Page 132 - 2021 Medical Plan SPD

Texas Mutual Insurance Company Medical Plan

• Use of mail-order pharmacy and Network providers.
Participation is completely voluntary and without extra charge. If you think you may be eligible to
participate or would like additional information regarding the program, please contact the number on your
ID card.

Wellness Management/Preventive Care

HealtheNotes
SM
SM
SM
The Claims Administrator provides a service called HealtheNotes . HealtheNotes provides you and
your Physician with information regarding preventive care, testing or medications, potential interactions
SM
with medications you have been prescribed, and certain treatments. In addition, your HealtheNotes
report may include health tips and other wellness information.
The Claims Administrator provides this information through a software program that provides
retrospective, claims-based identification of medical care. Through this process patients are identified
who may benefit from this information using the established standards of evidence based medicine as
described in Section 9: Defined Terms under the definition of Covered Health Care Services.

If your Physician identifies any concerns after reviewing his or her HealtheNotes SM report, he or she may
contact you if he or she believes it to be appropriate. In addition, you may use the information in your
report to engage your Physician in discussions regarding your health and the information the Claims
Administrator provides. Any decisions regarding your care, though, are always between you and your
Physician.
If you have questions or would like additional information about this service, please call the number on
your ID card.

Women's Health/Reproductive

Maternity Support Program
If you are pregnant or thinking about becoming pregnant, and you are enrolled in the medical Plan, you
can get educational information and comprehensive case management by calling the number on your ID
card. Your enrollment in the program will be handled by an OB nurse who is assigned to you.
This program offers:

• Enrollment by an OB nurse.

• Pre-conception health coaching.
• Written and online educational resources covering a wide range of topics.

• First and second trimester risk screenings.
• Identification and management of at- or high-risk conditions that may impact pregnancy.

• Pre-delivery consultation.
• Coordination with and referrals to other benefits and programs available under the medical plan.

• A phone call from a nurse approximately two weeks postpartum to provide information on
postpartum and newborn care, feeding, nutrition, immunizations and more.

• Post-partum depression screening.

129 Clinical Programs and Resources