Agreement for Preauthorized Benefit Premium Payments

A retired University of Michigan employee may have benefit premiums automatically withdrawn from a checking or savings account by completing the attached form and sending it to:

Payroll Office
G395 Wolverine Tower-Low Rise
3003 South State Street
Ann Arbor, Michigan 48109-1279

FAX: (734) 647-3983

Please contact the Human Resources & Payroll Service Center at (734) 615-2000 or toll free at (866) 647-7657 with any questions.