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Published byHector James Modified over 9 years ago
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Texas Star Network ® Option “Making the Right Choice”
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Today’s Focus ► Texas Star Network ® ► Network Benefits ► Network Responsibilities ► Employer Resources
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Workers’ Comp Health Care Networks ► Carriers chose whether to offer Network option ► Employer election into Network ► Texas Star Network ® certified
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Texas Star Network ® Availability ► 99% of policyholders ► All major metropolitan areas ► Up to 12% annual Network discount
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Texas Star Network ® Service Area As of 1/2010 – 231 Counties Certified
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Accessibility Requirements ► Treating doctors Urban – 30 miles Rural – 60 miles ► Specialty care Urban – 75 miles Rural – 75 miles
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Network Benefits ► Quality of Care Employees select from list ► Network designates specialties Providers versed in occupational medicine Providers focused on return- to-work
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Network Benefits Con’t. ► Reducing time employees are off work should Improve productivity Lower “indirect costs” Improve loss history Lower experience modifiers
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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.
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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
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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
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Notice Distribution Options ► Email ► Staff or safety meetings ► Obtain electronic signature ► Mail
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Notice Requirements ► Employer must provide notice at Time of acceptance AND Time of injury ► Notice must be posted at each location
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Required Recordkeeping ► Must have standard delivery process Delivery method Recipient Location Date(s) ► Retain copies of signed forms
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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 the provider ► To minimize this exposure Texas Mutual claims reorganization Specialized claims teams to accelerate determination of compensability
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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 Employee must comply with the network requirements to receive benefits.
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Employer Resources ► Policy packet Employer instructions Employee form and notice ► Texasmutual.com ► Your Agent
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Texasmutual.com Tools ► Notice of Network requirements ► Acknowledgment form ► Notice and acknowledgment form log ► Helpful hints for employers
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Texasmutual.com Tools ► Presentations for agents, employers and employees ► Provider search ► Service area map ► Provider nominations
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Questions
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