Page 105 - 2021 Medical Plan SPD

Texas Mutual Insurance Company Medical Plan

• No agent has the authority to change the Plan or to waive any of its provisions.

• No one has authority to make any oral changes or amendments to the Plan.

How Does the Claims Administrator Use Information and Records?

The Claims Administrator may use your individually identifiable health information as follows:
• To administer the Plan and pay claims.

• To identify procedures, products, or services that you may find valuable.
• As otherwise permitted or required by law.

The Claims Administrator may request additional information from you to decide your claim for Benefits.
The Claims Administrator will keep this information confidential. The Claims Administrator may also use
de-identified data for commercial purposes, including research, as permitted by law. More detail about
how the Claims Administrator may use or disclose your information is found in the Claims Administrator
Notice of Privacy Practices.
By accepting Benefits under the Plan, you authorize and direct any person or institution that has provided
services to you to furnish the Claims Administrator with all information or copies of records relating to the
services provided to you. The Claims Administrator has the right to request this information at any
reasonable time. This applies to all Covered Persons, including Enrolled Dependents whether or not they
have signed the Participant's enrollment form. UnitedHealthcare agrees that such information and records
will be considered confidential.

The Claims Administrator has the right to release records concerning health care services when any of
the following apply:

• Needed to put in place and administer the terms of the Plan.
• Needed for medical review or quality assessment.

• Required by law or regulation.
During and after the term of the Plan, the Claims Administrator and the Claims Administrator's related
entities may use and transfer the information gathered under the Plan in a de-identified format for
commercial purposes, including research and analytic purposes. Please refer to the Claims Administrator
Notice of Privacy Practices.

For complete listings of your medical records or billing statements you may contact your health care
provider. Providers may charge you reasonable fees to cover their costs for providing records or
completing requested forms.
If you request medical forms or records from the Claims Administrator, the Claims Administrator also may
charge you reasonable fees to cover costs for completing the forms or providing the records.
In some cases, as permitted by law, the Claims Administrator will designate other persons or entities to
request records or information from or related to you, and to release those records as needed. The
Claims Administrator's designees have the same rights to this information as the Claims Administrator
has.

The Use and Disclosure of Protected Health Information

Under the federal privacy regulations enacted pursuant to the Health Insurance Portability and
Accountability Act of 1996 (HIPAA), your health plans are required to protect the confidentiality of your
Protected Health Information. Protected Health Information (PHI) is individually identifiable health
information related to your condition, services provided to you, or payments made for your care, which is

102 Section 8: General Legal Provisions