Page 127 - 2021 Medical Plan SPD

Texas Mutual Insurance Company Medical Plan

If you do not receive a call from a Personal Health Support Nurse but feel you could benefit from any of
these programs, please call the number on your ID card.

Complex Medical Conditions, Programs and Services

Bariatric Resource Services (BRS)
Your Plan offers Bariatric Resource Services (BRS) program. The BRS program provides you with:

• Specialized clinical consulting services to Participants and Enrolled Dependents to educate on
obesity treatment options.

• Access to specialized Network facilities and Physicians for obesity surgery services.
Your Plan Sponsor is providing you with Travel and Lodging assistance. Refer to the Travel and Lodging
Assistance Program.

Cancer Resource Services (CRS) Program

Your Plan offers Cancer Resource Services (CRS) program to provide you with access to information and
member assistance through a team of specialized cancer nurse consultants and access to one of the
nation's leading cancer programs.
To learn more about CRS, visit www.myoptumhealthcomplexmedical.com or call the number on your ID
card or call the program directly at 1-866-936-6002.

Coverage for oncology services and oncology-related services are based on your health plan's terms,
exclusions, limitations and conditions, including the plan's eligibility requirements and coverage
guidelines. Participation in this program is voluntary.
Your Plan Sponsor is providing you with Travel and Lodging assistance. Refer to the Travel and Lodging
Assistance Program.

Congenital Heart Disease (CHD) Resource Services

The Claims Administrator provides a program that identifies and supports a Covered Person who has
Congenital Heart Disease (CHD) through all stages of treatment and recovery. This program will work
with you and your Physicians, as appropriate, to offer support and education on CHD. Program features
include clinical management by specialized CHD Nurses, support from specialized Social Workers,
assistance with choosing Physicians and Facilities, and access to Designated Providers.

To learn more about CHD Resource Services program, visit www.myoptumhealthcomplexmedical.com or
call the Claims Administrator at the number on your ID card.

Coverage for CHD surgeries and related services are based on your health plan's terms, exclusions,
limitations and conditions, including the plan's eligibility requirements and coverage guidelines.
Participation in this program is voluntary. If you are considering any CHD surgeries you must contact
CHD Resource Services prior to surgery to enroll in the program in order for the surgery to be a
considered a Covered Health Care Service under the Plan.

Your Plan Sponsor is providing you with Travel and Lodging assistance. Refer to the Travel and Lodging
Assistance Program.

124 Clinical Programs and Resources