The eligibility and enrollment rules for the U

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Retiree Health Care SPD Effective January 1, 2012 any reason (including non-payment of premiums), you will not be able to re-enroll in the Program unless you qualify for and complete a Health Care Special Enrollment. If you cancel or lose retiree health care coverage, any covered dependents will also lose coverage, subject under certain circumstances and rights to COBRA coverage. Similarly, if you cancel coverage for an eligible dependent for any reason, that dependent will not be able to re-enroll in the Program unless they qualify for and complete a Health Care Special Enrollment. If you and/or your dependents are enrolled in one of the pre-65 options or the Kaiser option, the coverage cancellation effective date is the first of the month following the date that you contact the U.S. Bank Employee Service Center to cancel coverage unless you contact the U.S. Bank Employee Service Center on the first of the month, then your coverage will be canceled on that day. 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. 166
Retiree Health Care SPD Effective January 1, 2012 Eligibility and Enrollment Rules Section C This eligibility and enrollment section only applies to: • East Employees who retired prior to January 1, 2002; • Employees formerly employed by Mercantile Bancorporation who retired before January 1, 2003; • Former eligible Mercantile employees that went out on severance or LTD prior to January 1, 2003. (This includes eligible employees that went out on severance or LTD prior to January 1, 2003, and with severance or LTD ending after January 1, 2003.) Retiree Eligibility You are eligible to participate in the Program if you satisfied the age, service and any other eligibility requirements in effect under the terms of the retiree health care plan applicable to you at the time of your termination. Employees formerly employed by Mercantile Bancorporation that went out on severance or LTD prior to January 1, 2003 (this includes eligible employees that went out on severance or LTD prior to January 1, 2003 and whose severance or LTD ended after January 1, 2003) did not need to be enrolled in a U.S. Bank active employee health care option at the time of termination to be eligible for this Program. 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. 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 a Firstar Group Health Insurance Plan benefit option at the time of your termination (except dependents of employees formerly employed by Mercantile Bancorporation who terminated before January 1, 2003 and dependents of former eligible Mercantile employees that went out on severance or Long-Term Disability (LTD) prior to January 1, 2003); • you are eligible to participate in the Program and you enroll yourself and your eligible dependent at the time of your termination;* and • your dependent continues to satisfy one of the following requirements: • 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; 167
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The eligibility and enrollment rules for the U

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