texas mutual insurance company texas star network sm option © 2007 texas mutual insurance company...
TRANSCRIPT
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Texas Mutual Insurance CompanyTexas Star NetworkSM Option
© 2007 Texas Mutual Insurance Company
“Making the Right Choice”
Updated 1/29/2007
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Today’s Focus
Texas Star NetworkSM option
Network benefitsNetwork responsibilitiesEmployer resources
© 2007 Texas Mutual Insurance Company
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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
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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
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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
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Accessibility Requirements
Treating doctors Urban – 30 miles Rural – 60 miles
Specialty care Urban – 75 miles Rural – 75 miles
© 2007 Texas Mutual Insurance Company
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Customized network includes Concentra clinics Other providers
© 2007 Texas Mutual Insurance Company
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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
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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
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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
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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
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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
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Required Employer Recordkeeping
Must have standard delivery process Delivery method Recipient Location Date(s)
Retain copies of signed forms
© 2007 Texas Mutual Insurance Company
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Notice Distribution Options
Email Staff or safety meetings Obtain electronic signature Mail
© 2007 Texas Mutual Insurance Company
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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
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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
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Employer Resources
Policy Packet Employer Instructions Employee Form & Notice
Texasmutual.com
Your agent
© 2007 Texas Mutual Insurance Company
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Texasmutual.com Tools
Notice of network requirements
Acknowledgment form
Notice and acknowledgment form log
Helpful hints for employers
© 2007 Texas Mutual Insurance Company
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Texasmutual.com Tools
Presentations for agents, employers and employees
Provider search
Service area map
Provider nominations
© 2007 Texas Mutual Insurance Company
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“Making the Right Choice”
Texas Star NetworkSM option
Network benefits Network responsibilities Employer resources
© 2007 Texas Mutual Insurance Company
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Questions?
© 2007 Texas Mutual Insurance Company