Health Benefits - Quick Reference


Please find below a quick reference for your Health Benefits needs.


Adding a Dependent

If you need to add a dependent to your health benefits, please complete and return this form: Supplemental Application


Computer Glasses

If you need glasses to work on your computer, please complete and return this form: Certification of VDT Use


Life Insurance

If you need to enroll or purchase additional coverage, please complete the Cigna Application.

If you need to designate a beneficiary, please complete the Cigna Beneficiary Designation Form.


Retirement Benefits

Are you an active employee thinking about retiring? Please complete and return the Application for Retiree Health Benefits form.


Health Benefits for New Retirees

Are you a new retiree? Health Benefits for New Retirees.

Additional Retiree forms and information can be found on the Retiree Forms page. 


Retirees and Survivors Enroll/Change

Are you a Retiree or a Survivor who needs to enroll or change your vision or dental benefits? Please complete and return the Retiree Enrollment/Change Form.

For additional resources, please visit this page: http://laccd.edu/Departments/HumanResources/healthbenefits/Pages/Survivors.aspx


COBRA Health Benefits Information

If you need to extend your COBRA health benefits please visit the COBRA Participants page for information