Page 5 - Vision Benefits Plan Document

TEXAS MUTUAL INSURANCE COMPANY VISION PLAN

SECTION 1 - WELCOME

Quick Reference Box
■ Claims submittal address for Non-Network services: UnitedHealthcare Vision Claims
Department, P.O. Box 30978, Salt Lake City, Utah 84130, Fax (248) 733-6060; and

■ Online assistance for UnitedHealthcare Vision participating Provider list at
www.myuhcvision.com or call (800) 839-3242 for the provider locator.

Texas Mutual Insurance Company is pleased to provide you with this Summary Plan
Description (SPD), which describes the vision Benefits available to you and your covered
family members under the Texas Mutual Insurance Company Welfare Benefit Plan. It
includes summaries of:

■ who is eligible;

■ services that are covered, called Covered Vision Services;
■ services that are not covered, called Exclusions;

■ how Benefits are paid; and
■ your rights and responsibilities under the Plan.

This SPD is designed to meet your information needs and the disclosure requirements of the
Employee Retirement Income Security Act of 1974 (ERISA). It supersedes any previous
printed or electronic SPD for this Plan.

Texas Mutual Insurance Company intends to continue this Plan, but reserves the right, in
its sole discretion, to modify, change, revise, amend or terminate the Plan at any time, for
any reason, and without prior notice subject to any collective bargaining agreements
between the Employer and various unions, if applicable. This SPD is not to be construed
as a contract of or for employment. If there should be an inconsistency between the
contents of this summary and the contents of the Plan, your rights shall be determined
under the Plan and not under this summary.

UnitedHealthcare Vision is a private healthcare claims administrator. UnitedHealthcare
Vision's goal is to give you the tools you need to make wise healthcare decisions.
UnitedHealthcare Vision also helps your employer to administer claims. Although
UnitedHealthcare Vision will assist you in many ways, it does not guarantee any Benefits.
Texas Mutual Insurance Company is solely responsible for paying Benefits described in this
SPD.

Please read this SPD thoroughly to learn how the Texas Mutual Insurance Company Welfare
Benefit Plan works. If you have questions contact Human Resources.

1 SECTION 1 - WELCOME