The eligibility and enrollment rules for the U

More documents

Recommendations

Info

Retiree Health Care SPD Effective January 1, 2012 All other retirees will be enrolled in the UnitedHealthcare® Group Medicare Advantage PPO M Plan. UnitedHealthcare and Medica provide their own materials. If you elect to enroll in the Program, you should carefully review and refer to these materials. Questions about your health care option, coverage and claims information should be directed to UnitedHealthcare or Medica. See the “Important Resources” section of this SPD. Kaiser Colorado Option Retirees enrolled in the Kaiser option prior to January 1, 2009 will continue to be enrolled in this option. If you are enrolled in the Kaiser option, you will generally receive benefits only for covered services you receive from a provider within Kaiser. If you receive non-emergency services from a provider outside Kaiser, you will likely receive no benefits. The Kaiser option is offered through insurance contracts with Kaiser Permanente. Kaiser has the sole authority, discretion and responsibility to interpret and construe the option; determine all factual and legal questions under such option, including but not limited to eligibility, the entitlement of benefits and the amounts of benefits to be paid; and determine all questions arising in the administration of the option. Kaiser Colorado provides its own materials. Be sure to refer to those materials, as Kaiser may have different provisions and requirements than those described in this SPD. If you will be moving out of the Kaiser service area and you are Medicare eligible, you must enroll in the UnitedHealthcare or Medica Plan option (depending on your new zip code) in order to continue coverage under the Program. Contact the U.S. Bank Employee Service Center at 1- 800-806-7009 sixty days prior to your move date. Kaiser Mergers/Terminations/Provider Changes. If you are enrolled in Kaiser and Kaiser merges with another company and is no longer offered by U.S. Bank, or if Kaiser terminates operations during the year, and you are Medicare eligible you must enroll in the UnitedHealthcare or Medica Plan option available in your area in order to continue coverage under the Program. Information on your options will be provided to you at that time. If either your physician or your clinic leaves Kaiser, you must select another physician or clinic affiliated with Kaiser – you will not be able to change health care options under this circumstance. Dependents. Kaiser's definition of dependent(s) may be different than the definition used by other U.S. Bank options described in this document. Refer to the Kaiser materials, or contact Kaiser's member service department for details. (See the “Important Resources” section of this SPD for phone numbers and Web site addresses.) Dependent Data Requirement Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) is a federal law that became effective January 1, 2009. This federal law requires U.S. Bank to provide the Social Security number (SSN) for your covered dependents that are U.S. citizens. Newborn dependents are also included in this requirement. This information is reported to assist the 20
Retiree Health Care SPD Effective January 1, 2012 Centers for Medicare and Medicaid Services (CMS) and health plans to properly coordinate payment of benefits among plans. Compliance is required in order to provide coverage for your dependents. When adding or enrolling a dependent, you will want to have that information available in order to complete the enrollment process. If you cannot or do not wish to provide your dependent’s SSN, you will need to call the U.S. Bank Employee Service Center at 800-806-7009 and speak with a representative. You should call: • If your dependent doesn’t have a SSN because he/she is not a U.S. citizen. Providing a dependent’s Tax Identification number (TIN) in place of the SSN is not sufficient. • If your dependent is a newborn and you have not yet been issued a Social Security number for the child. • If you wish to complete the form indicating your dependent is not a Medicare beneficiary or you refuse to provide the requested information. Please note that this form will need to be completed annually until the Social Security number is provided or the dependent is no longer covered. Pre-Existing Conditions Limitations* Note: The Pre-existing Conditions Limitations provisions do not apply to East Employees who retired before January 1, 2002, former Mercantile Employees who retired before January 1, 2003, or dependents under age 19. The Program has a 12-month pre-existing conditions limitation for retirees and their dependents (age 19 and older). However, if you enroll when you are first eligible, the pre-existing conditions limitation will not apply to you or any dependents who had coverage under a U.S. Bank active employee health care option for at least 12 months immediately preceding your termination date. That is because your coverage under a U.S. Bank health care option while you were an active employee is considered creditable coverage. If you or an eligible dependent (age 19 or older) was not covered by a U.S. Bank active employee health care option for the 12 months prior to your enrollment in the Program, you will need to provide the U.S. Bank Employee Service Center with a certificate of creditable coverage from your prior plan(s). Most group health plans, health insurers and HMOs automatically furnish these certificates when coverage is lost. In addition, all plans, insurers and HMOs are required to provide these certificates upon request. The certificate will tell U.S. Bank how long you had coverage under your prior plan(s) and when it ended. Most prior coverage will count as creditable health coverage if there has not been a period of 63 or more consecutive days without coverage. Creditable coverage will reduce the duration of the pre-existing-conditions limitation period under this Program, as explained below. *If you are enrolled in the Kaiser Colorado, UnitedHealthcare or Medica plan option, see the separate material provided by Kaiser, UnitedHealthcare and Medica. 21
Page 1 and 2: Retiree Health Care SPD Effective J
Page 19: Retiree Health Care SPD Effective J
Page 71 and 72:
Retiree Health Care SPD Effective J
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
show all

The eligibility and enrollment rules for the U

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?