The eligibility and enrollment rules for the U

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Retiree Health Care SPD Effective January 1, 2012 be responsible for the premiums due for retiree coverage back to the effective date of your retiree health care coverage. Deciding Between Retiree Health Care Coverage and COBRA Health Care Coverage. Separate from the Program enrollment information, you and any other covered dependents will also receive information on continuing the health care coverage you were enrolled in as an active employee under the provisions of COBRA. Each of your covered dependents will have an independent right to decide whether to elect COBRA. You and your covered dependents will need to decide whether to elect: • Retiree Health Care Program coverage; or • COBRA health care coverage. By electing Retiree Health Care Program coverage, you will waive your COBRA health care rights. You may, however, revoke such waiver at any time during the 60-day COBRA election period. If you elect COBRA health care rather than retiree health care coverage under the Program, you will not have an option to enroll in the Program when you either stop or exhaust your COBRA health care coverage. It is important to carefully compare the benefits of COBRA health care versus retiree health care coverage in making this decision. If you have questions about the two types of coverage, contact the U.S. Bank Employee Service Center at 1-800-806-7009. One-Time Option to Enroll in Retiree Program. There is a single point of entry into the Program – at the time of your termination. This means that if you do not enroll yourself and any eligible dependents in the Program by the enrollment deadline stated on your enrollment worksheet, you will not be able to enroll yourself and/or your dependents in retiree health care coverage at any time in the future. If, for example, at the time you terminate, you elect COBRA health care or coverage under a spouse’s/domestic partner’s plan or a new employer’s plan, instead of coverage under the Program, you will not be able to enroll in the Program at the time your COBRA health care continuation period or other coverage ends. Similarly, you must enroll any eligible dependents in the Program at the time of your termination to retain their coverage. Therefore, if you and/or a dependent want coverage under the Program at any point after your termination, you must enroll them when you terminate. You may, however, have the right to add new dependents gained after your termination. Refer to the “New Dependents Gained After Your Termination” section for more information. New Dependents Gained After Your Termination. If you gain a dependent after you terminate due to marriage, commencement of a domestic partnership, birth, adoption or commencement of a legal guardianship, your new dependent may be eligible for coverage under the Program if the following requirements are met: • You must enroll your new dependent within 60 days of the date they first become your dependent after your termination; and • Your new dependent continues to satisfy the requirements of an “eligible dependent”, as defined in the “Dependent Eligibility” section. 10
Retiree Health Care SPD Effective January 1, 2012 If, however, one of your current dependents later gains eligibility due to a change in the eligibility requirements, you will not be able to enroll that dependent in the Program. To enroll a new dependent, call the U.S. Bank Employee Service Center at 1-800-806-7009 and speak to a representative. If your new dependent is a domestic partner or dependent of a domestic partner, see the “Domestic Partner Eligibility” section in this SPD. If you are enrolling your dependent(s) into the Early Retiree Medical or Comprehensive option, your benefit changes will be effective on the first day of the month following the date you experience a qualifying new dependent enrollment event and contact the U.S. Bank Employee Service Center to make your election unless: • You are adding a newborn or newly adopted child (or a child newly placed with you for adoption). If you are adding a newborn or newly adopted/placed for adoption child, health care coverage for that dependent will be retroactive to the date of the event. If coverage is retroactive, premiums will also be retroactive; or • If your new dependent enrollment event occurs on the first of the month and you contact the U.S. Bank Employee Service Center on that day your coverage will become effective on that day. If you are enrolling your dependent(s) in the UnitedHealthcare or Medica Plan option, coverage is generally effective the first day of the month after your application is received and processed, or the first of the month following the date you experience a qualifying new dependent enrollment event and contact the U.S. Bank Employee Service Center to make your election, whichever is later. Coverage Cancellation. You can cancel coverage for yourself and/or your dependents at any time by calling the U.S. Bank Employee Service Center at 1-800-806-7009. If after electing coverage when you terminate, you cancel or lose retiree health care coverage under the Program for any reason (including non-payment of premiums), you will not be able to re-enroll in the Program. If you cancel or lose retiree health care coverage, any covered dependents will also lose coverage, subject under certain circumstances and rights to COBRA coverage. Similarly, if you cancel coverage for an eligible dependent for any reason, that dependent will not be able to re-enroll in the Program. If you and/or your dependents are enrolled in one of the Early Retiree Medical or Comprehensive option, the coverage cancellation effective date is the first of the month following the date that you contact the U.S. Bank Employee Service Center to cancel coverage unless you contact the U.S. Bank Employee Service Center on the first of the month, then your coverage will be canceled on that day. If you and your dependents are enrolled in the UnitedHealthcare or Medica Plan option, the coverage cancellation effective date is the first of the month following the date that the U.S. Bank Employee Service Center receives a written request to disenroll you and/or your dependents from the UHC or Medica Plan option. This request must be signed and dated by each member that wants to disenroll from the UnitedHealthcare or Medica Plan option. 11
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