need help?

Risk Management Department
Rose Carter, Benefits Specialist
401 S. Inglewood Avenue
Inglewood, CA 90301
Voice: (310) 419-2766
Fax: (310) 680-5135
email a question

You can also contact our Employee Benefit Consultants during business hours throughout the week. Their contact information is below:

MGU of the West Insurance Services, Inc.
Contact: David McDaniel
11661 San Vicente Blvd., #200
Los Angeles, CA 90049
Voice: (714) 600-6784
email a question

Miscellaneous Forms and Links:

All forms open in a view-only format and can be printed and filled out. If you are unable to open these forms, you can download adobe acrobat reader here: Download Adobe Acrobat Reader

General

Any and ALL forms MUST be returned to the Risk Managment Office for proper processing.

Student certification, newly eligible dependents and terminating dependents will require additional documentation. This may include a copy of transcripts, birth certificates, marriage certificates, divorce decrees or other legal documentation.

(Please note these forms may take several minutes to download)

Medical Plans

Blue Cross: (please note these forms may take several minutes to download)

1. Enrollment Form
2. COBRA Enrollment Form
3. Waiver of Premium Form
4. Medical Claim Form
5. Rx Claim Form

Kaiser:

1. Enrollment Form
2. Change Form
3. Student Certification Form

Dental Plans

Delta Premier:

1. Enrollment/Change Form
2. Claim Form

DeltaCare PMI:

1. Enrollment/Change Form

PacifiCare Dental: None Currently

Vision Plan

VSP:

Enrollment/change forms are not required for this plan. The District automatically enrolls you based on your medical plan selection.

Life Insurance

Blue Cross

1. Enrollment Form
2. Beneficiary Change Request Form
3. Life Conversion Form