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​2024 Forms and Documents



Employee Benefits Enrollment Change Form
Retiree Enrollment Change Form
ADA Active Enrollment Form
Dental Insurance Enrollment/Change Form
Vision Insurance Enrollment/Change Form
DD Open Enrollment Enrollment Form
KEHP Federal Post Tax Request Form
Open Enrollment Exception Request
​Exception Form
Checklist for New Employees


2024​ Benefits Selection Guide
2024​ Benefits Selection Guide in Spanish​
2024​​ Benefits Grid
2024 How to Enroll
2024 What's New or Changing​
2024 Open Enrollment Highlights​
Exception Request Information
2024 Waiver HRA
2024 Waiver Limited Purpose HRA
2024 ​CDHP HRA
2024 Basic CDHP HRA
2024 Child & Adult Care FSA
2024​ Healthcare FSA
2024 COBRA Rates

Legal Notices

Notice of Privacy Practices
KEHP Authorization for Release of Information
KEHP Request for Accounting of Disclosures
KEHP Request for Alternate Communications
KEHP Request for Restrictions
KEHP Request to Amend PHI
KEHP Request to Inspect or Copy PHI
2024 Legal Notices
2024​ Terms and Conditions
2024 Tobacco Use Declaration
2024 COBRA Dental Vision Notice
2024 COBRA Health Notice
2024 Kentucky Marketplace Notice Parts A and B
2024 Kentucky Marketplace Notice Part A Only
2024 Medicare Prescription Drug Creditable Coverage Notice
2024 USERRA Notice on Health Insurance Rights
2024 WHCRA Notice
2024 Well​being Program Notice
2024 CHIP Notice


Member-Friendly ACA Preventive Services List
ACA Preventive Services List
Value Formulary
​Advanced Control Specialty Formulary
PrudentRX Specialty Drug List for LivingWell PPO

Life Insurance

MetLife Enrollment Change Form
MetLife Portability Application
MetLife Privacy Notice
MetLife Portability v. Conversion Brochure
MetLife Conversion Application
2024​​​ MetLife Rates

Summaries of Benefits and Coverage

LivingWell CDHP SBC
LivingWell Basic CDHP SBC
Uniform Glossary​