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  • Employee Benefits Enrollment Form 2021-22
  • Click to view (pdf or doc)
  • Plan year July 1, 2021 through June 30, 2022 Enroll in UK health, dental and vision insurance. You must download and save it to your computer to complete the digital signature. Viewing the form in a web browser will not allow a digital signature.
  • Revision date: 04/23/2021
  • Submit paper form to Benefits Office, 112 Scovell Hall, Lexington KY 40506-0064
  • Email form back to