Southland
Member Enrollment
- LGHIP Enrollment Form (LG01)
- LGHIP Member Information Changes Form (LG02)
- LGHIP Cancellation Form (LG03)
- LGHIP Declination of Coverage Form (LG04)
- LGHIP New Dependent Form (LG05)
- LGHIP Dependent Cancellation Form (LG06)
- Automatic Payment Authorization Form (COBRA) (LG14)
- LGHIP Retiree Coverage Enrollment Form (LG22)
- LGHIP Retirement Years of Service Form (LG22-A)
- LGHIP ACA Verification Form (LG23)
