Texas Healthcare Networks Questions
What is the endorsement that I need to have on my workers compensation policy?
After your insurance carrier has signed a Network/Carrier Agreement with Coventry, you must add an HCN endorsement to your policy. (If you are not sure if your insurance carrier has a Network/Carrier Agreement with Coventry, please contact your Gallagher Bassett Account Manager.)
The endorsement sets the date to how far back in time you can transfer your existing claims into the HCN, and permits you to have additional PPO discounts applied to processed medical bills. The Texas Department of Insurance (TDI) requires that this endorsement be present before the HCN can be implemented. It is best that you contact your broker or insurance carrier on this matter first, before notifying Gallagher Bassett that you wish to implement a TX HCN.
Please click on this text to view the TDI Commissioner's Order on the endorsement
To view a sample endorsement, please click on this text
What if I change insurance carriers after implementing the Texas HCN for my employees?
As a Texas employer, you must re-implement the Texas HCN under your new insurance carrier, The policy and endorsement implementation steps listed above must be repeated. If the TX HCN is not properly re-implemented, TDI may issue financial penalties to your insurance carrier, and to you the employer.
Do we need to post a “panel” of physicians or does employee have freedom to choose?
The Texas Department of Insurance (TDI) does not allow provider panel postings. The issue is that a formal Panel Card appears to limit the employees choice and the employee has the choice of the entire network. Furthermore, if it can be shown the employer intentionally limits or directs the employee to a specific provider within the network, that provider can not be considered the First Choice of Treating provider in any dispute by the claimant..
Besides giving my employees the Notice of Network Requirements and the Acknowledgement Form, do I have to post anything at the work site?
A review of Sec. 1305.005(d)(2) and Rule 10.60 that requires the posting of the "notice of network requirements", which is also handed, mailed, etc to employees. There is no distinction in the rule between the posted notice and the delivered notice. At this time, we conclude that they must be the same documents.
I have employees who are staffed as temporary workers at customer’s work site. Where am I required to post HCN materials?
Because the temporary agency is the employer, the employer's carrier is the responsible carrier. We recommend posting a notice in the temporary employer's office, not in the customer’s company's office.
The new Texas HCN rules are effective January 1, 2023. If an employer uses outdated Employee Notification Documents (Notice of Network Requirements) that are not in compliance with the new Rules, and an injury occurs, is that claim still considered a “network” claim?
If an employer provides an outdated Notice of Network Requirements, there could be a rebuttal that it is not a valid notification and therefore subject to a contested case hearing final determination. The documentation that the employee was provided with the Notice is required to be maintained by the employer. When an injury occurs, and the employer is notified of the injury, the employer should provide the new notice to the injured employee.
Who is responsible to give the Notice of Network Requirements to employees?
Subchapter D. Network Requirements: Acknowledgement Forms 28 TAC §§10.60 - 10.63
The employer and carrier must determine whether the employer or carrier will be responsible for obtaining a signed employee acknowledgment form from each employee and delivering notices to employees, and generally substitute the term "responsible party chosen under subsection (g)" for references to the carrier and employer regarding notifications.
Where this is a dispute regarding whether an employer or carrier properly provided the information required by this section to an employee may be resolved by requesting a benefit review conference to conform to Insurance Code §1305.103 and §1305.451.
If you need additional information regarding programs and services offered by Gallagher Bassett Services, please contact your GB Account Executive.
DISCLAIMER. The content of this Web site is provided for informational purposes only, from a general insurance/risk management perspective, with the understanding that Gallagher Bassett Services, Inc. (GB) is not rendering legal, accounting or other professional advice on specific matters. Accordingly, GB assumes no liability whatsoever in connection with the use of such content. GB recommends that you consult your legal counsel or other professional advisor with respect to your individual situation.
The information provided throughout this Web site is provided from a general insurance/risk management perspective and is NOT legal advice. Gallagher Bassett Services, Inc. (GB) does not provide legal advice as it is not qualified to do so. GB recommends that you seek the advice of legal counsel in order to become fully apprised of the legal implications related to the information provided above as such implications are highly dependent on the unique facts and circumstances applicable to an individual situation.