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Human Resources

Benefits Forms

Retiree Medical Plans
Title Form description
ACH Bank Draft Authorization Form

Fill out and submit this form to enable automatic monthly payment of your UK Retiree Health Insurance premiums by bank draft (ACH).

Retiree Benefits Enrollment Form

Use this form to enroll in Health, Dental, or Vision coverage with UK as a UK Retiree.

Retiree Health Coverage Deferral
Retirement & Financial Security
Title Form description
Allocated Spending Goals

Write a list of everything you would like to do from most important to least important.  When you get extra money from any source, apply it to these goals.  Item one may be new clothes for $100, item two could be a weekend trip away for $300, and item three could be pay off a credit card for $800.  If you receive a $600 tax refund, you could do the first two items and put the remaining $200 towards the credit card debt.

Basic Cash Flow Plan

More than a budget, this will help plan what bills will be paid with each paycheck.

Debt Snowball Form

This form can give you a game plan to pay off your debt. List debts from smallest to largest, pay as much as you can on the smallest and the minimum on the rest.  As one debt is paid off, add the amount you were paying monthly on that debt to the minimum payment on the next debt on the list.

Faculty Phased Retirement Agreement

Use this form for faculty requesting entry into a Phased Retirement process. 

Fidelity 403b Enrollment Form & Beneficiary Designation

Complete this form to make 403(b) retirement savings plan contributions to Fidelity Investments. 

Fidelity 457b Enrollment Form & Beneficiary Designation

Complete this form to enroll in voluntary UK 457(b) retirement savings plan through Fidelity. This form is also used for designating a beneficiary.

Flexible Spending Account Enrollment Form

Use this form to enroll in health and/or dependent care flexible spending accounts. 

Income and Expense worksheet

This worksheet will give you a good basic understanding of what your current income and expenses really are.

Life Insurance and AD&D Enrollment Form

Use this form to enroll in additional levels of life insurance coverage in addition to the University's 1x annual salary coverage. This form also allows you to enroll in separate AD&D (accidental death & dismemberment) insurance, if desired.

Salary Reduction Agreement for Standard (Mandatory) UK 403b Retirement Savings Plan

Complete this form to authorize payroll deductions as contributions to UK's 403(b) retirement savings plan. 

Salary Reduction Agreement for Voluntary UK 403b Retirement Savings Plan

Complete this form to authorize salary deduction for voluntary contribution to your 403(b) retirement savings account. 

Staff Phased Retirement Agreement

This form allows staff of UK to enter a Phased Retirement process.

TIAA-CREF 403b Account Application

Complete this form to enroll in UK 403(b) retirement savings plan through TIAA-CREF. 

UK 403b Voluntary Additional Contribution Enrollment Form (Current Year)

Use this form for additional voluntary contributions, over and above standard 5 percent 403(b) employee contribution.

UK 403b Voluntary Additional Contribution Enrollment Form (Next Year)

UK 403b Voluntary Additional Contribution Enrollment Form (Current Year)

Use this form for additional voluntary contributions, over and above standard 5 percent 403(b) employee contribution.

UK 457b Voluntary Additional Contribution Enrollment Form (Current Year)

Use this form for voluntary contributions to a UK 457(b) retirement savings plan, separate from UK's 403(b) retirement plan.

UK 457b Voluntary Additional Contribution Enrollment Form (Next Year)

Use this form for voluntary contributions to a UK 457(b) retirement savings plan, separate from UK's 403(b) retirement pla

Employee Medical Plans
Title Form description
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.

Employee Benefits Enrollment Form

Use this form to enroll in UK health benefits, including our health, dental, and vision plans.

More Great Benefits
Title Form description
EAHP Application

This form allows UK Employees to apply for the Employer Assisted Housing Program.

EAHP House Listing Form for Sellers

Process for listing a house for sale by owner
1. Ensure that your property is within the UK Area either by reviewing the map.
2. If the property is in the 'UK Area,' complete the form below to request that it be listed on the EAHP website as being for sale.
3. After selling, please contact the EAHP Office by email or phone (859 257-9519, option 1) to request the property be removed from the Property For Sale by Owner page.

EAHP map

This map outlines the area surrounding UK that defines the boundaries of the UK Employee Assisted Housing Program.

EEP (Employee Education Program) Tuition Waiver Form for UK Employees

This fillable form allows UK Employees to enroll in the Employee Education Program (EEP) at UK.

EEP Max Hours Exception Request

This form allows enrolled participants in the Employee Education Program to request a one-time exemption from the semester limit to the number of hours an employee can take.

EEP Tuition Waiver for Murray State

Employees of Murray State who participate in the Employee Education Program must fill out and submit this tuition waiver form.

Family Education Program (FEP) Enrollment Form

As a UK employee, you have the opportunity to enroll a family member in the Family Education Program through UK.

Flexible Spending Claim Form
Benefits
Title Form description
Express Scripts Manual Claim Form for Employees and Retirees Under Age 65

Under some circumstances it may be necessary to manually file a prescription claim.  For example if you are out of town and cannot locate your Express-Scripts ID card, it may be necessary to pay for the prescription and manually file for reimbursement once you return. 

Please note claims must be filed within twelve (12) months of receiving a prescription.

Express Scripts Manual Claim Form for Retirees Age 65 and Over (Medicare Carveout Plan)

Under some circumstances it may be necessary to manually file a prescription claim.  For example if you are out of town and cannot locate your Express-Scripts ID card, it may be necessary to pay for the prescription and manually file for reimbursement once you return. 

Please note claims must be filed within twelve (12) months of receiving a prescription.

Name Change Form

Use this form for any name change(s). Once completed, the form must be forwarded to Departmental Business Office for entering into SAP; departmental Business Office enters change(s) into SAP; departmental Business Office then forwards form to Compensation; Compensation will forward form to Employee Records after processing, where the copy will be filed in the individual's Employee Record File. To change home and work addresses, go to myUK at https://myuk.uky.edu and update using the Employee Self Service (ESS) portal.