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Benefits

COBRA Enrollment form

Use this form to enroll in COBRA insurance coverage, available to UK employees which allows you to continue your group health, dental and vision insurance on an individual basis when you or your dependent(s) become ineligible for University benefits.

07/01/2014 (revision date)
Click to view form (pdf or doc): COBRA Enrollment form
Submission Options
Submit paper form to UK Employee Benefits Office (112 Scovell Hall; 859-257-9519)
Email form back to benefits@email.uky.edu