The eligibility and enrollment rules for the U

Retiree Health Care SPD Effective January 1, 2012
– your/your domestic partner’s foster children;
– children/grandchildren for whom you or your spouse/domestic partner have legal
guardianship****;
– children/grandchildren legally adopted by you or your spouse/domestic partner or
placed with you or your spouse/domestic partner for adoption****; and
– grandchildren who are eligible to be claimed as an exemption on you or your
spouse/domestic partner’s federal income tax return.
• Disabled children age 26 and older who otherwise meet the dependent children definition
may be covered as long as ALL of the following requirements are met:
– the child is severely disabled by prolonged physical or mental incapacity;
– the child became disabled prior to reaching age 26;
– the child was covered by the plan prior to reaching age 26, or, if older than age 26,
loses coverage under a parent’s/guardian’s plan. In the event of loss of coverage, proof of
prior coverage must be provided;
– the child remains unmarried and you/your domestic partner provide more than 50% of
his or her support because he or she is unable to earn a living; and
– disabled dependent status is approved by a medical Claims Administrator for U.S.
Bank.
* Eligible dependents of retirees of the former Mercantile only (at the time the retiree terminated employment) will
be allowed to enroll in the Program at a later date as long as the retiree enrolled at termination.
** Even though some localities may recognize same-sex marriages, the U.S. Bank Benefits Program is governed by
federal regulations which require that coverage for partners must be paid for on an after-tax basis, and the cost of
coverage be considered imputed income. Therefore, even in the event of marriage or civil union, if you are enrolling
your same-sex spouse you must designate him/her as a domestic partner.
*** For health care coverage, a newborn is not considered a dependent until birth.
**** Documentation of legal guardianship or adoption is required. Please call the U.S. Bank Employee Service
Center for instructions. The dependent cannot be added to your coverage until a copy of the applicable documents
are received and verified by the U.S. Bank Employee Service Center.
To have the disabled child considered for coverage, you and his or her doctor must complete an
application form for the child. The form is available from the applicable medical Claims
Administrator. To be considered, the form must be received by the medical Claims
Administrator no later than 30 days after the date the child turns age 26. See the “Important
Resources” section of this SPD for telephone numbers for the medical Claims Administrators. If
coverage for the child is approved, and the child is not considered permanently disabled,
periodically you will be asked to submit proof to the medical Claims Administrator that the child
continues to meet eligibility requirements. Failure to provide requested information may result in
loss of coverage for the dependent.
If your disabled dependent loses coverage under another health care plan, please contact the
U.S. Bank Employee Service Center for information regarding the procedure for applying for
coverage under the U.S. Bank Retiree Health Care Program.
Children who become disabled after age 26 are not eligible for coverage.
Ineligible Dependents. Ineligible dependents include but are not limited to the following:
• Dependents in the Military. Coverage is not available for any dependent on active duty in
the uniformed services or armed forces of any country.
• Dependent Parents. Coverage is not available for a retiree's or retiree's spouse's/domestic
partner’s parents.
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