Plan year July 1, 2024 through June 30, 2025 Enroll in UK health, dental and vision insurance. Qualifying dependent children may be covered to age 26. 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: 04/11/2024
Submit paper form to Benefits Office, 112 Scovell Hall, Lexington KY 40506-0064