Skip to main
Life Insurance and AD&D Beneficiaries Form 2021-22
Click to view (pdf or doc)
Plan year July 1, 2021 through June 30, 2022
Use this form to name your beneficiaries for your optional life insurance and optional accidental death & dismemberment insurance.
Revision date: 04/23/2021
Submit paper form to Benefits Office, 112 Scovell Hall, Lexington KY 40506-0064
Email form back to email@example.com