Texas Star Network ® Option

1. Texas Star Network® Option “Making the Right Choice”

2. Today’s Focus • Texas Star Network® • Network Benefits • Network Responsibilities • Employer Resources

3. Workers’ Comp Health Care Networks • Carriers chose whether to offer Network option • Employer election into Network • Texas Star Network® certified

4. Texas Star Network® Availability • 99% of policyholders • All major metropolitan areas • Up to 12% annual Network discount

5. Texas Star Network® Service Area As of 1/2010 – 231 Counties Certified

6. Accessibility Requirements • Treating doctors • Urban – 30 miles • Rural – 60 miles • Specialty care • Urban – 75 miles • Rural – 75 miles

7. Network Benefits • Quality of Care • Employees select from list • Network designates specialties • Providers versed in occupational medicine • Providers focused on return-to-work

8. Network Benefits Con’t. • Reducing time employees are off work should • Improve productivity • Lower “indirect costs” • Improve loss history • Lower experience modifiers

9. 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.

10. 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

11. 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

12. Notice Distribution Options • Email • Staff or safety meetings • Obtain electronic signature • Mail

13. Notice Requirements • Employer must provide notice at • Time of acceptance AND • Time of injury • Notice must be posted at each location

14. Required Recordkeeping • Must have standard delivery process • Delivery method • Recipient • Location • Date(s) • Retain copies of signed forms

15. 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

16. 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.

17. Employer Resources • Policy packet • Employer instructions • Employee form and notice • Texasmutual.com • Your Agent

18. Texasmutual.com Tools • Notice of Network requirements • Acknowledgment form • Notice and acknowledgment form log • Helpful hints for employers

19. Texasmutual.com Tools • Presentations for agents, employers and employees • Provider search • Service area map • Provider nominations

20. Questions