Page 8 - 2021 Medical Plan SPD

Texas Mutual Insurance Company Medical Plan

Pay the Cost of Excluded Services

You must pay the cost of all excluded services and items. Review Section 2: Exclusions and Limitations
to become familiar with the Plan's exclusions.

Show Your ID Card

You should show your ID card every time you request health care services. If you do not show your ID
card, the provider may fail to bill the correct entity for the services delivered.

File Claims with Complete and Accurate Information

When you receive Covered Health Care Services from an out-of-Network provider, you are responsible
for requesting payment from the Plan. You must file the claim in a format that contains all of the
information the Claims Administrator requires to process the claim, as described in Section 5: How to File
a Claim.

Use Your Prior Health Care Coverage

If you have prior coverage that, as required by state law, extends benefits for a particular condition or a
disability, the Plan will not pay Benefits for health care services for that condition or disability until the
prior coverage ends. The Plan will pay Benefits as of the day your coverage begins under the Plan for all
other Covered Health Care Services that are not related to the condition or disability for which you have
other coverage.

5 Your Responsibilities