The eligibility and enrollment rules for the U

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Retiree Health Care SPD Effective January 1, 2012 Plan Fiduciaries The plan fiduciaries are responsible for the proper operation of the Program. They have a duty to act prudently and in the sole interest of Program participants and beneficiaries. Benefits Claims and Legal Actions If you have any questions or problems concerning any of your Program benefits or about applying for benefits, please call the U.S. Bank Employee Service Center at 1-800-806-7009. If you have a claim for benefits that is denied in whole or in part, you should receive a written explanation of the reason for denial. You have the right to have the Plan Administrator review and reconsider your claim. If you have completed the appeals process, your claim for benefits is denied (as described in this SPD) and you believe you are entitled to the benefits you claimed, you can take your case to federal or state court. If you discover that a plan fiduciary is misusing the plan's money or if you are discriminated against for exercising your rights under ERISA, you can file suit in a federal court or ask the U.S. Department of Labor for help. If you make a written request for material and do not receive the material within 30 days after your request, you can bring suit if there is no valid reason for the delay. In this situation, the court can require the Plan Administrator to provide the material and pay you up to $110 a day until you receive the materials. If you bring suit in federal or state court to protect any of the ERISA rights discussed in this section, the court will decide who will pay court costs and legal fees. If you win your case, the court may ask that the losing party pay these costs and fees. If you lose your case – for example, if the court finds your claim is frivolous, the court may ask you to pay these costs and fees. Exercising Your ERISA Rights The law provides that you will not be fired or discriminated against in any way for the sole purpose of preventing you from getting plan benefits or from exercising the rights you have as a plan member under ERISA. If you have any questions about your rights under ERISA or if you need assistance in obtaining documents from the Plan Administrator, you should contact the nearest office of the Employee Benefits Security Administration (formerly known as Pension and Welfare Benefits Administration), U.S. Department of Labor, listed in your telephone directory, or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue NW, Washington, DC 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration. HIPAA Privacy The information that follows describes how medical and dental information about you may be used and disclosed, and how you can get access to this information. For the Program, these regulations took effect April 14, 2003. The Health Insurance Portability and Accountability Act (“HIPAA”) is a federal law designed to increase the portability of health insurance and protect health information. As part of HIPAA, the Department of Health and Human Services, in cooperation with the Department of Labor and 138
Retiree Health Care SPD Effective January 1, 2012 Department of Treasury, issued regulations that apply to health plans and programs (referred to herein as “health plan” or “health plans”) regarding the privacy of health information. Understanding Your Health Record and Health Information Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information serves as (i) a basis for planning your care and treatment, (ii) a means of communication among health professionals who contribute to your care, (iii) a legal document describing the care you received and a means by which you or a third-party payer can verify that services billed were actually provided, (iv) a source of data for medical research, (v) a source of information for public health officials, and (vi) a tool by which U.S. Bank can assess and work to improve the U.S. Bank health programs. Understanding what is in your record and how your health information is used helps you to ensure its accuracy, better understand who, what, when, where, and why others may access your health information and will help you make more informed decisions when authorizing disclosure to others. Your Health Information Rights Although the U.S. Bank health programs have the right to use your health information in the administration of the Program, the information belongs to you. You have the right, upon submitting a written request, (i) to request a restriction on certain uses and disclosures of your information, (ii) to receive confidential communication by alternative means or at alternative locations if disclosure of the information could endanger you, (iii) to inspect and copy your protected health information, (iv) to amend your protected health information, (v) to receive a paper copy of this request, (vi) to obtain an accounting of the disclosures of your private health information, and (vii) to revoke your authorization to use or disclose health information except to the extent that the information has already been used or disclosed. To submit a written request, send the request to: U.S. Bank – EP-MN-R2BN Benefits Administration 4000 W. Broadway Robbinsdale, MN 55422-2299 U.S. Bank is not required to agree to any restriction that you request on your health information. In addition, U.S. Bank may notify you that it is unable to communicate your health information by alternative means or at alternative locations that you request. Responsibilities of U.S. Bank The Program is required to maintain the privacy of your health information, including electronic health information, and to provide you with a notice as to the legal duties and privacy practices with respect to information that the Program collects and maintains about you. Administrative, physical and technical safeguards have been implemented to protect the confidentiality, integrity and availability of health information. The Ability of U.S. Bank to Change Its Practices The Program reserves the right to amend or change their practices and to make the new provisions effective for all protected health information maintained by the health programs. Should the practices change, the Program will provide you with a revised notice. This communication or revised notice will be provided to you either (i) through the U.S. mail, 139
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