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 ► ► 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

Questions