1. Our company has purchased a workers’ comp policy from Texas Mutual Insurance Company. We have elected to purchase a policy that includes access to the Texas Star Network for our injured workers. This is a health care network for on-the-job injuries. I wanted to bring you here today to cover a few of the major components of the Texas Star Network program.
© 2006 Texas Mutual Insurance Company

2. Employee Benefits Timely access to:
Treating doctors
Specialty care
Quality doctors who will get you well and back to work
You have a choice of treating doctors in the network
If you are hurt on the job, you will go to a Network doctor for your workers’ comp medical care. The doctors that have signed up with Texas Star Network have agreed to provide timely and appropriate treatment to injured workers that are participating in the network.
The network is required to meet certain standards for timely access to both treating (or primary care) doctors and specialists, such as surgeons. The Texas Star Network is made up of a group of health care providers that are committed to getting injured workers well and back to work. These providers have experience treating workplace injuries. You will be able to choose your treating doctor from among the network’s list of treating providers.

3. Changing Doctors
You may change your treating doctor once without approval
You will need to get approval if you change doctors a second time
Your primary care doctor will be a network doctor. This doctor will be responsible for managing your non emergency medical care. You may change treating doctors once within the network without approval being required. If you want to change treating doctors again, you’ll have to contact the Network to get approval for the change. If you change doctors a second time and do not receive approval from the network you might be liable for payment of services to that doctor.

4. Employee Requirements
If you’re hurt on the job:
Follow company procedures
If emergency care is needed, get it!
Report your injury as soon as possible
Select your treating doctor from the network list
(800)
If you go to a non-network doctor, you may be responsible for payments to the doctor
You also have some responsibilities related to health care for your on-the-job injury. If you’re hurt, report your injury to your supervisor as soon as possible. Then, select your treating doctor from the network’s list. Once emergency treatment is addressed this treating doctor will take charge of needed follow up care. You can search for the provider nearest to you at Texas Mutual’s website, or you can call the number listed here and they’ll give you a list of names of treating doctors in our area.
The next point is very important. If you go to a non-network treating doctor, for non-emergency care you’re probably going to be responsible for paying for your health care. As always, there are some exceptions to this requirement.
© 2006 Texas Mutual Insurance Company

5. Exceptions You do not have to go to a network treating doctor if:
it is an emergency
you use your HMO primary care doctor*
you are referred to a specialist by your
treating doctor
you live outside the “service area”
* - applies only if employer offers HMO coverage
You do not have to go to a network treating doctor if it is an emergency. The most important thing in an emergency situation is to get you the health care you need.
<IF APPLICABLE – NOTE TO EMPLOYER – DO NOT DISCUSS IF YOU DO NOT OFFER A HMO> If you already have an HMO doctor, you can use that doctor to also treat your workplace injury. The doctor must agree to the terms of the network in order for you to use them as your workers’ comp doctor.
If it’s needed, your network treating doctor may refer you to a specialist who is not part of the network. If this is the case, you won’t be responsible for paying for that health care.
Also, if you live outside the Texas Star Network’s service area, you don’t have to see a network doctor. The service areas are noted on the map that’s included with your notice of network requirements.

6. Service Area Principal residence (NOT a P.O. Box)
Where network health care is available and accessible
If you live in a service area, you must choose a
network treating doctor
“Live” means
Principal residence (NOT a P.O. Box)
Temporary residence required by
employment
Temporary residence for receiving help
with daily activities
What exactly is a “service area?” It’s a geographic area (usually a county) where health care from the network is available and accessible. The Texas Department of Insurance is responsible for determining whether or not a network has enough available doctors in an area available for it to be certified.
As I said, if you live in one of these service areas, you have to choose your treating doctor from the network’s list.
How do you know if you live in a service area? There are three possible definitions of “live.” The first is your principal residence. This is your physical address, and not a PO Box. The second possibility is a temporary residence that’s required by your employment. If we assign you to another location long-term, you may use that location as where you live. The third definition is a temporary residence for receiving help with routine daily activities like shaving, bathing, dressing, etc. based upon your workers’ comp injury.
© 2006 Texas Mutual Insurance Company

7. Network Notice Rules to help you get care from the network
You will receive a copy of the notice now and if you have an injury
You must sign a form stating that you have received and read the network notice
To make sure that you completely understand your rights and responsibilities as they relate to the Texas Star Network, you’re going to receive an official network notice at the end of this meeting.
This notice includes your responsibilities and directions to help you get care from the network should you be injured on the job. We’ll also give you the notice again if you get hurt, so that you’re fully aware of what you have to do.

8. Questions? Are there any questions I can answer?
NOTE TO EMPLOYERS: If you have additional questions please feel free to reference our website or call
© 2006 Texas Mutual Insurance Company