The eligibility and enrollment rules for the U

Retiree Health Care SPD Effective January 1, 2012
RETIREE HEALTH CARE OPTIONS
The health care option available to you depends on your age (as the U.S. Bank retiree), Medicare
eligibility and the area in which you live.
• If you are under age 65 (and not Medicare eligible), you can enroll yourself and your
eligible dependents (regardless of their ages) in the pre-65 health care option available in
your location.
• If you and your eligible dependents are age 65 or older or pre-65 and Medicare eligible,
you and your eligible dependents must enroll in the UnitedHealthcare or Medica Plan
option available in your area.
• If you are age 65 or older but your covered dependents are under age 65 and not
Medicare eligible, you must enroll in the UnitedHealthcare or Medica option available in
your area and your covered dependents can enroll in the pre-65 health care option
available in your area.
Your Health Care Options — Retirees Under Age 65 and non-Medicare
Eligible
The option available to you at your initial enrollment is listed on your enrollment form and
depends on where you live.
Choices for retirees under age 65 are:
Option Claims Administrator(s)
No Coverage
Early Retiree Medical (in locations with access to the BCBS BCBS of MN
BlueCard PPO network)
Comprehensive (in locations without access to the BCBS BCBS of MN
BlueCard PPO network)
Blue Cross and Blue Shield of Minnesota and other Blue Cross Blue Shield plans are independent licensees of the
Blue Cross Blue Shield Association.
Following is a brief summary of the pre-65 non-Medicare eligible health care options.
Early Retiree Medical Option
This option is available to pre-65 non-Medicare eligible retirees and their dependents and is
available in areas that have access to the BCBS BlueCard PPO network. This option is
administered by Blue Cross and Blue Shield of Minnesota. Specific details about the deductible
and out-of-pocket maximum related to each option can be found in the “Health Care Option
Summary” section in this SPD. Under this option:
• You may choose any provider each time you need care – either in or out of the BCBS
BlueCard PPO network. However, your benefit level depends on the provider you select.
If you use an in-network provider, your expenses are generally covered at a higher level.
Refer to the “Which Network Providers to Use” section in this SPD for more information
on the provider networks. Benefits are not available for preventive care if you use an outof-network
provider.
• If either your physician or your clinic leaves the network, you must select another
physician or clinic affiliated with your network in order to receive in-network benefits.
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