Skip to main
  • COBRA enrollment form 2021-22
  • Click to view (pdf or doc)
  • Plan year July 1, 2021 through June 30, 2022 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.
  • Revision date: 04/23/2021
  • Submit paper form to
  • Email form back to Benefits Office, 112 Scovell Hall, Lexington KY 40506-0064