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Retiree Benefits Enrollment Form 2023-24
Retiree Benefits Enrollment Form 2023-24
Click to view (pdf or doc)
Plan year July 1, 2023 through June 30, 2024 Retirees should use this form to enroll in health, dental and vision plans.
Revision date:
04/13/2023
Submit paper form to Benefits Office, 112 Scovell Hall, Lexington KY 40506-0064
Email form back to
benefits@uky.edu