RHC BROCHURES & FORMS
INSTRUCTIONS FOR DOWNLOADING MATERIALS
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ENROLLMENT/CHANGE FORMS:
• Dental and Vision Plan - New Enrollment, Change, Cancellation (Form DCD) |
PRINTED 4/15 |
• Medical Plan New Enrollment, Change, Cancellation (Form NC) |
PRINTED 10/16 |
| PRINTED 4/15 | |
| Please note, the three forms above are interactive but cannot be submitted electronically as each requires your signature. You may fax the completed form at 626-564-6155, or mail to LACERA at PO Box 7060, Pasadena, CA 91109-7060. | |
BROCHURES & RATE TABLES:
| PRINTED 5/17 | |
| PRINTED 6/17 | |
| PRINTED 6/17 | |
| PRINTED 6/17 | |
| PRINTED 6/17 | |
| PRINTED 6/17 | |
| PRINTED 12/16 | |
• How Your Anthem Blue Cross Plans I, II, and III Coordinate with Medicare |
PRINTED 12/16 |
| PRINTED 9/15 |
NEW RETIREE HEALTHCARE PACKET:
| PRINTED 5/17 | |
| PRINTED 5/17 | |
| PRINTED 5/17 | |
| PRINTED 9/15 | |
| PRINTED 5/17 | |
| PRINTED 9/15 | |
| PRINTED 11/15 |
2017–2018 ANNUAL RETIREE HEALTHCARE PACKET:
To order healthcare forms and packets, call 800-786-6464, and press 1 for Retiree Healthcare.
To order other retirement information, visit the Brochures & Forms page.