The eligibility and enrollment rules for the U

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Retiree Health Care SPD Effective January 1, 2012 When You Have Other Coverage – Medco .............................................................................................................81 When You Have Other Coverage – Medicare Part B Program ...............................................................................81 Health Management Program..................................................................................................................................82 BCBS of MN Options – General Information ......................................................83 Your ID Card...........................................................................................................................................................83 Bariatric Surgery......................................................................................................................................................83 Cardiac Care ............................................................................................................................................................84 Complex and Rare Cancers .....................................................................................................................................84 Emergency Care ......................................................................................................................................................85 Knee and Hip Replacements....................................................................................................................................85 Inpatient Maternity Care..........................................................................................................................................86 Mental Health and Substance Abuse Coverage.......................................................................................................87 Preventive Care........................................................................................................................................................88 Spine Surgery ..........................................................................................................................................................96 The Women’s Health and Cancer Rights Act of 1998.............................................................................................96 Transplants ..............................................................................................................................................................97 Non-Custodial and Full-Time Student Dependents Under the Early Retiree Medical Option ................................97 Filing Health Care Claims - BCBS..........................................................................................................................98 Allowed Amounts....................................................................................................................................................98 Eligible Health Care Professionals ........................................................................................................................100 Eligible Facilities...................................................................................................................................................101 General Exclusions................................................................................................................................................102 Using Your ID Card When Traveling....................................................................................................................107 Address Changes ...................................................................................................................................................107 Filing Claim Disputes ............................................................................................110 Eligibility and Enrollment Claims for All Options................................................................................................110 Release of Medical Records and Medical Reviews...............................................................................................110 Internal ERISA Claims Procedures .......................................................................................................................111 Request for Review of Adverse Benefit Determinations.......................................................................................113 Determination Upon Request for Review..............................................................................................................114 External Appeal Process........................................................................................................................................115 General Rules for Internal and External Claims ....................................................................................................118 Exhaustion of Administrative Remedies ...............................................................................................................118 Time Limitations for Commencing a Claim..........................................................................................................119 Time Limitations for Commencing a Legal Action...............................................................................................119 Venue for Legal Action .........................................................................................................................................119 Applicable Law for Legal Action ..........................................................................................................................119 Cost of Retiree Health Care Coverage ................................................................120 Retiree Health Care Credits...................................................................................................................................120 Eligibility for Retiree Health Care Credits ............................................................................................................120 Accumulating Retiree Health Care Credits............................................................................................................120 Nature of Retiree Health Care Credits and Reservation of Rights to Change Credits...........................................121 Interest on Retiree Health Care Credits .................................................................................................................121 Long-Term Disabilities and Retiree Health Care Credits......................................................................................122 Severance and Retiree Health Care Credits...........................................................................................................122 U.S. Citizens Working Overseas Do Not Earn Credits..........................................................................................122 Paying for Retiree Health Care Coverage with Credits .........................................................................................122 If You Die with Accumulated Credits ...................................................................................................................123 Special Transition Rules........................................................................................................................................123 Benefits Administrative Information...................................................................126 When Coverage Ends ............................................................................................................................................126 Failure to Notify U.S. Bank of Dependent Ineligibility.........................................................................................126 USERRA ...............................................................................................................................................................127 Situations That Affect Your Coverage ..................................................................................................................127 Health Coverage Certificates.................................................................................................................................127 Dependents Continuing Coverage After It Would Otherwise End — COBRA ....................................................127 Important Facts About Your Program ...................................................................................................................130 4
Retiree Health Care SPD Effective January 1, 2012 Plan Administrator and Plan Sponsor....................................................................................................................133 Claims Administrator Information.........................................................................................................................134 Plan Year ...............................................................................................................................................................136 Questions About the Program................................................................................................................................136 VEBAs and Plan Trustee.......................................................................................................................................136 ERISA – Your Rights as a Member of the Program..............................................................................................136 HIPAA Privacy......................................................................................................................................................138 Glossary of Terms..................................................................................................143 Important Resources .............................................................................................152 Appendix.................................................................................................................154 Eligibility and Enrollment Rules Section A...........................................................................................................155 Eligibility and Enrollment Rules Section B...........................................................................................................161 Eligibility and Enrollment Rules Section C...........................................................................................................167 5
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The eligibility and enrollment rules for the U

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