Umbrella Rx | Human Resources | Colorado State University

Open Enrollment 2022

The annual open enrollment period for current participants of the CSU Umbrella Rx Plan begins today and ends November 15, 2021. Your opportunity to add or delete eligible dependents occurs during this open enrollment period.

Changes are effective January 1, 2022. You do not need to return an Umbrella Rx Change Form unless you are making a change. However, please indicate your status below.

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 2022 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.