel your coverage, this step-by-step walkthrough provides clear instructions to fill out your forms with confidence.

Topics are broken out into separate videos so you can watch the whole video on demand by clicking on the tiles below, where you will be directed to LACERA’s YouTube page for viewing.

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Doctor and patient reviewing her medical plan.

Medical Plan Enrollment Form

How to fill out and submit your Medical Plan Enrollment Form.

Couple filling out medical plan enrollment form.

Medical Plan Change Form

How to fill out and submit your Medical Plan Change Form.

Patient filling out medical plan form.

Medical Plan Cancellation Form

How to fill out and submit your Medical Plan Cancellation Form.

Couple reviewing Medicare Advantage Prescription Drug Plan with nurse.

Medicare Advantage Prescription Drug Plan (MAPD) Enrollment Form

How to fill out and submit your MAPD Form.

Patient looking at his dental work.

Dental/Vision Plan Enrollment Form

How to fill out and submit your Dental/Vision Plan Enrollment Form.

Patient reviewing vision plan.

Dental/Vision Plan Change Form

How to fill out and submit your Dental/Vision Plan Change Form.

Patient cancelling his dental and vision plans.

Dental/Vision Plan Cancellation Form

How to fill out and submit your Dental/Vision Plan Cancellation Form.