RHC BROCHURES & FORMS
INSTRUCTIONS FOR DOWNLOADING MATERIALS
To 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.
ENROLLMENT/CHANGE FORMS:
• Dental and Vision Plan - New Enrollment, Change, Cancellation (Form DCD) |
PRINTED 12/17 |
• Medical Plan New Enrollment, Change, Cancellation (Form NC) |
PRINTED 12/17 |
PRINTED 3/18 | |
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 12/17 | |
• How Your Anthem Blue Cross Plans I, II, and III Coordinate with Medicare |
PRINTED 12/1 |
PRINTED 9/15 |
NEW RETIREE HEALTHCARE PACKET:
PRINTED 7/17 | |
PRINTED 5/17 | |
PRINTED 5/17 | |
PRINTED 9/15 | |
PRINTED 5/17 | |
PRINTED 9/15 | |
PRINTED 11/15 |
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.