Below is a list of downloadable Medical forms for members’ convenience.
- Medical Plan Enrollment/Change Form
- Flu Vaccine Claim Form
- Disabled Dependent Certification
- Medical Claim Form and Authorization (aka Green Form)
- Prescriptions: Express Scripts Home Delivery (Mail) Order Form
Unless otherwise stated on the form, these forms must be mailed to:
Los Angeles Firemen’s Relief Association
P.O.Box 41903
Los Angeles, CA 90041
By FAX:
Add/Drop Dependent FAX to (323) 259-5297
Flu Vaccine Claim Form FAX to (323) 259-5295
Unprocessed Medical Expenses Claim Form For CA Members (Green Form) FAX to (323) 259-5295