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HEALTHCARE


RHC BROCHURES & FORMS

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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

Medicare Advantage Prescription Drug Plan Enrollment Form

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:

2016–2017 Medical & Dental/Vision Premium Rates

PRINTED 5/16

2016–2017 Medical Premium Rates - Out of Area

PRINTED 6/16

2016–2017 Dental Vision Chart

PRINTED 6/16

2016–2017 Plan Comparison

PRINTED 6/16

2016–2017 Plan Comparison - Medicare

PRINTED 6/16

2016–2017 Plan Comparison - Out of Area

PRINTED 6/16

2017 Medicare Benefits Chart

PRINTED 12/16

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

PRINTED 12/16

Changing Medical Plans

PRINTED 9/15

NEW RETIREE HEALTHCARE PACKET:

Exploring Your Healthcare Benefits Through LACERA

PRINTED 11/16

Contact Information

PRINTED 9/15

Decision Guide

PRINTED 9/15

Dental/Vision Plans

PRINTED 9/15

Medical Plans Overview

PRINTED 10/13

When You Travel

PRINTED 9/15

Request Enrollment Forms

PRINTED 11/15

2016–2017 ANNUAL RETIREE HEALTHCARE PACKET:

Annual Healthcare Letter

Benefits Guide

Benefits Update

Notice of Creditable Coverage

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.