The eligibility and enrollment rules for the U

Retiree Health Care SPD Effective January 1, 2012
HOW COVERAGE WORKS IF YOU ARE AGE 65
OR OLDER OR PRE-65 AND MEDICARE
ELIGIBLE
Note: If you are enrolled in Kaiser Colorado, this information does not apply to you. Please see
the separate Kaiser materials.
Your Benefit Option If You are Medicare Eligible
If you are age 65 and older or pre-65 and Medicare eligible. You can enroll in the insured
UnitedHealthcare or Medica Plan option available in your area up to 90 days prior to your
termination date. You can initiate the enrollment process online at
www.yourbenefitsresources.com/usbank or by calling the U.S. Bank Employee Service Center.
Once you initiate your enrollment, you will be sent an enrollment kit, which will include an
enrollment form. You must be enrolled in Medicare Parts A and B in order to enroll in the
Program. If you are not enrolled in Medicare Parts A and B, your application for enrollment will
not be accepted. Once the U.S. Bank Employee Service Center receives your completed and
signed enrollment application, this information is submitted to CMS (Medicare) for verification
of eligibility. If CMS rejects your enrollment application, the U.S. Bank Employee Service
Center will contact you for additional information in order to resubmit your application. The
effective date of coverage will be the first of the month following the date when your application
is received and processed or the date you are first eligible to enroll in the Program, whichever is
later. You should refer to the UnitedHealthcare or Medica Plan option materials.
If you and your eligible dependents are age 65 and older or pre-65 and Medicare eligible.
You and your dependent(s) can enroll in the insured UnitedHealthcare or Medica plan option
available in your area up to 90 days prior to your termination date. You can initiate the
enrollment process online at www.yourbenefitsresources.com/usbank or by calling the U.S. Bank
Employee Service Center. Once you initiate your enrollment, you will be sent an enrollment kit,
which will include enrollment forms. You and your dependent(s) must be enrolled in Medicare
Parts A and B in order to enroll in the Program. If you and your dependent(s) are not enrolled in
Medicare Parts A and B, your application for enrollment will not be accepted. Once the U.S.
Bank Employee Service Center receives your completed and signed enrollment applications (a
separate application needs to be completed by you and each of your Medicare eligible
dependents), this information is submitted to CMS for verification of eligibility. If CMS rejects
your enrollment application(s), the U.S. Bank Employee Service Center will contact you for
additional information in order to resubmit your application. The effective date of coverage will
be the first of the month following the date when your application(s) is received and processed or
the date you are first eligible to enroll in the Program, whichever is later. You should refer to the
UnitedHealthcare or Medica Plan option materials.
If you are age 65 and older or pre-65 and Medicare eligible and have dependents that are
pre-65 and not Medicare eligible. You can enroll in the insured UnitedHealthcare or Medica
Plan option available in your area and your dependent can enroll in the pre-65 option available in
your area, until they turn age 65 or become Medicare eligible prior to age 65 (see the “How
Coverage Works if You are Under Age 65 And Not Medicare Eligible” section in this SPD).
You can enroll yourself and your dependent(s) in the Program up to 90 days prior to your
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