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  • COBRA enrollment form 2022-23
  • Plan year July 1, 2022 through June 30, 2023 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: 04/25/2022
  • Submit paper form to Benefits Office, 112 Scovell Hall, Lexington KY 40506-0064
  • Email form back to