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  • ACH Bank Draft Authorization Form
  • Click to view (pdf or doc)
  • Fill out and submit this form to enable automatic monthly payment of your UK Retiree Health Insurance premiums by bank draft (ACH).
  • Revision date: 09/15/2021
  • Submit paper form to Benefits Office, 112 Scovell Hall
  • Email form back to benefits@email.uky.edu