Page 131 - 2021 Medical Plan SPD

Texas Mutual Insurance Company Medical Plan

• Expectations of treatment.

• Information on providers and programs.
Conditions for which this program is available include:
• Back pain.

• Knee & hip replacement.

• Prostate disease.
• Prostate cancer.
• Benign uterine conditions.

• Breast cancer.

• Coronary disease.
• Bariatric surgery.
Participation is completely voluntary and without extra charge. If you think you may be eligible to
participate or would like additional information regarding the program, please contact the number on your
ID card.

Disease Management
If you have been diagnosed with certain chronic medical conditions you may be eligible to participate in a
disease management program at no additional cost to you. The heart failure, coronary artery disease,
diabetes, asthma and Chronic Obstructive Pulmonary Disease (COPD) programs are designed to support
you. This means that you will receive free educational information, and may even be called by a
registered nurse who is a specialist in your specific medical condition. This nurse will be a resource to
advise and help you manage your condition.
These programs offer:

• Educational materials that provide guidance on managing your specific chronic medical condition.
This may include information on symptoms, warning signs, self-management techniques,
recommended exams and medications.

• Access to educational and self-management resources on a consumer website.

• An opportunity for the disease management nurse to work with your Physician to ensure that you are
receiving the appropriate care.

• Access to and one-on-one support from a registered nurse who specializes in your condition.
Examples of support topics include:
• Education about the specific disease and condition.

• Medication management and compliance.

• Reinforcement of on-line behavior modification program goals.
• Preparation and support for upcoming Physician visits.
• Review of psychosocial services and community resources.

• Caregiver status and in-home safety.

128 Clinical Programs and Resources