Benefits Plans - Prescription Drug Plan: Eligibility and Enrollment

All eligible participants in U-M health plans—active employees, retirees, and dependents—are automatically enrolled in the U-M Prescription Drug Plan.

It is your responsibility to notify the Benefits Office immediately if your address changes. To do so, you can call the HR/Payroll Service Center or send an email to address.change@umich.edu.

• Eligibility
• New Employee or New Eligibility for Health Benefits
• Coverage Level
• Dependents
• Exceptions and Special Conditions
• COBRA Participants
• LTD Participants
• Lapse of Appointment
• Enrollment Information by Phone

Eligibility

To be eligible, active employees must have at least a 50% appointment. Graduate Student Instructors (GSIs), Graduate Student Staff Assistants (GSSAs), and Graduate Student Research Assistants (GSRAs) must have at least a 25% appointment.

New Employee or New Eligibility for Health Benefits

When you enroll in a U-M health plan, you will be concurrently enrolled in the U-M Prescription Drug Plan. You must enroll within 30 days of your service date (date of hire or eligibility) or the date your appointment was put online by Human Resources Records and Information Systems (HRRIS). Coverage is effective on your service date.

There are no separate enrollment forms for the Prescription Drug Plan. You cannot elect U-M health plan coverage without participating in the Prescription Drug Plan. Likewise, you cannot elect the Prescription Drug Plan without participating in a health plan.

Coverage Level

The university considers prescription drug coverage an essential part of health plan coverage and treatment. Therefore, your prescription drug coverage will be at the same level as your health plan coverage (you only; you plus your spouse or OQA; you plus one dependent; or you plus one or more dependents) and for the same named dependents as for your health plan coverage.

Dependents

You may enroll your eligible dependents at the time you first enroll in a heath care plan. Newly acquired dependents-such as a newborn or adopted child, a new spouse, or a new other qualified adult, may be added to your health plan and prescription drug plan within 30 days of your acquiring the new dependent. If you do not report the change within 30 days, you may be required to wait until the next Open Enrollment to add the new dependent to your coverage. Coverage is retroactive to the date the dependent is acquired if you apply for enrollment within the required time period.

Report any changes in the eligibility of covered dependents, such as divorce, to the HR/Payroll Service Center within 30 days of the event.

Exceptions and Special Conditions

Active members of AFSCME, Trades, and IUOE have separate prescription drug co-pay designs, with annual adjustments in co-pays, as outlined in their respective union contracts.

For COBRA Participants

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) is a federal law that allows employees and/or dependents to continue certain benefits at their own expense if they become ineligible for these benefits due to termination or change in appointment status.

COBRA participants have the option to elect health plan and prescription drug coverage through the university or waive both. They cannot buy drug coverage separately.

After the maximum COBRA coverage period has ended, participants may purchase a commercial product from their respective health plan vendor. While that product may include prescription drugs, coverage may differ from the university's plan.

For LTD Participants

Long-Term Disability participants are regarded as “actives” for benefits purposes. Their prescription drug coverage is consistent with their secondary job/career family (i.e., AFSCME, Trades, and IUOE) and will continue to do so if they retire. Medical plan premium co-payments, if any, become the responsibility of the retiree upon retirement.

Lapse of Appointment

If you were enrolled in a medical plan and a lapse of appointment occurred of no more than one term (four months), your coverage will resume when you return to work with an eligible appointment. The Benefits Office will attempt to automatically reinstate your coverage, but it is your responsibility to check your pay stub and verify reinstatement has occurred.

If a lapse of more than one term occurred, you must establish a new date of eligibility when you return work.

A leave without salary or layoff does not constitute a lapse of appointment, and medical and drug coverage may be continued at your own expense during a leave or layoff period.

Enrollment Information by Phone

For information on enrollment, call the HR/Payroll Service Center at 734-615-2000 or 1-866-647-7657 (toll free).