Board of Los Angeles City Employees Retirement System Forms and Office Locations – Government Agency in Los Angeles, CA

1 - 20 of 65 forms

Form Title	Topics
2022 Anthem Blue Cross Medicare Preferred (PPO)
2022 Anthem Blue Cross Medicare Prescription Enrollment
2022 Dental Plan Enrollment Form
2022 Kaiser Senior Advantage HMO form
2022 Medical/Dental Plan Cancellation Form
2022 Medical/Dental Plan Family Account Change Form
2022 Medical Plan Enrollment Form
2022 SCAN Health Plan Medicare Advantage HMO
2022 UnitedHealthcare Medicare Advantage HMO – Southern California
2023 Dental Plan Enrollment Form
2023 Medical/Dental Plan Cancellation Form
2023 Medical/Dental Plan Family Account Change Form
2023 Medical Plan Enrollment Form
2023 Medical Plan Enrollment Form
Affidavit of Retired Domestic Partnership
Application to Purchase Previous City Service
Application to Purchase Public Service Form
Back Contribution Information Sheet
Back Contribution Information Sheet for Participants of the Pension Savings Plan
Cancellation of Election to Participate in Family Death Benefit Plan

1 contact point

Address:
202 W. First Street
Suite 500
Los Angeles, CA 90012

Phone numbers:

Hours of operation:

Board of Los Angeles City Employees Retirement System