An Official Website of the Commonwealth of Kentucky
Click on a category below to find the related documents.
Benefits Selection Guide
Benefits Grid
LivingWell CDHP SBC
LivingWell PPO SBC
LivingWell Basic CDHP SBC
LivingWell Limited High Deductible Plan SBC
Summary of benefits and Coverage- Uniform Glossary
Medical Benefit Booklet
RX SPD
2019 Integrated HRA SPD
2019 Waiver Dental Vision ONLY HRA SPD
2019 Waiver General Purpose HRA SPD
2019 Dependent Care FSA SPD
2019 Healthcare FSA SPD
Member-Friendly ACA Preventive Services List
ACA Preventive Services List
2020 Advanced Control Formulary
2020 Value Formulary Quick Reference List
2020 Advanced Control Specialty Formulary
2019 Preventive Therapy Drug Benefit List
2019 Value Formulary
SmartShopper Reward Service List
Dependent Eligibility Chart
2020 Health Insurance Monthly Premiums
Checklist for New Employees
2019 Diabetes Report
2020 KEHP Employee Health Insurance Enrollment-Change Application
2020 KEHP FSA Enrollment-Change Application
2020 Retiree Enrollment Form
2020 ADA Active Enrollment Form
2020 KEHP Federal Post Tax Request Form
Exception Form
Credit Request Form
HIPAA Authorization for Release of Information
HIPAA Request for Accounting of Disclosure of Protected Health Information
HIPAA Request for Alternate Communications
HIPAA Request to Amend or Correct Protected Health Information
HIPAA Request to Inspect or Copy Protected Health Information
HIPAA Request for Restrictions on Use or Disclosure of Protected Health Information
Medicaid Eligibility Termination Form
Retro Cap Override Form
Tobacco Cessation Voucher Form
Tobacco Use Change Form
WageWorks Dependent Care Reimbursement Form
WageWorks Health Reimbursement Form
Go365 Personal Physician voucher
2020 Legal Notice
2020 Terms and Conditions
2020 Tobacco Use Declaration
2020 COBRA Dental Vision Notice
2020 COBRA Health Notice
2020 Kentucky Marketplace Notice Parts A and B
2020 Kentucky Marketplace Notice Part A Only
2020 Medicare Prescription Drug Creditable Coverage Notice
USERRA Notice on Health Insurance Rights
2020 WHCRA Notice
2020 Wellness Program Notice
CHIP Notice
2019 Advanced Control Formulary
2019 Advanced Control Specialty Formulary
2019 Value Formulary Quick Reference List
Health Insurance Monthly Premiums
2019 KEHP Employee Health Insurance Enrollment-Change Application
2019 KEHP FSA Enrollment-Change Application
2019 Retiree Health Insurance Application
2019 ADA Active Application
2019 KEHP Federal Post Tax Request Form
2019 Summer Transfer Application BOEs Only
2019 COBRA Dental Vision Notice
2019 COBRA Health Notice
2019 Kentucky Marketplace Notice Parts A and B
2019 Kentucky Marketplace Notice Part A Only
2019 Legal Notice
2019 Medicare Prescription Drug Creditable Coverage Notice
2019 Notice of Privacy Practices
2019 Terms and Conditions
2019 Tobacco Use Declaration
2019 USERRA Notice on Health Insurance Rights
2019 WHCRA Notice
2019 Wellness Program Notice
2019 CHIP Notice
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