Texas Mutual Insurance Company Texas Star Network SM Option © 2007 Texas Mutual Insurance Company “Making the Right Choice” Updated 1/29/2007
Today’s Focus Texas Star Network SM option Network benefits Network responsibilities Employer resources © 2007 Texas Mutual Insurance Company
Workers’ Comp Health Care Networks Carriers can create or contract with network Employers may elect network option Texas Star Network SM certified © 2007 Texas Mutual Insurance Company
Texas Star Network SM Availability 95% of policyholders Major metropolitan areas Austin Corpus Christi Dallas Houston Lubbock Midland/Odessa Rio Grande Valley San Antonio 12% annual network discount © 2007 Texas Mutual Insurance Company
Network Definitions Service Area Where network health care is available and accessible “Live” Principal residence Temporary residence for employment Temporary residence for receiving assistance “In network” vs. “out of network” © 2007 Texas Mutual Insurance Company
Accessibility Requirements Treating doctors Urban – 30 miles Rural – 60 miles Specialty care Urban – 75 miles Rural – 75 miles © 2007 Texas Mutual Insurance Company
Customized network includes Concentra clinics Other providers © 2007 Texas Mutual Insurance Company
Why Networks? Quality of care Employees select from list Network designates specialties Providers versed in occupational medicine Providers focused on return-to-work © 2007 Texas Mutual Insurance Company
Why Networks? Reducing time employees are off work should Improve productivity Lower “indirect costs” Improve loss history Lower experience modifiers © 2007 Texas Mutual Insurance Company
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 © 2007 Texas Mutual Insurance Company
Employer Responsibilities Provide network notice Obtain signed acknowledgment form Texas Mutual will provide employers network notice and acknowledgment form Facilitate claim investigation and return to work © 2007 Texas Mutual Insurance Company
Notice Requirements Employer must provide notice of network requirements to employee(s) at BOTH Time of acceptance AND Time of injury Notice must be posted at each location © 2007 Texas Mutual Insurance Company
Required Employer Recordkeeping Must have standard delivery process Delivery method Recipient Location Date(s) Retain copies of signed forms © 2007 Texas Mutual Insurance Company
Notice Distribution Options Staff or safety meetings Obtain electronic signature Mail © 2007 Texas Mutual Insurance Company
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 provider To minimize this exposure Texas Mutual claims reorganization Specialized claims teams to accelerate determination of compensability © 2007 Texas Mutual Insurance Company
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 © 2007 Texas Mutual Insurance Company
Employer Resources Policy Packet Employer Instructions Employee Form & Notice Texasmutual.com Your agent © 2007 Texas Mutual Insurance Company
Texasmutual.com Tools Notice of network requirements Acknowledgment form Notice and acknowledgment form log Helpful hints for employers © 2007 Texas Mutual Insurance Company
Texasmutual.com Tools Presentations for agents, employers and employees Provider search Service area map Provider nominations © 2007 Texas Mutual Insurance Company
“Making the Right Choice” Texas Star Network SM option Network benefits Network responsibilities Employer resources © 2007 Texas Mutual Insurance Company
Questions? © 2007 Texas Mutual Insurance Company