COBRA INFORMATION

Under federal law, the LACCD is required to offer covered employees and covered family members the opportunity for a temporary extension of health coverage at group rates when coverage under the plan would otherwise end due to certain qualifying events. The COBRA Q&A below answers some basic questions about this program. Please read over the information provided, and call the LACCD Health Benefit Call Center at (888) 428-2980 if you have any questions.

Documents and Forms

For 2010
COBRA Premium Rates (includes medical, dental and vision)
CalPERS Health Plan Enrollment Form (medical plans only)
CalPERS Health Plan Enrollment/Change Form
Please complete only the highlighted portions of the form. To add a new dependent, please put an "A" in the Action Code column (highlighted on the form) to the left of the new dependent's name. To delete a dependent from your medical plan, put a "D" in the Action Code column to the left of the name of the dependent you wish to delete from your plan.
Dental and Vision Enrollment/Change Form (rates included)
For 2009
2009 Enrollment/Change Form
2009 COBRA Premium Rates
General Information
COBRA important information
General notice of COBRA continuation coverage rights
Kaiser - Claim for Emergency Services

last updated: 1/15/2010
lam