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.
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
