Texas Health Care Network and Pharmacy Program

July 2016

Dear Policyholder:

Texas’s Health Care Network (HCN) Regulations took effect on January 1, 2011. As of that date, Section 415.015 of the Texas Workers Compensation Act required that all Voluntary and Informal Networks become certified workers compensation health care networks pursuant to Section 135.051 of the Texas Insurance Code. Texas defines voluntary networks as healthcare provider networks that are established under a contract between an insurance carrier and health care provider with a specific fee. As of January 1, 2011, voluntary and informal networks are no longer allowed to offer discounted provider fees and must apply the appropriate state medical fee schedule.

At Chubb, we believe that timely, appropriate medical care and early reporting of a claim is the best approach to containing your workers compensation costs and assuring your employees receive appropriate care. Participation in the Texas HCN will help support medical cost containment and facilitate prompt return to work. If you are not already enrolled in the HCN, you may wish to notify Chubb prior to participating to discuss proper implementation.

Here are some reminders for you regarding participation in Chubb’s Texas Health Care Network and Pharmacy Program:

• As of January 1, 2011,  if you have not enrolled in a certified HCN, provider fees are subjected to the Workers Compensation fee guidelines in Texas and no reductions below fee schedule will be allowed.  However, medical costs incurred under a certified HCN may be eligible for preferred rates dependent upon HCN provider contractual obligations.
• If you are interested in participating in a certified HCN you will need to distribute the Employer Implementation packet to your employees which is attached in the additional information section of this letter. If you need assistance, please contact your local Chubb branch or agent.
• To assist you with participation in Chubb's pharmacy benefit management program, the First Fill form is attached along with information specific to Texas rules.

• Texas Health Care Network Information Packet

English        Spanish

• Texas Pharmacy Program Notice to Texas Employers Only
• Texas Pharmacy Program Insured Worker's First Fill Prescription Form

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