Forms

Change your permanent address online using myUK, or submit the PDF form.

Use this form for any name change(s). Note: The employee completes the form with the appropriate change. Then, employee takes form to HR Benefits for entering into SAP. HR Benefits enters change into SAP. To change home and work addresses, go to myUK at https://myuk.uky.edu and update using the Employee Self Service (ESS) portal.

For UK employees only. Authorize an individual to contact the HR Benefits office and receive information regarding UK benefits on employee’s behalf.

Write a list of everything you would like to do from most important to least important. When you get extra money from any source, apply it to these goals. Item one may be new clothes for $100, item two could be a weekend trip away for $300, and item three could be pay off a credit card for $800. If you receive a $600 tax refund, you could do the first two items and put the remaining $200 towards the credit card debt.

More than a budget, this will help plan what bills will be paid with each paycheck.

This form can give you a game plan to pay off your debt. List debts from smallest to largest, pay as much as you can on the smallest and the minimum on the rest.  As one debt is paid off, add the amount you were paying monthly on that debt to the minimum payment on the next debt on the list.

Employees should complete this form to make matching 403(b) retirement savings plan contributions to Fidelity Investments and designate beneficiaries.

Employees should complete this form to make voluntary 403(b) retirement savings plan contributions to Fidelity Investments and designate beneficiaries.

Employees should complete this form to enroll in voluntary 457(b) retirement savings plan through Fidelity. This form is also used for designating a beneficiary.

This worksheet will give you a good basic understanding of what your current income and expenses really are.

Complete this form to authorize payroll deductions as contributions to UK's Matching Retirement Savings Plan.

This form allows staff or faculty of UK to enter a Phased Retirement process.

Employees should complete this form to make matching 403(b) retirement savings plan contributions to TIAA and designate beneficiaries.

Employees should complete this form to make voluntary 403(b) retirement savings plan contributions to TIAA Investments and designate beneficiaries.

Employees should complete this form to enroll in voluntary 457(b) retirement savings plan through TIAA. This form is also used for designating a beneficiary.

Use this form for additional voluntary contributions, over and above the standard 5 percent 403(b) employee contribution.

Use this form for voluntary contributions to a UK 457(b) retirement savings plan, separate from UK's 403(b) retirement plan.

Fill out and submit this form to enable automatic monthly payment of your UK Retiree Health Insurance premiums by bank draft (ACH).

Plan year July 1, 2024 through June 30, 2025

Retirees should use this form to enroll in health, dental and vision plans.
 

Fill out and submit this form to defer retiree health coverage one time and have the option to return to university coverage in the future.

Use this form to manually submit a health insurance claim with Anthem.

Plan year July 1, 2024 through June 30, 2025

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.

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.

Plan year July 1, 2024 through June 30, 2025

Use this form at any time during the year to start, stop, increase, or decrease the amount you contribute to you HSA.
 

Plan year July 1, 2024 through June 30, 2025

Use this form if you are enrolling in the UK Saver HSA health plan and would like to make additional employee contributions. This also includes the option to open a limited flexible spending account. You must download the form and save it to your computer to complete the digital signature. Viewing the form in a web browser will not allow a digital signature.
 

This form allows UK Employees to apply for the Employer Assisted Housing Program.

This map outlines the area surrounding UK that defines the boundaries of the UK Employee Assisted Housing Program.

As a UK employee, you have the opportunity to enroll a family member in the Family Education Program through UK.

Plan year July 1, 2023 through June 30, 2024

Use this form to enroll in health and/or dependent care flexible spending accounts (FSA). You must download the form and save it to your computer to complete the digital signature. Viewing the form in a web browser will not allow a digital signature.

Plan year July 1, 2024 through June 30, 2025

Use this form to enroll in health and/or dependent care flexible spending accounts (FSA). You must download the form and save it to your computer to complete the digital signature. Viewing the form in a web browser will not allow a digital signature.

Use this form to manually submit a flexible spending account claim with ASI Flex.

Click here to complete form 

Use this form to name your beneficiaries for your optional life insurance and optional accidental death & dismemberment insurance.

Plan year July 1, 2024 through June 30, 2025 Use this form to enroll in additional life insurance coverage for yourself, spouse/sponsored dependent, or children. Qualifying dependent children may be covered to age 26.  This form also allows you to enroll in separate accidental death & dismemberment insurance.  

Plan year July 1, 2024 through June 30, 2025

Use this form to enroll in legal services insurance or cancel it.
 

This form allows enrolled participants in the Employee Education Program to request a one-time exemption from the semester limit to the number of hours an employee can take.

This form is for use by students who are also employed by the University of Kentucky as regular employees using the tuition waiver benefit to attend other Kentucky state-funded institutions. Students who wish to use the tuition waiver benefit must release their academic records in order for University of Kentucky Human Resources to receive academic records from these other Kentucky public institutions. The information is for internal use only, related to benefit eligibility and administration and will not be shared with any parties outside of the University of Kentucky.

This fillable form allows UK Employees to enroll in the Employee Education Program (EEP) at UK.

Under some circumstances it may be necessary to manually file a prescription claim.  For example if you are out of town and cannot locate your Express Scripts ID card, it may be necessary to pay for the prescription and manually file for reimbursement once you return. 

Please note claims must be filed within twelve (12) months of receiving a prescription.

Under some circumstances it may be necessary to manually file a prescription claim.  For example if you are out of town and cannot locate your Express Scripts ID card, it may be necessary to pay for the prescription and manually file for reimbursement once you return. 

Please note claims must be filed within twelve (12) months of receiving a prescription.

Prescription formularies for UK health plan members on either HMO, PPO, RHP, EPO, Saver or Indemnity plans.



If you have any questions, call our pharmacists with the Know Your Rx Coalition at (859) 218-5979 or (855) 218-5979 for information specific to your medication, formulary and costs.

What the EPO plan covers and what you pay for covered services.

What the HMO plan covers and what you pay for covered services.

What the Indemnity plan covers and what you pay for covered services.

What the PPO plan covers and what you pay for covered services.

What the RHP plan covers and what you pay for covered services.