The eligibility and enrollment rules for the U

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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 130
Retiree Health Care SPD Effective January 1, 2012 any eligible expenses you incurred or benefits to which you become otherwise entitled prior to the Program amendment or termination. If the Program is terminated and replaced by a new plan(s), you can enroll in the new plans if you meet eligibility requirements. If new plans are not established, you may be eligible to continue your retiree health care coverage or, under certain circumstances, to convert your coverage to individual policies. These individual policies will not duplicate your benefits from U.S. Bank exactly. Recovery of Excess Payments and Correction of Errors As a condition of the Program, U.S. Bank has a right to recover any excess benefit payments. Excess payments can occur if benefits from U.S. Bank, or from U.S. Bank and other sources combined, exceed those due to you under the Program. Excess payments may also occur if benefits were paid because of a mistake or incorrect information regarding your or your dependent’s entitlement to benefits. U.S. Bank will recover any excess amount paid to you by: • reducing or suspending future benefit payments; • requesting direct payment from you; • withholding any payments from U.S. Bank otherwise due you, if permitted by law; or • any other method allowed by law. The company also may correct any errors that may occur in administering the Program. Erroneous contributions and/or benefit payments can be returned to the company as permitted by law. Contributions may also be returned if they do not meet the requirements for deductibility under applicable tax laws. Reimbursement and Subrogation This Plan maintains both a right of reimbursement and a separate right of subrogation. As an express condition of your participation in this Plan, you agree that the Plan has the subrogation rights and reimbursement rights explained below. The Plan’s Right of Subrogation. If you or your dependents receive benefits under this Plan arising out of an illness or injury for which a responsible party is or may be liable, this Plan shall be subrogated to your claims and/or your dependents’ claims against the responsible party. Obligation to Reimburse the Plan. You are obligated to reimburse the Plan in accordance with this provision if the Plan pays any benefits and you, or your dependent(s), heirs, guardians, executors, trustees, or other representatives recover compensation or receive payment related in any manner to an illness, accident or condition, regardless of how characterized, from a responsible party, a responsible party’s insurer or your own (first party) insurer. You must reimburse the Plan to the full extent of benefits paid by the Plan, not to exceed the amount of recovery, before you or your dependents, including minors, are entitled to keep or benefit by any payment, regardless of whether you or your dependent has been fully compensated and regardless of whether medical or dental expenses are itemized in a settlement agreement, award or verdict. You are also obligated to reimburse the Plan from amounts you receive as compensation or other payments as a result of settlements or judgments, including amounts designated as compensation for pain and suffering, non-economic damages and/or general damages. The Plan is entitled to recover from any plan, person, entity, insurer (first party or third party), and/or insurance policy 131
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The eligibility and enrollment rules for the U

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