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Texas Star Network® offers a comprehensive option for employers to enhance Workers' Compensation health care. With a 99% availability rate across major metropolitan areas and a 12% annual discount, it prioritizes quality care and timely treatment. Employers can facilitate productivity by utilizing designated providers familiar with occupational medicine. Responsibilities include providing network notice, facilitating claim investigations, and maintaining proper record-keeping. Learn how to maximize the benefits while ensuring compliance with network requirements for both employers and employees.
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Texas Star Network® Option “Making the Right Choice”
Today’s Focus • Texas Star Network® • Network Benefits • Network Responsibilities • Employer Resources
Workers’ Comp Health Care Networks • Carriers chose whether to offer Network option • Employer election into Network • Texas Star Network® certified
Texas Star Network® Availability • 99% of policyholders • All major metropolitan areas • Up to 12% annual Network discount
Texas Star Network® Service Area As of 1/2010 – 231 Counties Certified
Accessibility Requirements • Treating doctors • Urban – 30 miles • Rural – 60 miles • Specialty care • Urban – 75 miles • Rural – 75 miles
Network Benefits • Quality of Care • Employees select from list • Network designates specialties • Providers versed in occupational medicine • Providers focused on return-to-work
Network Benefits Con’t. • Reducing time employees are off work should • Improve productivity • Lower “indirect costs” • Improve loss history • Lower experience modifiers
Network Endorsement • Eligibility requirements • Mid-term or at renewal • Discount prorated • Effective date request is received • 12% annual network discount Employer must comply with network requirements to receive benefits.
Texas Mutual Network Results • Final conclusions are premature, but early indications suggest: • Network claims have fewer days of lost time than non-network claims • Network claims have lower severities than non-network claims • Texas Mutual will continue to analyze network data as claims mature
Employer Responsibilities • Provide network notice • Obtain signed acknowledgment form • Facilitate claim investigation and return-to-work Texas Mutual will provide both the notice and acknowledgment form
Notice Distribution Options • Email • Staff or safety meetings • Obtain electronic signature • Mail
Notice Requirements • Employer must provide notice at • Time of acceptance AND • Time of injury • Notice must be posted at each location
Required Recordkeeping • Must have standard delivery process • Delivery method • Recipient • Location • Date(s) • Retain copies of signed forms
Importance of Claim Reporting • Non-compensable network claims • Carrier liable for payments up to $7,000 in medical care until dispute notice is given to the provider • To minimize this exposure • Texas Mutual claims reorganization • Specialized claims teams to accelerate determination of compensability
Employee Requirements • Select from network list • If not, employee may be required to pay • Exceptions • Emergencies • Employee lives out of service area • HMO doctor • Referral to specialist Employee must comply with the network requirements to receive benefits.
Employer Resources • Policy packet • Employer instructions • Employee form and notice • Texasmutual.com • Your Agent
Texasmutual.com Tools • Notice of Network requirements • Acknowledgment form • Notice and acknowledgment form log • Helpful hints for employers
Texasmutual.com Tools • Presentations for agents, employers and employees • Provider search • Service area map • Provider nominations
