Benefits

Enrollment Forms

Below, you'll find links to printer-friendly (PDF) enrollment forms.

2011-12 Enrollment Forms

For coverage during the 2011-12 plan year (July 1, 2011 - June 30, 2012).

  1. Health/Dental/Vision benefits form
  2. Life and AD&D insurance form
  3. Flexible Spending Accounts Form

2012-13 Open Enrollment Forms

For coverage during the 2012-13 plan year (July 1, 2012 - June 30, 2013).

  1. Health/Dental/Vision benefits form
  2. Life and AD&D insurance form
  3. Flexible Spending Accounts form

 

2011-12 Retiree Enrollment Forms

For coverage during the 2011-12 plan year (July 1, 2011 - June 30, 2012).

  1. Retiree Health/Dental/Vision benefits form

2012-13 Retiree Open Enrollment Forms

For coverage during the 2012-13 plan year (July 1, 2012 - June 30, 2013).

  1. Retiree Health/Dental/Vision benefits form

 

Form Pickup Locations

Printed forms are available for pick up at 112 Scovell Hall.



University of Kentucky - An Equal Opportunity University
Human Resources · 115 Scovell Hall · Lexington, KY 40506-0064
Phone: (859) 257-9555 · Fax: (859) 323-8512
Questions/Feedback: HR | HR Site
About Human Resources
Last Modified: March 4, 2011 | Off-site Link Disclaimer