Page 130 - 2021 Medical Plan SPD

Texas Mutual Insurance Company Medical Plan

The Claims Administrator must receive valid receipts for such charges before you will be reimbursed.
Reimbursement is as follows:

Lodging
• A per diem rate, up to $50.00 per day, for the patient or the caregiver if the patient is in the
Hospital.
• A per diem rate, up to $100.00 per day, for the patient and one caregiver. When a child is the
patient, two persons may accompany the child.
Examples of items that are not covered:

• Groceries.
• Alcoholic beverages.

• Personal or cleaning supplies.
• Meals.

• Over-the-counter dressings or medical supplies.
• Deposits.

• Utilities and furniture rental, when billed separate from the rent payment.
• Phone calls, newspapers, movie rentals.

Transportation
• Automobile mileage (reimbursed at the IRS medical rate) for the most direct route between the
patient's home and the Designated Facility.
• Taxi fares (not including limos or car services).

• Economy or coach airfare.
• Parking.

• Trains.
• Boat.

• Bus.
• Tolls.

Decision Support

Decision Support
In order to help you make informed decisions about your health care, the Claims Administrator has a
program called Decision Support. This program targets specific conditions as well as the treatments and
procedures for those conditions.

This program offers:
• Access to health care information.

• Support by a nurse to help you make more informed decisions in your treatment and care.

127 Clinical Programs and Resources