Lausd health benefits enrollment form 2026

1. Click ‘Get Form’ to open the lausd health benefits enrollment form in the editor.
2. Begin by filling in your personal information. Enter your last name, first name, middle initial, employee number, address, city, state, zip code, phone number, and social security number. Ensure all entries are legible.
3. Indicate your gender and marital status by selecting the appropriate options provided on the form.
4. In the coverage section, review the available health plans and check only one option that you wish to enroll in. Make sure to read through each plan's details before making a selection.
5. List any eligible dependents you want to enroll by providing their names, social security numbers, relationships to you, and dates of birth. Remember that social security numbers are mandatory for all dependents.
6. Sign and date the form at the bottom to certify that all information is accurate. This step is crucial for processing your enrollment.

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