Texas Mutual Network Information

"With Texas Mutual Insurance Company’s health care network, our employees get treated faster and are back on the job sooner."
—Sally Casas, San Miguel Electric

Download "Make the Right Choice"
The fact sheet on our workers' comp health care network.

Network option
Network tools
Find a network provider
Employer benefits
Employee benefits
Employer responsibilities
Employee responsibilities

Texas Star Network^® option
The Texas Star Network^® was the first workers' compensation health care network certified by the Texas Department of Insurance. Policyholders with locations in network service areas may be eligible to purchase a workers’ compensation policy that includes the network. Network providers are focused on getting injured employees well and back to work. Most policyholders who are eligible for and select this option also receive a 12 percent annual network premium discount. Eligible policyholders do not have to wait until their policy renews to take advantage of the network.

Network Tools

Agents: Get a network quote for new business or an endorsement for current Texas Mutual^® clients
Find a network provider
Policyholder packet and notice of network requirements
Notice of network requirements
- English
- Spanish
- Croatian
- Laotian
- Tagalog
- Thai
- Turkish
- Vietnamese
Service area map
Helpful hints for employers
Sample notice/acknowledgment form log
Network presentations for
Network Facts and Frequently Asked Questions
Links

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Network Benefits for Employers

Employers benefit from the network’s focus on providing prompt medical care to injured employees and returning them to work as soon as medically reasonable. Employees who return to work quickly feel more productive, and they often recover faster. This occupational focus should help improve productivity and reduce costs associated with workplace accidents. Most employers also receive a discount on their workers’ compensation premium based on their network choice.

Network Benefits for Employees

Employees receive care from doctors and specialists that have extensive occupational experience. The network's focus is on directing employees to the right providers while allowing them to maintain choice by selecting their doctor from those in the network.

Employer Responsibilities

Network participation comes with responsibilities:

The law requires that at the time of network selection or within three days of new employee hire and at the time of injury, employers must provide employees with a notice of network requirements. The notice must be in English, Spanish or any other language common to employees. It must include a list of network providers, a notice that the employee must see a treating doctor that is in the network, and an explanation of the complaint process.

In addition to delivering the notice, employers must obtain a signed acknowledgment form from employees at the time of notice and the time of injury. Employers must establish a standardized process for delivering the notice. Texas Mutual has a template employers can use to record delivery and employees' signatures. If an employee refuses to sign the acknowledgment, he or she will still be required to comply with the terms of the network if the employer fulfills his responsibility and maintains a record of delivery.

Employers that choose to distribute the notice of network requirements at an employee meeting may want to also show our employee presentation, which explains several key elements of the notice and employee responsibilities.

NOTE: To play the Windows Media file, you must have Windows Media Player installed on your computer. Click here to download a free copy. Click here for a PowerPoint-only version of the employee presentation. We also have the presentation available in Spanish. Click here for the Spanish presentation with audio or here for a PowerPoint-only version of the Spanish presentation.

NOTE: If an employee has not received the notice at the time of injury, they may seek care from any provider who has a license to practice in Texas. Texas Mutual will reimburse the provider for medical care delivered in accordance with Division of Workers’ Compensation fee guidelines and will begin the process of transferring the claim to the network.

Employee Responsibilities

Download an employee rights and obligations flyer.

Employees who meet the following conditions must seek care within the network:

the policyholder has purchased a policy with network coverage
the policyholder has provided the employee with the required notice and obtained a signed acknowledgement form
the employee lives within a network’s service area

If the employee meets these conditions, he or she must select a treating doctor from among the doctors offered by the network in their service area. If the employee does not seek care within the network, he or she may be responsible for payment to non-network medical providers.

Employees are entitled to one change of treating doctor within the network. Any subsequent requests to change treating doctor must be approved by the network.

Employees may seek treatment from their HMO doctor, if the HMO doctor will accept the network’s terms and conditions. This provision does not apply to preferred provider organization (PPO) plans or family doctors. Employees who select their HMO primary care physician as their treating doctor should inform Texas Mutual Insurance Company.

In addition to the ability to treat with their HMO doctor, employees may go outside the network:

if they live outside the network’s service area
to receive emergency care
to visit a specialist upon the referral of their network treating doctor