Page 77 - 2021 Medical Plan SPD

Texas Mutual Insurance Company Medical Plan

Section 4: When Coverage Ends

General Information about When Coverage Ends

As permitted by law, the Plan Sponsor may end the Plan and/or all similar benefit plans at any time for
the reasons explained in the Plan.
Your right to Benefits automatically ends on the date that coverage ends, even if you are hospitalized or
are otherwise receiving medical treatment on that date.
When your coverage ends, the Claims Administrator will still process Plan payments on claims for
Covered Health Care Services that you received before the date your coverage ended. However, once
your coverage ends, the Claims Administrator will not process Plan payments on claims for any health
care services received after that date (even if the medical condition that is being treated occurred before
the date your coverage ended).
Unless otherwise stated, an Enrolled Dependent's coverage ends on the date the Participant's coverage
ends.

What Events End Your Coverage?

Coverage ends on the earliest of the dates specified below:

• The Entire Plan Ends
Your coverage ends on the date the Plan ends. In this event, the Plan Sponsor is responsible for
notifying you that your coverage has ended.
• You Are No Longer Eligible
Your coverage ends on the last day of the calendar month in which you are no longer eligible to be
a Participant or Enrolled Dependent. Please refer to Section 9: Defined Terms for definitions of the
terms "Eligible Person," "Participant," "Dependent" and "Enrolled Dependent."

• The Claims Administrator Receives Notice to End Coverage
The Plan Sponsor is responsible for providing the required notice to the Claims Administrator to
end your coverage. Your coverage ends on the last day of the calendar month in which the Claims
Administrator receives the required notice from the Plan Sponsor to end your coverage, or on the
date requested in the notice, if later.
• Participants Retires

The Plan Sponsor is responsible for providing the required notice to the Claims Administrator to
end your coverage. Your coverage ends the last day of the calendar month in which the Participant
retires.

Fraud or Intentional Misrepresentation of a Material Fact

The Plan will provide at least 30 days advance required notice to the Participant that coverage will end on
the date identified in the notice because you committed an act, practice, or omission that constituted
fraud, or an intentional misrepresentation of a material fact. Examples include knowingly providing
incorrect information relating to another person's eligibility or status as a Dependent. You may appeal this
decision during the notice period. The notice will contain information on how to appeal the decision.

74 Section 4: When Coverage Ends