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Human Capital Services

Limited Health Care Bridge Transmittal Form

Fill out the Limited Health Care Bridge Transmittal (pdf)

This form is to be filled out by the requester's department, and then submitted to the dean. If the dean supports approval, he/she will then forward to Human Capital Services – Benefits for processing and to route for final approval by the provost or appropriate vice president.  View more about the limited health care bridge.

Related KSU Policy and Procedures Manual Chapter:  4810.90 Limited Health Care Bridge