Page 7 - Dental Benefit Plan Summary
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TEXAS MUTUAL INSURANCE COMPANY DENTAL PPO PLAN
Network and Non-Network Benefits
This SPD describes both Network and Non-Network benefit levels available under the Plan.
Network Benefits - These benefits apply when you choose to obtain Dental Services from
a Network Dentist. Section 3, How the Plan Works describes the procedures for obtaining
Covered Dental Services as Network Benefits. Unless otherwise noted in Section 4, Plan
Highlights, Network Benefits generally provide Coverage at a higher level than Non-Network
Benefits.
Non-Network Benefits - These benefits apply when you decide to obtain Dental Services
from Non-Network Dentists. Section 3, How the Plan Works describes the procedures for
obtaining Coverage of Dental Services as Non-Network Benefits. Unless otherwise noted in
Section 4, Plan Highlights, Non-Network Benefits are subject to an Annual Deductible and
are generally Covered at a lower level than Network Benefits. In addition, when you obtain
Dental Services from Non-Network Dentists, you must file a claim to be reimbursed for
Eligible Expenses. For information on the Plan's reimbursement policy guidelines used to
determine Eligible Expenses, you should contact UnitedHealthcare Dental at the telephone
number on your ID card.
Dental Services Covered Under the Plan
In order for Dental Services to be Covered as Network Benefits, you must obtain all Dental
Services directly from or through a Network Dentist.
You should always verify the participation status of a Dentist prior to seeking services. From
time to time, the participation status of a Dentist may change. You can verify the
participation status by calling UnitedHealthcare Dental. If necessary, UnitedHealthcare
Dental can provide assistance in referring you to Network Dentists. If you use a Dentist that
is not a participating Dentist, you will be required to pay the amount of the Dentist's fee, if
any, which is greater than the Eligible Expense.
Only Necessary Dental Services are Covered under the Plan. The fact that a Dentist has
performed or prescribed a procedure or treatment, or the fact that it may be the only
available treatment for a dental disease does not mean that the procedure or treatment is
Covered under the Plan.
Important Information Regarding Medicare
Coverage under the Plan is not intended to supplement any coverage provided by Medicare,
but in some circumstances Covered Persons who are eligible for or enrolled in Medicare may
also be enrolled for Coverage under the Plan. If you are eligible for or enrolled in Medicare,
please read the following information carefully.
If you are eligible for Medicare and do not enroll for and maintain coverage under both
Medicare Part A and Part B and if the Plan Sponsor is the secondary payer as described in
the Section 9, Coordination of Benefits, the Plan Sponsor will pay benefits under the Plan as if
you were covered under both Medicare Part A and Part B and you will incur a larger out of
pocket cost for Dental Services.
2 SECTION 1 - WELCOME