The eligibility and enrollment rules for the U

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Retiree Health Care SPD Effective January 1, 2012 complaint with the Human Resources Department at the address listed above. There will be no retaliation for filing a complaint. 142
Retiree Health Care SPD Effective January 1, 2012 GLOSSARY OF TERMS Admission Inpatient stay (in bed) that lasts at least one day and night. Allergy Services Medical services that involve evaluation and management of immune system disorders. Allowed Amounts The amount that is the basis for payment with regard to a given covered service. All benefit payments under the BCBS administered options are based on the allowed amount. The allowed amount may vary from one provider to another for the same service. Also, the Claims Administrator may periodically adjust the allowed amount. Medco uses the amount a participating pharmacy would charge if you showed your Medco ID card. The BCBS allowed amount is the negotiated amount of payment that a participating provider has agreed to accept as payment in full (less deductibles, coinsurance and copayments) for a covered service at the time your claim is processed. The allowed amount may be based on an estimated final price (including anticipated adjustments), or it may be based on discounts from billed charges. See the “Allowed Amounts” section in this SPD for more information about the determination of allowed amounts by BCBS. Annual Maximum The cumulative maximum amount payable by the U.S. Bank Retiree Health Care Program for a particular covered medical service or prescription drug incurred by you during each plan year or by each of your covered dependents during the plan year. The maximum does not include amounts that are your responsibility (deductibles, coinsurance, copayments, penalties and other amounts). Refer to the “What the Options Cover” section in this SPD for specific annual maximums on certain medical services. For annual maximums related to prescription drugs, if any, see the “Pharmacy” section in this SPD. Average Semiprivate Room Rate The average rate charged for a room with more than one bed. If the provider has no semiprivate rooms, the program still uses the average semiprivate room rate for payment of the claim. Claims Administrator For the self-funded benefit options, U.S. Bank has delegated authority to several third party claims administrators ("Claims Administrator") to interpret and construe the terms of the Program and to determine all factual and legal questions under the Program with respect to all initial claims for benefits and requests for review of adverse benefit determinations. This delegated authority includes, but is not limited to, determinations of entitlement to benefits and the amounts of the benefits to be paid. Your location and the coverage option you choose will determine your specific Claims Administrator. For a list of Claims Administrators, see the “Claims Administrator Information” section in this SPD. 143
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The eligibility and enrollment rules for the U

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