Page 11 - Vision Benefits Plan Document

TEXAS MUTUAL INSURANCE COMPANY VISION PLAN

Foreign Services
Foreign Services will be treated as Non-Network Benefits under this Plan. Payments will be
made in U.S. currency and dispersed to the U.S. address of the Participant. The Company
makes no guarantee on value of payment and will not protect against currency risk.

Eligible Expenses

Eligible Expenses are charges for Covered Vision Services that are provided while the Plan is
in effect, determined according to the definition in Section 10, Glossary. Texas Mutual
Insurance Company has delegated to UnitedHealthcare Vision the initial discretion and
authority to decide whether a treatment or supply is a Covered Vision Service and how the
Eligible Expenses will be determined and otherwise covered under the Plan.

Maximum Non-Network Benefit

The Maximum Non-Network Benefit is the maximum amount the Plan will pay for a
particular service.

Copayment

A Copayment (Copay) is the amount you pay each time you receive certain Covered Vision
Services. The Copay is a flat dollar amount and is paid at the time of service or when billed
by the Provider.

7 SECTION 3 - HOW THE PLAN WORKS