The eligibility and enrollment rules for the U

Retiree Health Care SPD Effective January 1, 2012
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.
Your Benefit Option as of August 1, 2002. If you were an East retiree already participating in
the Program and under age 65 as of August 1, 2002, you were automatically enrolled in the
Standard Managed Care option, unless no network was available in your region, in which case,
you were enrolled in the Comprehensive option. If you were over age 65 as of August 1, 2002,
you were automatically enrolled in the Comprehensive option. The Low option was not available
to East Employees who terminated before August 1, 2002.
If you are under age 65 and not Medicare eligible, you may not change your benefit option,
unless you are enrolled in the Comprehensive option, and access to the BCBS BlueCard PPO
network subsequently becomes available or you move to a region with access to the BCBS
BlueCard PPO network. Under these circumstances, you will automatically be moved to the
Early Retiree Medical option.
When you or your covered dependent becomes eligible for Medicare, your Program option may
change. For more information, refer to the “Medicare Eligible Retirees and Dependents Turning
Age 65” section of this SPD.
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