Page 112 - 2021 Medical Plan SPD

Texas Mutual Insurance Company Medical Plan

The refund equals the amount the Plan paid in excess of the amount the Plan should have paid under the
Plan. If the refund is due from another person or organization, you agree to help the Plan get the refund
when requested.
If the refund is due from you and you do not promptly refund the full amount, the Plan may recover the
overpayment by reallocating the overpaid amount to pay, in whole or in part, your future Benefits that are
payable under the Plan. If the refund is due from a person or organization other than you, the Plan may
recover the overpayment by reallocating the overpaid amount to pay, in whole or in part; (i) future
Benefits that are payable in connection with services provided to other Covered Persons under the Plan;
or (ii) future Benefits that are payable in connection with services provided to persons under other plans
for which the Claims Administrator processes payments, pursuant to a transaction in which the Plan's
overpayment recovery rights are assigned to such other plans in exchange for such plans' remittance of
the amount of the reallocated payment.
The reductions will equal the amount of the required refund. The Plan may have other rights in addition to
the right to reduce future benefits.

Is There a Limitation of Action?

You cannot bring any legal action against the Plan or the Claims Administrator to recover reimbursement
until you have completed all the steps in the appeal process described in Section 6: Questions,
Complaints and Appeals. After completing that process, if you want to bring a legal action against the
Plan or the Claims Administrator you must do so within three years of the date the Plan notified you of its
final decision on your appeal or you lose any rights to bring such an action against the Plan or the Claims
Administrator.

What Is the Entire Plan?
The SPD, the Schedule of Benefits, and any SMMs and/or Amendments, make up the entire Plan.

109 Section 8: General Legal Provisions