Benefits Enrollment/Change Form for Retirees
Purpose
This form allows for retirees to either enroll in a benefits program or change their current benefits enrollment program.
NOTE: This form must be submitted within 31 days of your date of eligibility or qualifying life event.
Open Enrollment Form: Use the Open Enrollment form only if you are unable to access your employee portal event during CU Medicare Open Enrollment, which ends at 5 p.m. MST, Oct. 23, 2026.
Last updated: 10/2026
