The eligibility and enrollment rules for the U

Retiree Health Care SPD Effective January 1, 2012
Conversion Privilege
If your dependents continued Program coverage throughout the COBRA maximum coverage
period by making all required premium payments, they may be able to convert all or part of their
coverage to individual policies at the end of that maximum coverage period. If they convert to
individual policies, no evidence of insurability will be required. More information is available
from the appropriate medical Claims Administrator.
Important Facts About Your Program
This section includes some facts about your U.S. Bank benefits and other benefit plans and
programs, collectively referred to hereafter as “Plans.” The Plans are identified as follows:
Official Plan Name Plan Type Plan Number
U.S. Bank Comprehensive
Welfare Benefit Plan*
Welfare Plan 518
* The plan administrator has chosen to prepare more than one summary plan description for the U.S. Bank
Comprehensive Welfare Benefit Plan pursuant to 29 CFR §2520.102-4. The list of the separate summary plan
descriptions required pursuant to 29 CFR §2520.104a-3 follows.
1. The summary of the Severance Pay Program for certain full- or part-time employees of U.S. Bank who are not
classified as temporary employees, and for certain former employees of businesses acquired by U.S. Bank who
are specifically declared to be covered under the Program.
2. The summary of the Health Care Program and the U.S. Bank Wellness Program for certain persons classified by
U.S. Bank as employees.
3. The summary of the Dental Care Program for certain persons classified by U.S. Bank as employees.
4. The summary of the Retiree Health Care Program (including the separate summary provided only to
participants enrolled in an HMO benefit option) for certain retirees of U.S. Bank or U.S. Bancorp who are/were
enrolled in a U.S. Bank or Health Care plan at termination of employment.
Reports on the Plan are identified and filed with the federal government using an Employer
Identification Number (EIN) assigned by the Internal Revenue Service. The EIN for U.S. Bank is
41-0255900. The address is:
U.S. Bancorp Center
800 Nicollet Mall
Minneapolis, MN 55402.
Amendment or Termination of the Program
U.S. Bank has reserved the right to amend the U.S. Bank Retiree Health Care Program including
any Program or option offered under the plans, by written action of the Benefits Administration
Committee of U.S. Bank (and the Severance Administration Committee for severance plans or
programs) at any time, for any reason and in any respect at its sole discretion. U.S. Bank’s right
to amend or terminate the Program includes, but is not limited to, changes in the eligibility
requirements, premiums or other payments charged, availability and/or amount of retiree health
care credits or subsidies, benefits provided and termination of all or a portion of the coverages
provided under the Program. If the Program is amended or terminated, you will be subject to all
the changes effective as a result of such amendment or termination, and your rights will be
reduced, terminated, altered or increased accordingly, as of the effective date of the amendment
or termination. You do not have ongoing rights to any Program benefit, other than payment of
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