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Texas Mutual Insurance Company Texas Star Network SM Option © 2007 Texas Mutual Insurance Compa “Making the Right Choice” Updated 1/29/2007
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Texas Mutual Insurance CompanyTexas Star NetworkSM Option
© 2007 Texas Mutual Insurance Company
“Making the Right Choice”
Updated 1/29/2007
Today’s Focus
Texas Star NetworkSM option
Network benefitsNetwork responsibilitiesEmployer 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 NetworkSM certified
© 2007 Texas Mutual Insurance Company
Texas Star NetworkSM 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
Email 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 NetworkSM option
Network benefits Network responsibilities Employer resources
© 2007 Texas Mutual Insurance Company
Questions?
© 2007 Texas Mutual Insurance Company
