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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 />

dependents do not call <strong>the</strong> U.S. Bank Employee Service Center within this time frame,<br />

COBRA continuation will not be available.<br />

For coverage to continue, <strong>the</strong> U.S. Bank Employee Service Center must receive completed<br />

election <strong>for</strong>ms within 60 days after whichever is later:<br />

• <strong>the</strong> date <strong>the</strong> coverage would o<strong>the</strong>rwise end; or<br />

• <strong>the</strong> date your dependents are provided notice of <strong>the</strong>ir right to continue coverage.<br />

Although your dependents have 60 days in which to make <strong>the</strong>ir decision, COBRA coverage is<br />

not reinstated back to <strong>the</strong> date <strong>the</strong> Retiree Health Care Program coverage ended until your<br />

dependents return <strong>the</strong> election <strong>for</strong>ms <strong>and</strong> make full payment <strong>for</strong> coverage. Once <strong>the</strong>ir election<br />

<strong>for</strong>m <strong>and</strong> payment are received, it generally takes about three weeks <strong>for</strong> <strong>the</strong>ir coverage to be<br />

reactivated. Until coverage is reactivated, your dependents must pay <strong>for</strong> services. When <strong>the</strong>ir<br />

coverage is reactivated, <strong>the</strong>y can <strong>the</strong>n submit <strong>the</strong> bills <strong>for</strong> reimbursement.<br />

When Continued Coverage Ends<br />

Continued coverage will end be<strong>for</strong>e <strong>the</strong> 36-month limit <strong>and</strong> will not be reinstated if:<br />

• Your dependent(s) fail to pay <strong>the</strong> required premiums in full by <strong>the</strong> specified deadlines<br />

(checks returned <strong>for</strong> insufficient funds do not qualify as payment <strong>and</strong> special <strong>rules</strong> <strong>for</strong> partial<br />

payment may apply). It is your dependent's responsibility to make payment in full by <strong>the</strong><br />

required due date each month. <strong>The</strong>y will not receive a reminder notice.<br />

• Your dependent(s) become covered under ano<strong>the</strong>r group plan after <strong>the</strong> date COBRA is<br />

elected (unless <strong>the</strong> plan includes pre-existing condition limitations that apply to your<br />

dependent(s)).<br />

• U.S. Bank no longer offers group health coverage to its employees or retirees.<br />

• Your dependent(s) become entitled to Medicare benefits after <strong>the</strong> date COBRA is elected.<br />

• It is determined that your dependent does not meet <strong>eligibility</strong> requirements or you fail to<br />

provide documentation verifying your dependent’s <strong>eligibility</strong>.<br />

Cost of Continued Coverage<br />

During <strong>the</strong> COBRA continuation period your dependents will pay <strong>the</strong> full cost of coverage on a<br />

monthly basis as well as an additional 2% <strong>for</strong> administrative expenses each month.<br />

Your dependents have 45 days from <strong>the</strong> date continuation coverage is elected to make <strong>the</strong> first<br />

premium payment. Subsequent premium payments are due in full by <strong>the</strong> first day of each month.<br />

In<strong>for</strong>mation regarding payment deadlines will be included with <strong>the</strong> in<strong>for</strong>mation you receive<br />

regarding continuation. If <strong>the</strong> first payment is not made in full within <strong>the</strong> 45-day period (checks<br />

returned <strong>for</strong> insufficient funds do not qualify as payment <strong>and</strong> special <strong>rules</strong> <strong>for</strong> partial payments<br />

may apply), no COBRA coverage will be provided. If any subsequent payment is not made in<br />

full within 30 days of <strong>the</strong> first day of <strong>the</strong> month (checks returned <strong>for</strong> insufficient funds do not<br />

qualify as payment <strong>and</strong> special <strong>rules</strong> <strong>for</strong> partial payments may apply), coverage will be cancelled<br />

retroactive to <strong>the</strong> end of <strong>the</strong> last month <strong>for</strong> which payment was made. Your dependents will not<br />

receive a reminder notice. Once coverage is cancelled, it will not be reinstated.<br />

U.S. Bank reserves <strong>the</strong> right to change premiums at any time <strong>and</strong> as permitted by law.<br />

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