Employee Resources
KSU 1-11.pdf Instructions

KSU 1-11
Payment of Health Care Premiums for State of Kansas Employee Health Care Program for Non-State Groups


If you've never used the web version of Administrative Forms before, please start by reading the general instructions before proceeding.

As stated in the general instructions, this form can be filled in and printed. Use tab key or mouse to navigate this form.

Each Extension Council/District Governing Body employee who participates in the State of Kansas Employee Health Care Program for Non-State Groups is to complete this form by January 10 each year. File in the employee's personnel file.

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Please send your questions, comments, and suggestions about this form to Cheryl Christian, cchristi@ksu.edu. Thank you.