Cal MediConnect – Forms and Literature

Cal MediConnect Forms and Publications for Los Angeles

 

• Cal MediConnect Guidebook for LA County – Will be mailed to individuals approximately 60 days prior to their scheduled date of passive enrollment                                                            

•  Los Angeles County Choice Form  – Will be mailed with the Guidebook  

• Choice Form Instructions  – A visual guide to filling out the Choice Form. This is posted online only. This will not be mailed out

•  Basic CCI fact sheet

• Los Angeles County Fact Sheet

• LA Voluntary Enrollment Notice                                                                                             
  

• Watch for Blue Mail

• Who to Call

• Find a Doctor

• LA County Specific Slides

 

Enrollment and Disenrollment Notices

• 90 Day

• 60 Day

• 30 Day

• Opting Out after 90-Day Notice – This is the notice received if you opt out of Cal MediConnect after receiving the 90-day notice but before receiving the 60-day notice.

• Opting out after 60-Day Notice –  This is the notice received if you opt out of Cal MediConnect after receiving the 60-day notice.

• Disenrollment Notice – This is the notice received if you disenroll from Cal MediConnect after the coverage has begun.