Page 4 - Dental Benefit Plan Summary

TEXAS MUTUAL INSURANCE COMPANY DENTAL PPO PLAN

Right of Recovery ...................................................................................................................... 33
Right to Subrogation ................................................................................................................. 33

Right to Reimbursement ........................................................................................................... 34
Third Parties ............................................................................................................................... 34

Subrogation and Reimbursement Provisions ........................................................................ 34

SECTION 8 - WHEN COVERAGE ENDS ....................................................................................... 37

Extended Coverage .................................................................................................................... 38
Coverage for a Disabled Child ................................................................................................. 38

Continuing Coverage Through COBRA ................................................................................ 39
When COBRA Ends ................................................................................................................. 43
Uniformed Services Employment and Reemployment Rights Act .................................... 43

SECTION 9 - COORDINATION OF BENEFITS ............................................................................. 45
Coordination of Benefits Applicability ................................................................................... 45

Definitions .................................................................................................................................. 45
Order of Benefit Determination Rules ................................................................................... 46

Effect on the Benefits of This Coverage Plan ....................................................................... 48
Right to Receive and Release Needed Information .............................................................. 49
Payments Made .......................................................................................................................... 49

Right of Recovery ...................................................................................................................... 49

SECTION 10 - OTHER IMPORTANT INFORMATION ................................................................... 50

Qualified Medical Child Support Orders (QMCSOs) .......................................................... 50
Your Relationship with UnitedHealthcare Dental and Texas Mutual Insurance
Company ..................................................................................................................................... 50
Relationship with Dentists ........................................................................................................ 51

Your Relationship with Dentists ............................................................................................. 52
Interpretation of Benefits ......................................................................................................... 52

Information and Records .......................................................................................................... 52
Incentives to Dentists................................................................................................................ 53

Incentives to You ....................................................................................................................... 54
Workers' Compensation Not Affected ................................................................................... 54
Future of the Plan ...................................................................................................................... 54

Plan Document .......................................................................................................................... 54

II TABLE OF CONTENTS