The eligibility and enrollment rules for the U

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Retiree Health Care SPD Effective January 1, 2012 How to Show Previous Creditable Coverage Obtain a certificate of creditable coverage from your previous insurer. Call the U.S. Bank Employee Service Center at 1-800-806-7009 to find out how and where to submit your certificate of creditable coverage. You have the right to request a certificate from a prior plan, insurer, HMO or other entity through which you had creditable coverage. If, after making reasonable efforts, you have difficulty getting a certificate from your prior plan, insurer, HMO or other entity through which you had creditable coverage, please contact the U.S. Bank Employee Service Center at 1-800- 806-7009 for assistance. Without creditable prior coverage, coverage under any Program option is subject to a 12-month pre-existing conditions limitation. A pre-existing condition is any chronic and/or ongoing condition (other than pregnancy) for which you or a covered dependent (age 19 or older) has received prescription medications or treatment or for which treatment was recommended during the six months prior to the effective date of your coverage. Pre-existing conditions include such things as cancer, ear infections, heart and other organ disorders, diabetes, and other chronic conditions, but exclude conditions such as the flu, where the condition is treated and cured. Treatment includes visiting a physician for diagnosis, advice or care, and such actions as taking prescription medication to control an illness. Although some conditions, such as ear infections, may appear to have been treated and cured, they are considered chronic because they frequently recur. No pre-existing-conditions limitation will apply to pregnancy or to newborn/newly adopted dependents or for dependents under age 19. If you have questions regarding whether a condition will be considered pre-existing, call your Claims Administrator’s customer service department at the number listed on the “Important Resources” section of this SPD. Any costs relating to a pre-existing condition will not be covered under the Program for a maximum of 12 months from the enrollment date. (Refer to the “Glossary of Terms” section for a definition of Enrollment Date.) This 12-month period will be reduced by the number of days of prior creditable health coverage, if any, applicable to you or your dependent with a pre-existing condition. After the U.S. Bank Employee Service Center receives your certificate of creditable coverage, you will be notified about the determination of U.S. Bank of any prior creditable coverage that will reduce a pre-existing-conditions limitation period. Individuals who have a pre-existing condition and who do not have 12 months of creditable coverage may want to continue their previous coverage until the end of their pre-existing condition limitation period. To allow claims to be processed more efficiently, your Claims Administrator may pay some claims related to a pre-existing condition. Please be aware that payment of a claim for a preexisting condition will not eliminate the possibility of such coverage being denied at a future date. For example, a claim for an office visit related to a pre-existing condition may be paid, but a subsequent surgery claim for the condition may be denied. 22
Retiree Health Care SPD Effective January 1, 2012 Wellness General Information and Eligibility The U.S. Bank Wellness Program, is designed to provide eligible employees and retirees with health education and information materials and services. Optimal Health® care support program: offers resources and support for retirees living with certain chronic conditions enrolled in the Comprehensive or Early Retiree Medical health care options. U.S. Bank will distribute the health education and information materials from time to time as it, in its sole discretion, determines. There may be no distributions of materials or provisions of services in a given year. Information about additional materials or services provided under this program will be announced as they become available. Retirees who are under age 63 are eligible to participate, as are their dependents, regardless of age. Those who enroll may remain in the program until the first day of the month in which the retiree becomes Medicare eligible. Persons deemed eligible will receive an invitation to participate in the program via mail and/or telephone. Enrollment and participation is voluntary, confidential and paid for by U.S. Bank. Filing Claims If you do not receive materials or services you believe you are entitled to, contact the U.S. Bank Employee Service Center at 1-800-806-7009. If this does not resolve the issue, you may file a claim and seek review of that claim by submitting it in writing to: U.S. Bank Benefit Claim Subcommittee EP-MN-R2BN 4000 W. Broadway Robbinsdale, MN 55422-2299 Fax: 763-971-1285 Within 60 days after your claim is received, you will receive a written notice of the decision. If your claim is denied, in whole or in part, the Claim Reviewer will further notify you of your right to additional review of your denied claim. If your request for review is denied in whole or in part and you still disagree with the decision, within 60 days of the date you receive written notice, you must deliver to the U.S. Bank Benefit Claim Subcommittee a written request for a final claims determination at the above address. Your request for a final claims determination should include any documentation supporting your claim. Termination of Participation Your participation in this program ends the day you cease to be enrolled in an eligible selfinsured health care option. You may also decline or terminate participation at any time, since participation is voluntary. 23
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