Benefits Enrollment/Change Form for Surviving Spouse

Purpose

 This form allows a surviving spouse/partner to either enroll in benefit programs or change current benefit programs.

NOTE: This form must be submitted within 31 days of your date of eligibility or qualifying life event.

Last updated: 4/20/2020

Download a form below and open in Adobe Acrobat. Forms can be submitted electronically or printed and mailed/faxed to Employee Services.