The eligibility and enrollment rules for the U

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Retiree Health Care SPD Effective January 1, 2012 above and claims and appeals guidance issued by the Department of Labor, you will be deemed to have exhausted the internal claims and appeals process and you may initiate an external review or bring suit under section 502 of ERISA. However, this strict adherence rule does not apply if the violation is: • very minor, • non-prejudicial, • attributable to a good cause or matters beyond the Plan’s control, • made in the context of an ongoing good faith exchange of information, and • not reflective of a pattern or practice of noncompliance. If the claims procedures have not been strictly adhered to, you have the right to request a written explanation of the violation from the Claims Administrator. Within 10 days after receipt of your request, the Claims Administrator will provide you an explanation of the basis, if any, for asserting the violation should not cause the internal claims and appeals process to be deemed to be exhausted. If an external reviewer or court rejects your request for immediate review, you will be able to resubmit your claim and pursue the internal claims process. General Rules for Internal and External Claims • Your initial claim, any request for review of an adverse benefit determination, and any request for external appeal must be made in writing, except for requests for review of adverse benefit determinations relating to Urgent Claims, which may also be made orally. • You must follow the claim-and-review procedure contained in this SPD carefully and completely and you must file your claim before any applicable deadlines. If you do not do so, you may give up important legal rights. • Your casual inquiries and questions will not be treated as claims or requests for a review or submissions to the external appeal process, • You may have a lawyer or other representative help you with your claim at your own expense (the Claims Administrator or U.S. Bank may require written authorization to verify that an individual has been authorized to act on your behalf, except that for Urgent Claims a health care professional with knowledge of the claimant's medical condition will be permitted to act as an authorized representative). • You are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to any adverse benefit determination. You will also be allowed to review the claim file and present evidence and testimony as part of the internal claims and appeal process. • You must comply with any additional requirements for filing a claim (e.g., using a specific claim form) imposed by the Claims Administrator. Exhaustion of Administrative Remedies The exhaustion of the claim-and-review procedure (with the exception of the external claim review process) is mandatory for resolving every claim and dispute arising under this Program prior to initiating legal action (except if the internal claim and appeal process is deemed exhausted under the rules in the section “Failure to Strictly Adhere to Internal Claims and Appeals Process”). In any legal action brought after you have exhausted the administrative remedies, all determinations made by the Claims Administrator, U.S. Bank or other fiduciary, shall be afforded the maximum deference permitted by law. 118
Retiree Health Care SPD Effective January 1, 2012 Time Limitations for Commencing a Claim You must submit your claim for benefits within one year after whichever is earliest – the date on which you were denied benefits or received benefits at a different level than you believed the Program provides, or the date you knew or reasonably should have known of the principal facts on which your claim is based. After you file your claim, you must complete the entire claim-andreview procedure (with the exception of the external claim process) before you can sue over your claim. It is important that you include all the facts and arguments that you want considered during the claim-and-review procedure. Time Limitations for Commencing a Legal Action If you file your claim within the required time and complete the entire claim-and-review procedure (including, if you pursue it, completion of external review), any lawsuit must be commenced within six months after the claim-and-review procedure is complete. In any event, you must commence the suit within two years after whichever is earliest – the date on which you were denied benefits or received benefits at a different level than you believed the Program provides; or the date you knew or reasonably should have known of the principal facts on which your claim is based. Venue for Legal Action Any legal action filed with respect to the Plan must be filed in the federal court for Minnesota located in Hennepin County. Applicable Law for Legal Action If federal law is not controlling, the Plan shall be construed and enforced in accordance with the laws of the State of Minnesota (except that the state law will be applied without regard to any choice of law provisions). 119
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