The eligibility and enrollment rules for the U

Retiree Health Care SPD Effective January 1, 2012
the date that your coverage is effective, if you enroll them at the same time that you enroll. You
will be responsible for the premiums due for retiree coverage back to the effective date of your
retiree health care coverage.
If you elect coverage by your enrollment deadline or within 60 days of the date your coverage
ends under COBRA (if you elect COBRA at the time you terminate), and are enrolling yourself
and/or your dependents in the UnitedHealthcare or Medica Plan option, coverage is generally
effective the first day of the month after your application(s) is received and processed. You will
be responsible for the premiums due for retiree coverage back to the effective date of your retiree
health care coverage.
Deciding Between Retiree Health Care Coverage and COBRA Health Care Coverage.
Separate from the Program enrollment information, you and any other covered dependents will
also receive information on continuing the health care coverage you were enrolled in as an active
employee under the provisions of COBRA. Each of your covered dependents will have an
independent right to decide whether to elect COBRA.
You and your covered dependents will need to decide whether to elect:
• Retiree Health Care Program coverage; or
• COBRA health care coverage and then enroll in the Retiree Health Care Program.
By electing Retiree Health Care Program coverage, you will waive your COBRA health care
rights. You may, however, revoke such waiver at any time during the 60-day COBRA election
period.
Special Enrollment Rights under CHIPRA
CHIPRA is an acronym for the Children’s Health Insurance Program Reauthorization Act of 2009 and
was signed into law on Feb. 9, 2009. It extends and expands the Children’s Health Insurance Program
(CHIP, formerly known as the State Children’s Health Insurance Program or SCHIP). CHIPRA provides
for the following:
• If you or your dependent’s Medicaid or CHIP coverage is terminated because you are no longer
eligible, you qualify for a Health Care Special Enrollment which will allow you to enroll in U.S.
Bank coverage.
• If you or your dependents become eligible for a premium assistance subsidy under Medicaid or CHIP,
you qualify for a Health Care Special Enrollment which will allow you to enroll in U.S. Bank
coverage.
Later Enrollment (Health Care Special Enrollment). To enroll yourself or an eligible
dependent after the deadline on your election materials, you or your eligible dependent must
qualify for a Health Care Special Enrollment. You may qualify for a Health Care Special
Enrollment if you have new dependents or you or a dependent loses existing health care
coverage through another source.
To request a Health Care Special Enrollment, you must contact the U.S. Bank Employee
Service Center and speak to a representative no later than 60 days after the date of your
Health Care Special Enrollment event. (A copy of the certificate or other official paperwork
showing the date of the event or proving loss of coverage may be required.)
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