Umbrella Rx | Human Resources | Colorado State University

During your initial enrollment, you can add or delete eligible dependents. The plan is effective the first of the month following your enrollment.

The Umbrella Rx Plan is a supplemental prescription plan that reimburses out-of-pocket expenses for prescription drugs (minus co-payments) purchased through the PERACare Medicare Advantage prescription drug plan, administered by UnitedHealth care and Optum Rx. The Umbrella Rx claim form can also be found on our website.
Retiree Name*
First Middle Last
CSU ID, if known
Email Address
For Umbrella Rx Coverage:
- I will remain in the Umbrella Rx plan and do not need to make changes (Skip to Attestation)
- I will remain in the Umbrella Rx plan, and do need to make changes
- I don't intend on enrolling in the Umbrella Rx plan
If you do need to make changes or pay for dependent coverage:
- I will upload my change form to the CSU Secure Drive.
- I will mail a copy to HR along with my payment for dependent coverage.
Attestation (Type Full Name)*
By typing my name in the field above, I hereby attest that this is considered my Umbrella Rx open enrollment election and that the information above is true and accurate to the best of my knowledge.
By submitting this form, I consent to the use of electronic disclosure for all retiree communications. I consent to receive retirement related documents from Human Resources electronically will no longer receive a paper copy.