2009 Forms
The state has published a benefits guide, a handbook and a health insurance application: Kentucky Personnel Cabinet's state health plan.
Health Insurance
- Kentucky Employees Health Plan Handbook
- Benefits Selection Guide
- Application Form
- Online Enrollment
- Rates (deductions) for FCPS - Non-smoker | Smoker
- Provider list (Humana site includes lots of information about health and prescription benefits)
- Health Insurance Update Form
- Dependent Add Form | Dependent Drop Form
- Medicaid Eligibility / Termination Form
Health Reimbursement Accounts /Flexible Spending Accounts
- Overview
- Claim Form
- Debit Card Quick Reference Guide
- For Family Coverage Participants
- HumanaAccess Visa | IRS requirements
- Medical Plan and Pharmacy Benefits
- IIAS Retailers List (OTC purchases)
- Flexible Spending Account Qualifying Event Change Form
Delta Dental
- Web site | Customer assistance
- Overview and rates
- Enrollment form
- Option 1 (Delta Premier Traditional) | Providers directory
- Option 2 (Delta Preferred Provider) | Providers directory
- Option 3 (D73A) | Providers directory
- Delta Vision Plan
Davis Vision
Beneficiary Change Forms
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State-Sponsored Term Life (Prudential)
-
Kentucky Teachers' Retirement -- Call (800) 618-1687.
Investments
Unum Voluntary Benefits
Disability Income Insurance
- Educator Select Income Protection Plan
- Disability Rate Sheet - 18 payroll deductions
- Disability Rate Sheet - 24 payroll deductions
- Enrollment Form
- Claim Form
- Beneficiary Change Form
- Certificate of Coverage
Term Life Insurance
- Plan Highlights
- Term Life Rate Sheet
- Enrollment Form
- Evidence of Insurability | When do I complete EOI?
- Certificate of Coverage
- Portability Instructions
- Portability Application
- Conversion Application
- Waiver of Premium Form
- Beneficiary Change Form
Accidental Death & Dismemberment Insurance
Other products
About this page
- Author: Karin Pabian
- Updated: September 25, 2009