The eligibility and enrollment rules for the U

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Retiree Health Care SPD Effective January 1, 2012 If you and your dependents are enrolled in the UnitedHealthcare or Medica Plan option, the coverage cancellation effective date is the first of the month following the date that the U.S. Bank Employee Service Center receives a written request to disenroll you and/or your dependents from the UnitedHealthcare or Medica Plan option. This request must be signed and dated by each member that wants to disenroll from the UnitedHealthcare or Medica Plan option. 160
Retiree Health Care SPD Effective January 1, 2012 Eligibility and Enrollment Rules Section B This eligibility and enrollment section only applies to: • West Employees who retired before January 1, 2002; • West Employees who retired between January 1, 2002, and December 31, 2002, and who elected the fixed subsidy option; • West Employees whose LTD or severance period began before January 1, 2002; and • West Employees who retired or whose LTD or severance period began between January 1, 2002, and December 31, 2002, and who elected the fixed subsidy option. Retiree Eligibility You are eligible to participate in the Program if: • you are age 55 or older at the time of your termination, or if you are involuntarily terminated, the date that your subsidized health care benefits end; • you have five or more Years of Service as determined under the terms of the U.S. Bank Pension Plan; except if you are involuntarily terminated, any period of time that you are enrolled in subsidized health care benefits will count for purposes of calculating a Year of Service (refer to the “Glossary of Terms” section of this SPD for the definition of Years of Service); • your age and Years of Service total at least 65; and • you are eligible for and enrolled in a U.S. Bank active employee health care option at the time of your termination. Dependent Eligibility Refer to the materials from Kaiser for information about dependent eligibility under this option. “Eligible dependents” for the purposes of U.S. Bank benefits are listed below. You will need to provide your dependent’s Social Security number (SSN) when adding or enrolling a dependent. Refer to “Dependent Data Requirement” in this SPD for further information about this requirement. In addition, U.S. Bank and its designated administrators may request proof of dependent eligibility at any time. Failure to provide such proof may result in termination of coverage. Your dependent(s) will be eligible to participate in the Program, if: • your dependent was covered by your U.S. Bank active employee health care option at the time of your termination; and • your dependent continues to satisfy one of the following requirements except as noted:* • Your spouse/domestic partner** (unless legally separated from you). Under the federal Defense of Marriage Act (DOMA), a spouse is a husband or wife of opposite sex. A common-law spouse may be covered only if you reside in a state that recognizes common-law marriage and you meet the common-law requirements at the time you enroll the dependent in coverage. To enroll a domestic partner in coverage, you must meet the eligibility criteria defined under “Domestic Partner Eligibility” section in this SPD. • You or your domestic partner’s children/grandchildren under age 26*** who are: – your/your domestic partner’s biological children; – your stepchildren; – your/your domestic partner’s foster children; 161
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The eligibility and enrollment rules for the U

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