2010 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
- Rates (deductions) for FCPS - Non-smoker | Smoker
- Provider list (The Humana site includes lots of information about health and prescription benefits.)
- Health insurance update form
- Release of information form
- Dependent add | Dependent drop
- Medicaid eligibility / termination form
- Post-tax request
- Cancellation of insurance request
Health Reimbursement Accounts /Flexible Spending Accounts
Delta Dental
- Web site | Customer assistance
- Overview and rates
- Enrollment form
- Option 1 (Delta Premier Traditional)
- Option 2 (Delta Preferred Provider)
- Option 3 (D73A Delta Care)
- Delta Dental providers
- DeltaVision discounts
Davis Vision
Beneficiary change forms
-
State-sponsored term life (Prudential)
-
Kentucky Teachers' Retirement System -- Call (800) 618-1687.
Investments
Voluntary benefits:
'Standard' products
* Note these rates for dependents (which were omitted from the brochure):
For 18-pay week employees: $5,000 benefit is 72 cents per pay period and $10,000 benefit is $1.43 per pay period.
For 24-pay week employees: $5,000 benefit is 54 cents per pay period and $10,000 benefit is $1.08 per pay period.
- Medical history form
- Beneficiary designation
- Post-employment insurance conversion request
- Post-employment portability application
- Premium waiver request
- Long-term disability claim
- Life insurance benefit claim form
Other products
About this page
- Author: Karin Pabian
- Updated: November 18, 2009