Page 60 - 2021 Medical Plan SPD
P. 60
Texas Mutual Insurance Company Medical Plan
specialist, through use of live audio with video technology or audio only outside of a medical facility (for
example, from home or from work).
Network Benefits are available only when services are delivered through a Designated Virtual Network
Provider. You can find a Designated Virtual Network Provider by contacting the Claims Administrator at
www.myuhc.com or the telephone number on your ID card.
Please Note: Not all medical conditions can be treated through virtual visits. The Designated Virtual
Network Provider will identify any condition for which treatment by in-person Physician contact is needed.
Benefits do not include email, fax and standard telephone calls, or for telehealth/telemedicine visits that
occur within medical facilities (CMS defined originating facilities).
Wigs
Wigs and other scalp hair prosthesis regardless of the reason for hair loss, up to annual maximum of
$500.
57 Section 1: Covered Health Care Services
