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- Click ‘Get Form’ to open the lausd retirement benefits application in the editor.
- Begin by entering your Employee Number, Last Name, First Name, and Date of Birth in the designated fields. Ensure all personal information is accurate.
- Select your retirement type (Service or Disability) and provide your Retirement Date. This information is crucial for processing your application.
- In the Health Plans section, choose the medical, dental, and vision plans you wish to enroll in at retirement. Make sure to review eligibility requirements for each plan.
- Fill out the Dependent Information section if applicable. Include Social Security numbers and other required details for each dependent.
- Complete the Medicare Information section if you or your spouse is over 65. Provide necessary Medicare Claim Numbers and effective dates.
- Finally, sign and date the form at the bottom to authorize your selections. Remember that this form will not be processed without a signature.
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