The eligibility and enrollment rules for the U

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,
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