Skip to main
  • Life Insurance and AD&D Enrollment Form 2022-23
  • Plan year July 1, 2022 through June 30, 2023 Use this form to enroll in additional life insurance coverage for yourself, spouse/sponsored dependent, or children. This form also allows you to enroll in separate accidental death & dismemberment insurance.
  • Revision date: 05/04/2022
  • Submit paper form to Benefits Office, 112 Scovell Hall, Lexington KY 40506-0064
  • Email form back to