The eligibility and enrollment rules for the U

Retiree Health Care SPD Effective January 1, 2012
Coverage, other than for Children under age 19, newly adopted children or children newly placed
for adoption, may be subject to a pre-existing conditions limitation.
A Health Care Special Enrollment is available only to retirees to whom this Section B applies
and who:
• previously qualified for the U.S. Bank Retiree Health Care Program;
• declined participation when initially eligible because of other health coverage; and
• have now lost the other coverage.
Events that may qualify for a Health Care Special Enrollment include the following situations:
• loss of other coverage* for reasons such as:
– divorce, legal separation, annulment or termination of domestic partnership;
– death;
– termination of employment;
– reduction in hours;
– ineligibility for Medicare, Medicaid or CHIP;
– exhaustion of your COBRA coverage (if you were enrolled in COBRA through another
source); or
– termination of another employer's contribution toward the cost of coverage.
• gaining a dependent due to:
– marriage;***
– birth, adoption, placement for adoption/legal guardianship; or
– establishment of a qualified domestic partnership (including, for Kaiser Colorado only, the
establishment of a common-law marriage by qualified opposite-sex domestic partners, as
recognized by the state of Colorado).**
If you are pre-65 and not Medicare eligible, coverage for you and your dependents in the pre-65
option will be effective on the first day of the month following the date you experience a
qualifying Health Care Special Enrollment event and you contact the U.S. Bank Employee
Service Center to make your election. There are two exceptions: (1) If your Health Care Special
Enrollment occurs on the first day of the month and you contact the U.S. Bank Employee Service
Center on that day, your coverage becomes effective on that day; and (2) If you are adding a
newborn or newly adopted child (or a child newly placed with you for adoption), health care and
pharmacy care coverage for that dependent and for any other dependent you add due to that
event, will be retroactive to the date of the event. If coverage is retroactive, premiums will also
be retroactive.
If you and your eligible dependents are age 65 or older or pre-65 and Medicare eligible, your
coverage in the UnitedHealthcare or Medica Plan option is generally effective the first day of the
month after your application is received and processed, or the first of the month following the
date that you lose your other coverage, whichever is later.
* Loss of coverage due to non-payment of premiums or termination for cause, such as making fraudulent claims or
intentional misrepresentation, is not a qualifying event.
** Qualified domestic partners and dependents of domestic partners of West Employees who terminated before
January 1, 2002, are not eligible for coverage under the Program and may not be added to coverage due to a special
enrollment event.
***Under DOMA, marriage is defined as the legal union of a man and a woman.
Coverage Cancellation. You can cancel coverage for yourself and/or your dependents at any
time by calling the U.S. Bank Employee Service Center at 1-800-806-7009. If after electing
coverage at termination, you cancel or lose retiree health care coverage under the Program for
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