Address and Emergency Contact Information

Change of Home/Mailing and Emergency Contact Information

Active Employee Health and Dental

Active Employee Rate and Subsidy Charts
Active Employee Rate and Subsidy Charts only for Load Dispatchers Association, MEA, ACE
2018-2019 Employee Benefit Guide
2018 Benefits Open Enrollment Newsletter for Employees
Active Enrollment/Change Form
Affidavit of Domestic Partnership
Termination of Domestic Partnership

Active Employees Summary of Benefits

Delta Dental Active Summary of Benefits 2018-19
Kaiser Active Summary of Benefits 2018-19
United Concordia DHMO Active Summary of Benefits 2018-19
United Healthcare HMO Active Summary of Benefits 2018-19
United Healthcare HMO Active Summary of Benefits for Prescription 2018-19
United Healthcare PPO Active Summary of Benefits 2018-19
United Healthcare PPO Active Summary of Benefits for Prescription 2018-19
United Healthcare PPO Owens Valley Active Summary of Benefits 2018-19
United Healthcare PPO Owens Valley Active Summary of Benefits for Prescription 2018-19

Retirees

Important Information Regarding the Health Plan of Nevada Medical Plan for Retirees Over Age 65 with Medicare Parts A and B
Retiree Benefit Guide
Benefits Newsletter for Retirees
Retiree Enrollment/Change Form
Retiree Health Plan Subsidy Chart
Retiree Dental Rate Chart
Retiree Health Rate Chart
Affidavit of Domestic Partner Form
Termination of Domestic Partner Form

Retirees Summary of Benefits

Kaiser Retiree Post 65 Summary of Benefits 2018-19
Kaiser Retiree Pre 65 Summary of Benefits 2018-19
United Concordia Dental DHMO Retirees CA 21 Schedule of Benefits 2018-19
United Concordia Dental Retiree DHMO Exclusions and Limitations 2018-19
United Healthcare HMO Post 65 With Medicare A and B Rx MAPD 2018-19
United Healthcare HMO Retiree Pre 65 Summary of Benefits for Prescription 2018-19
United Healthcare HMO Retiree Pre 65 Summary of Benefits 2018-19
United Healthcare PPO Pre 65 Retiree Summary of Benefits ERT Plan A 2018-19
United Healthcare PPO Pre 65 Retiree Summary of Benefits ERT Plan B 2018-19
United Healthcare PPO Pre 65 Retiree Summary of Benefits ERT Plan C 2018-19
United Healthcare PPO Retiree PDP Rx Plan A 2018-19
United Healthcare PPO Retiree PDP Rx Plan B 2018-19
United Healthcare PPO Retiree PDP Rx Plan C 2018-19
United Healthcare PPO Pre 65 Prescription Summary of Benefits ERET Rx Plan A 2018-19
United Healthcare PPO Pre 65 Prescription Summary of Benefits ERET Rx Plan B 2018-19
United Healthcare PPO Pre 65 Prescription Summary of Benefits ERET Rx Plan C 2018-19
United Healthcare PPO Retiree Post 65 Plan A 2018-19
United Healthcare PPO Retiree Post 65 Plan B 2018-19
United Healthcare PPO Retiree Post 65 Plan C 2018-19

Flex Plan

Flex Plan Open Enrollment Newsletter Short Plan Year 2018
Flex Plan Summary Plan Document (SPD) Short Plan Year 2018

Forms

Marital Status Change Form - Personnel Services Form Should Be W/Personnel Services Items
Name Change Form - Personnel Services Form Should Be W/Personnel Services Items

DWP Employee Hiring Packages

1 - Regular Appointment
2 - Construction Exempts
3 - Exempt to Regular
4 - Emergency (EM), Limited (LI) Appt
5 - Part-time Exempt (Student Engineers)
6 - Part-time Exempt (Student Workers under age 18)
7 - Part-time Exempt (Student Workers age 18 or over)

Additional Information Form for Conditional Job Offer

Additional Information Form

Medical Packages

General Medical History Questionnaire
OSHA Respirator Evaluation Questionnaire
Hearing Questionnaire
Initial Asbestos and/or Silica Questionnaire
Lead and/or Hazmat Questionnaire

Worker's Compensation

Burn Treatment Directive For Work Related Injuries
Time of Hire Pamphlet - English
Time of Hire Pamphlet - Spanish


For questions using eBenefits, e-mail at eBenefits@ladwp.com.