Forms

2010 Active Employee Application (PDF - 233 KB)

2010 Kentucky Retirement System Retiree Application (PDF - 135 KB)

2010 Kentucky Teachers' Retirement System Retiree Application (PDF - 128 KB)

2010 Judicial and Legislative Retirement Systems Retiree Application  (PDF - 82 KB)

2010 Update Form (PDF - 49 KB)

2010 Add Form (PDF - 61 KB)

2010 Drop Form (PDF - 158 KB)

Non-Smoker Affidavit (PDF - 33 KB)

Post-Tax Request Form (PDF - 42 KB)

Authorization for Release of Information

Shortfall Refund Request (PDF - 7.94 KB)

Health Insurance Refund Request For KY Employees(PDF-9.52 KB)

Web Billing form (PDF-25KB)

Pre Tax Request Form 2010 (PDF-204KB)

Insurance Coordinator Verification Form (PDF - 39 KB)

Transmittal Log (PDF - 10 KB)

Medicaid Eligibility/Termination Form and Instructions (PDF -  40 KB)