1. Texas Health Care Network - Employer Presentation

2. What’s New Texas House Bill 7 (HB-7) Health Care Networks
Coventry Workers’ Comp Network
Out of Network Care
Employer and Employee Roles and Responsibilities
Claim Roles and Responsibilities
Case Management Roles and Responsibilities
Employee and Employer Tool Box

3. HB-7 Abolishes Texas Workers’ Compensation Commission (TWCC).
Creates the Division of Workers’ Compensation (DWC) administered as a division of the Texas Department of Insurance (TDI).
TDI approves and regulates the use of medical provider networks.
Requires networks to select medical treatment guidelines which network physicians must follow.

4. Health Care Networks
Allows insurance carriers to create or contract with a network.
Allows voluntary participation in a certified network at the employer level.
Limits choice of physician to doctors selected by the network.
Employees receive care for workplace injuries through the network IF they live in the network’s service area.

5. Why participate in a Health Care Network?
Employee selects treating doctor at time of injury.
Employer and carrier have more control over direction of care and medical treatment.
Referral to appropriate specialty care is channeled within network.
Network providers and emergency care must be available and accessible 24 hours a day, seven days a week.
Focus on treatment and return-to-work outcomes.
Improved quality of care.

6. Coventry Workers’ Comp Network
CNA has contracted with Coventry to utilize the Coventry Workers’ Comp Network.
The Coventry Workers' Comp Network meets all state access and availability requirements. Primary care will be available within 30 miles in non rural areas, and 60 miles in rural areas. Specialty and hospital care will be available within 75 miles.
The Coventry Workers’ Comp Network includes a continuous and comprehensive Quality Improvement program that is in accordance with state specific requirements.

7. Coventry Workers’ Comp Network – cont’d
The Coventry Workers’ Comp Network includes a complaint process accessible to all injured workers.
The Coventry Workers’ Comp Network provides a toll free 800 number to assist injured workers in finding a network physician.
Network service area is certified in all 254 counties.

8. Out of Network Care
Carriers are responsible for out of network care involving:
Emergency care.
Care outside the service area.
Care that has been referred and approved by the carrier.
Care where the employee has not received appropriate notice of network requirements.

9. Role and Responsibility of Employer
Prior to implementation, the employer must provide each employee with a letter and handbook entitled Employee Notification of Network Requirements.
Each employee must sign an acknowledgement form that states the information was received.
Employers should document to whom the notice was delivered, the method of delivery, the location of delivery and the date of delivery.
An employee who does not sign the acknowledgement form still must comply with the network requirements.
The employee handbook includes information about the employee’s right to receive care from their HMO primary care doctor if they receive group health benefits from an HMO. The HMO doctor must agree to abide by the network’s terms and conditions.

10. Role and Responsibility of Employer – cont’d:
Post notice of network requirements at each place of employment.
Provide the employee acknowledgement letter and handbook to new employees no later than the third day after the date of hire.
Provide the employee acknowledgement letter and handbook to an injured employee at the time the employer receives actual or constructive notice of an injury.
If the employee refuses to use the network, any out of network expenses may be the liability of the employee.

11. Role and Responsibility of the Employee
Read and acknowledge receipt of the Employee Notification of Network Requirements.
If employees would like to use their HMO primary treating physician as their network treating doctor, they must fill in that doctor’s name at the time of notification.
If they have an emergency, they should be instructed to get immediate medical care.
When an injury occurs, they should choose a treating doctor from the network list.
For existing claims, they should select a treating doctor from the network list within 14 days or a treating doctor will be selected for them.

12. Role and Responsibility of the Employee – cont’d
If they wish to change a treating doctor, they must choose a doctor from the network list. Change to a third doctor requires permission from CNA.
Employees may have to pay for medical expenses if they do not use a network doctor.

13. Role and Responsibility of Claim Adjuster
Direct care into the Coventry Workers’ Comp Network.
Coordinate return-to-work with employer.
Refer out of network referral request to Nurse Case Manager for review.
Document selection of alternate treating doctor.
Approve subsequent treating doctor requests.

14. Role and Responsibilities of Case Management
Direct care into the Coventry Workers’ Comp Network.
Coordinate return to work with employer.
Review out of network referral requests.
Provide in-network alternatives to requesting provider or injured worker.
Contact HMO providers, when applicable, to inform them of network requirements.

15. Role and Responsibilities of Case Management – cont’d.
Review continuity of care impact on existing claims in determining whether to transfer care into the HCN.
Facilitate selection of a network treating doctor on existing claims.
Document selection of alternate treating doctor.
Approve subsequent treating doctor requests.
Coordinate health care services and facilitate return to modified duty and full duty work.

16. Employer and Employee Tool Box
Visit CNA at - Report a Claim > Additional Claim Resources> 2. WORKERS COMPENSATION MEDICAL PROVIDERS NETWORKS to access:
Texas Healthcare Network (HCN)
Employee Communication Materials.
Frequently Asked Questions.
Agent and Employer Presentations.
The link to locating a Network Provider can also be found on this page. Look up is also at -
For Network questions the number is
Your CNA Client Service Director, Claim Consultant, or Case Manager is also a resource.

17. One or more of the CNA companies provide the products and/or services described. The information is intended to present a general overview for illustrative purposes only. It is not intended to constitute a binding contract. Please remember that only the relevant insurance policy can provide the actual terms, coverages, amounts, conditions and exclusions for an insured. Any references to non-CNA websites are provided solely for convenience and CNA disclaims any responsibility with respect thereto. CNA does not endorse, recommend, or make any representations or warranties as to the accuracy, completeness, effectiveness, suitability, or performance of any of the products, applications, software, or programs identified herein. All products and services may not be available in all states and may be subject to change without notice. “CNA" is a registered trademark of CNA Financial Corporation. Certain CNA Financial Corporation subsidiaries use the "CNA" service mark in connection with insurance underwriting and claims activities. Copyright © 2018 CNA. All rights reserved.