The eligibility and enrollment rules for the U
The eligibility and enrollment rules for the U
The eligibility and enrollment rules for the U
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Retiree Health Care SPD Effective January 1, 2012<br />
If, however, one of your current dependents later gains <strong>eligibility</strong> due to a change in <strong>the</strong><br />
<strong>eligibility</strong> requirements, you will not be able to enroll that dependent in <strong>the</strong> Program.<br />
To enroll a new dependent, call <strong>the</strong> U.S. Bank Employee Service Center at 1-800-806-7009 <strong>and</strong><br />
speak to a representative. If your new dependent is a domestic partner or dependent of a<br />
domestic partner, see <strong>the</strong> “Domestic Partner Eligibility” section in this SPD.<br />
If you are enrolling your dependent(s) into <strong>the</strong> Early Retiree Medical or Comprehensive option,<br />
your benefit changes will be effective on <strong>the</strong> first day of <strong>the</strong> month following <strong>the</strong> date you<br />
experience a qualifying new dependent <strong>enrollment</strong> event <strong>and</strong> contact <strong>the</strong> U.S. Bank Employee<br />
Service Center to make your election unless:<br />
• You are adding a newborn or newly adopted child (or a child newly placed with you <strong>for</strong><br />
adoption). If you are adding a newborn or newly adopted/placed <strong>for</strong> adoption child,<br />
health care coverage <strong>for</strong> that dependent will be retroactive to <strong>the</strong> date of <strong>the</strong> event. If<br />
coverage is retroactive, premiums will also be retroactive; or<br />
• If your new dependent <strong>enrollment</strong> event occurs on <strong>the</strong> first of <strong>the</strong> month <strong>and</strong> you contact<br />
<strong>the</strong> U.S. Bank Employee Service Center on that day your coverage will become effective<br />
on that day.<br />
If you are enrolling your dependent(s) in <strong>the</strong> UnitedHealthcare or Medica Plan option, coverage<br />
is generally effective <strong>the</strong> first day of <strong>the</strong> month after your application is received <strong>and</strong> processed,<br />
or <strong>the</strong> first of <strong>the</strong> month following <strong>the</strong> date you experience a qualifying new dependent<br />
<strong>enrollment</strong> event <strong>and</strong> contact <strong>the</strong> U.S. Bank Employee Service Center to make your election,<br />
whichever is later.<br />
Coverage Cancellation. You can cancel coverage <strong>for</strong> yourself <strong>and</strong>/or your dependents at any<br />
time by calling <strong>the</strong> U.S. Bank Employee Service Center at 1-800-806-7009. If after electing<br />
coverage when you terminate, you cancel or lose retiree health care coverage under <strong>the</strong> Program<br />
<strong>for</strong> any reason (including non-payment of premiums), you will not be able to re-enroll in <strong>the</strong><br />
Program. If you cancel or lose retiree health care coverage, any covered dependents will also<br />
lose coverage, subject under certain circumstances <strong>and</strong> rights to COBRA coverage.<br />
Similarly, if you cancel coverage <strong>for</strong> an eligible dependent <strong>for</strong> any reason, that dependent will<br />
not be able to re-enroll in <strong>the</strong> Program.<br />
If you <strong>and</strong>/or your dependents are enrolled in one of <strong>the</strong> Early Retiree Medical or<br />
Comprehensive option, <strong>the</strong> coverage cancellation effective date is <strong>the</strong> first of <strong>the</strong> month<br />
following <strong>the</strong> date that you contact <strong>the</strong> U.S. Bank Employee Service Center to cancel coverage<br />
unless you contact <strong>the</strong> U.S. Bank Employee Service Center on <strong>the</strong> first of <strong>the</strong> month, <strong>the</strong>n your<br />
coverage will be canceled on that day.<br />
If you <strong>and</strong> your dependents are enrolled in <strong>the</strong> UnitedHealthcare or Medica Plan option, <strong>the</strong><br />
coverage cancellation effective date is <strong>the</strong> first of <strong>the</strong> month following <strong>the</strong> date that <strong>the</strong> U.S.<br />
Bank Employee Service Center receives a written request to disenroll you <strong>and</strong>/or your<br />
dependents from <strong>the</strong> UHC or Medica Plan option. This request must be signed <strong>and</strong> dated by each<br />
member that wants to disenroll from <strong>the</strong> UnitedHealthcare or Medica Plan option.<br />
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