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It sets expectations for covered health services by requiring completion of enrollment, payment of applicable premiums, and acceptance of the contract terms. The notice highlights premium change possibilities at renewal and clarifies exclusions such as workers' compensation and Medicare supplement coverage. 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THIS DOCUMENT DESCRIBES YOUR RIGHTS AND RESPONSIBILITIES IN RELATION TO YOUR COVERED HEALTH SERVICES AND BENEFITS.  \nCeltic Insurance Company  \n200 East Randolph Street  \nSuite 3600  \nChicago, IL 60601  \n1-877-687-1196  \nInsert Total Premium Payable. Please note that premiums are subject to change.  \nIMPORTANT NOTICES:  \nTHIS IS NOT A POLICY OF WORKERS' COMPENSATION INSURANCE. THE EMPLOYER DOES NOT BECOME A SUBSCRIBER TO THE WORKERS' COMPENSATION SYSTEM BY PURCHASING THIS POLICY , AND IF THE EMPLOYER IS A NON-SUBSCRIBER, THE EMPLOYER LOSES THOSE BENEFITS WHICH WOULD OTHERWISE ACCRUE UNDER THE WORKERS' COMPENSATION LAWS. THE EMPLOYER MUST COMPLY WITH THE WORKERS' COMPENSATION LAW AS IT PERTAINS TO NON-SUBSCRIBERS AND THE REQUIRED NOTIFICATIONS THAT MUST BE FILED AND POSTED.  \nTHIS POLICY IS NOT A MEDICARE SUPPLEMENT POLICY OR CERTIFICATE. If you are eligible for Medicare, review the Guide to Health Insurance for People with Medicare available from the company.  \nHave a complaint or need help?  \nIf you have a problem with a claim or your premium, call your insurance company or HMO first. If you can't work out the issue, the Texas Department of Insurance may be able to help.  \nEven if you file a complaint with the Texas Department of Insurance, you should also file a complaint or appeal through your insurance company or HMO. If you don't, you may lose your right to appeal.  \nAmbetter from Superior HealthPlan  \nTo get information or file a complaint with your insurance company or HMO:  \nCall: Member Services at 1-877-687-1196 Toll-free: 1-877-687-1196  \n[Online:](Online: Ambetterhealth.com/en/tx)[ ](Online: Ambetterhealth.com/en/tx)[Ambetterhealth.com/en/tx](Online: Ambetterhealth.com/en/tx)  \n[Mail: 5900 E. Ben White Blvd.](Mail: 5900 E. Ben White Blvd.)  \nAustin, Texas 78741  \nFor general inquiries you may also contact Ambetter via the email and mailing addresses below.  \nEmail: HPMSCONTACTUS@CENTENE.COM  \nMail: Attn: Ambetter  \n5900 E. Ben White Blvd.  \nAustin, Texas 78741  \nTo file a complaint in writing you can send your complaint to the address below or by using the online complaint form located on the Ambetter website.  \nAttn: Complaints  \n5900 E. Ben White Blvd.  \nAustin, Texas 78741  \n[Online:](Online: Ambetterhealth.com/en/tx)[ ](Online: Ambetterhealth.com/en/tx)[Ambetterhealth.com/en/tx](Online: Ambetterhealth.com/en/tx)  \nThe Texas Department of Insurance  \nTo get help with an insurance question or file a complaint with the state:  \nCall with a question: 1-800-252-3439  \n[File a](File a complaint: www.tdi.texas.gov)[ complaint](File a complaint: www.tdi.texas.gov)[:](File a complaint: www.tdi.texas.gov)[ ](File a complaint: www.tdi.texas.gov)[www.tdi.texas.gov](File a complaint: www.tdi.texas.gov)  \n[Email: ConsumerProtection@tdi.texas.gov](Email: ConsumerProtection@tdi.texas.gov)  \nMail: MC CO-CP, P.O. Box 12030, Austin, TX 78711-2030  \n¿Tiene una queja o necesita ayuda?  \nSi tiene un problema con una reclamación o con su prima de seguro, llame primero a su compañía de seguros o HMO. Si no puede resolver el problema, es posible que el Departamento de Seguros de Texas (Texas Department of Insurance, por su nombre en inglés) pueda ayudar.  \nAun si usted presenta una queja ante el Departamento de Seguros de Texas, también debe presentar una queja a través del proceso de quejas o de apelaciones de su compañía de seguros o HMO. Si no lo hace, podría perder su derecho para apelar.  \nA","cbCaimeFZmMzrgiy","https://ap.wps.com/l/cbCaimeFZmMzrgiy","pdf",1538842,137,"English","# IMPORTANT NOTICES\n## Workers' compensation and Medicare clarifications\n# COMPLAINTS AND HELP\n## Member services contacts and claim issues\n## Texas Department of Insurance assistance","[{\"question\":\"What does the Major Medical Expense Policy contract require from enrollees?\",\"answer\":\"Enrollees agree to adhere to provisions for covered health services by completing the enrollment form, paying the applicable premium, and accepting the contract terms.\"},{\"question\":\"Can premiums increase at renewal?\",\"answer\":\"Yes. The notice states premiums may be increased upon the renewal date and are subject to change.\"},{\"question\":\"What is clarified in the policy about workers' compensation and Medicare?\",\"answer\":\"The document states it is not workers' compensation insurance and does not make the employer part of the workers' compensation system. It also states it is not a Medicare supplement policy or certificate.\"}]","2026 Evidence of Coverage - Major Medical Expense Policy | PDF",48]