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Enroll or Update Your Coverage
To initiate an enrollment, change, or cancellation of your medical or dental/vision plan, select the appropriate option below.
To help you complete your healthcare forms accurately, refer to the step-by-step instructions and samples provided while filling out your forms.
You can upload your completed forms on My LACERA, or submit them by mail, fax, or LACERA's secure onsite dropbox (available 24/7 outside our Member Service Center).
Medical Plan Enrollment, Change, Cancellation Form
Medical Instructions and Sample Forms
Dental and Vision Plan Enrollment, Change, Cancellation Form
Dental and Vision Instructions and Sample Forms
Medicare Advantage Prescription Drug Plan Enrollment Form
Medicare Advantage Prescription Drug Instructions and Sample Form
Kaiser Permanente Hawaii Arbitration Agreement
Brochures & Rate Tables
New Retiree Healthcare Packet
Annual Retiree Healthcare Packet
To order healthcare forms and packets, call Retiree Healthcare Division at 800-786-6464.
To order other retirement information, visit the Forms and Publications page.
Appointment Reservations