The eligibility and enrollment rules for the U

Retiree Health Care SPD Effective January 1, 2012
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.
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.
If you elect COBRA health care rather than retiree health care coverage under the
Program, you will not have an option to enroll in the Program when you either stop or
exhaust your COBRA health care coverage.
It is important to carefully compare the benefits of COBRA health care versus retiree health care
coverage in making this decision. If you have questions about the two types of coverage, contact
the U.S. Bank Employee Service Center at 1-800-806-7009.
One Time Option to Enroll in Program. There is a single point of entry into the Program –
at the time of your termination. This means that if you do not enroll yourself and any
eligible dependents in the Program by the enrollment deadline stated on your enrollment
worksheet, you will not be able to enroll yourself and/or your dependents in retiree health
care coverage at any time in the future.
If, for example, at the time you terminate, you elect COBRA health care or coverage under a
spouse’s/domestic partner’s plan or a new employer’s plan, instead of coverage under the
Program, you will not be able to enroll in the Program at the time your COBRA health care
continuation period or other coverage ends. Similarly, you must enroll any eligible dependents in
the Program at the time of your termination to retain their coverage. Therefore, if you and/or a
dependent wants coverage under the Program at any point after your termination, you must
enroll when you terminate. You may, however, have the right to add new dependents gained
after your termination. Refer to the “New Dependents Gained After Your Termination” section
for more information.
However, eligible dependents of retirees of the former Mercantile (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 the time they terminated). The eligible dependent must qualify for and
complete the Mercantile Health Care Special Enrollment. To request a Mercantile Health Care
Special Enrollment, call the U.S. Bank Employee Service Center at 1-800-806-7009 and speak to
a representative. Eligible dependents are only allowed one enrollment into the Program.
Therefore if the eligible dependent enrolls in coverage and subsequently cancels coverage, they
will not be allowed to enroll in the Program at a later date.
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