Page 23 - Vision Benefits Plan Document

TEXAS MUTUAL INSURANCE COMPANY VISION PLAN

Other Events Ending Your Coverage
The Plan will provide prior written notice to you that your coverage will end on the date
identified in the notice if:

■ you commit an act, practice, or omission that constituted fraud, or an intentional
misrepresentation of a material fact including, but not limited to, false information
relating to another person's eligibility or status as a Dependent; or
■ you commit an act of physical or verbal abuse that imposes a threat to Texas Mutual
Insurance Company's staff, UnitedHealthcare Vision's staff, a provider or another
Covered Person.

If covered Services are in progress on the date which coverage terminates, such Services will
be completed, except where termination is due to fraud, misrepresentation, material violation
of the terms of the Plan, failure to pay required premiums, or acts of physical or verbal
abuse.

Reimbursement for Services
The Covered Person will be responsible for any claims paid by UnitedHealthcare Vision
when coverage was provided in error, except where that error was made by
UnitedHealthcare Vision.

Coverage for a Disabled Child
If an unmarried enrolled Dependent child with a mental or physical disability reaches an age
when coverage would otherwise end, the Plan will continue to cover the child, as long as:

■ the child is unable to be self-supporting due to a mental or physical handicap or
disability;
■ the child depends mainly on you for support;

■ you provide to Texas Mutual Insurance Company proof of the child's incapacity and
dependency within 31 days of the date coverage would have otherwise ended because
the child reached a certain age; and

■ you provide proof, upon Texas Mutual Insurance Company's request, that the child
continues to meet these conditions.

The proof might include medical examinations at Texas Mutual Insurance Company's
expense. However, you will not be asked for this information more than once a year. If you
do not supply such proof within 31 days, the Plan will no longer pay Benefits for that child.

Coverage will continue, as long as the enrolled Dependent is incapacitated and dependent
upon you, unless coverage is otherwise terminated in accordance with the terms of the Plan.

Continuing Coverage Through COBRA

If you lose your Plan coverage, you may have the right to extend it under the Consolidated
Budget Reconciliation Act of 1985 (COBRA), as defined in Section 10, Glossary.

19 SECTION 8 - WHEN COVERAGE ENDS