This Internet page shows the TDI approval information related to the Coventry HCN Service Areas and the approved Service Areas.

Additionally, the Texas HCN Implementation Documents can be downloaded from this page.

 

May 31, 2007: Texas Department of Insurance has certified the Coventry Health Care Workers Compensation, Inc. DBA Coventry Workers' Comp Network. The CERTIFICATE NUMBER is 12392151.

To view the approved service areas and service area map, please click on this hyperlink: http://www.tdi.state.tx.us/wc/wcnet/networks/coventryhcwc.html

Please click on this text to view HCN providers www.talispoint.com/cvty/gbcvtyhcn

Texas HCN Implementation Documents Employer Requirements under Texas Insurance Code § 1305.005: Participation in Network; Notice of Network Requirements.

The Notice of Network Requirements document package is the formal notice the employee receives about the HCN. The HCN is effective when your employees are notified.

When an employer elects to provide health care services through their carrier’s HCN, the employer must provide each employee a notice of the network requirements by providing a copy of the “Employee Notification Packet” and obtain a signed “Acknowledgment Form” from each employee. This notification must be done at the time you decide to be part of the HCN, within three (3) days of hiring new employees, and again at the time your company receives notification of an injury. 

The Notice of Network Requirements is given to the employee at the following instances:

  • Initial Roll Out §1305.005(d): The insurance carrier shall provide to the employer, and the employer shall provide to the employer’s employees, notice of network requirements, including all information required by Section 1305.451.
  • New Hires §1305.005(e): The employer shall provide to each employee hired after the notice is given under Subsection (d) the notice of and information required under that subsection not later than the third day after the date of hire.
  • (f) An injured employee who has received notice of network requirements but refuses to sign the acknowledgment form required under Subsection (d) remains subject to the network requirements established under this chapter.
  • Time of Injury §1305.005(g): The employer shall notify an injured employee the notice of network requirements at the time the employer receives actual or constructive notice of an injury.
  • (h) An injured employee is not required to comply with the network requirements until the employee receives the notice under Subsection (d), (e), or (g). An insurance carrier that establishes or contracts with a network is liable for the payment of medical care under the requirements of Title 5, Labor Code, for an injured employee who does not receive notice until the employee receives notice of network requirements under this section.

New Texas HCN Rules - Effective 1/1/2023

Adopted on August 1, 2022, and Effective January 1, 2023:
The Texas Department of Insurance (TDI) has adopted changes to workers' compensation network rules, utilization review rules, and aligned the regulatory text for the Texas Labor Code, the Texas Administrative Code (TAC) and the Texas Insurance Code (TIC).

https://tdi.texas.gov/rules/2022/index.html

Beginning January 1, 2023, employers must use the new TX HCN Notification Documents which are available on this Internet Page.

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.

Subchapter D. Network Requirements: Acknowledgement Forms 28 TAC §§10.60 - 10.63

  • (a) An insurance carrier that establishes or contracts with a network must deliver to the employer, and the employer or carrier, as applicable under subsection (g) of this section, must deliver to the employer's employees in the manner and at the times prescribed by Insurance Code §1305.005, concerning Participation in Network; Notice of Network Requirements...
  • c) The carrier must provide to the employee all information required by Insurance Code §1305.451. The notice must include an employee acknowledgment form and comply with all requirements under subsections (d) - (i) of this section, as applicable.
  • (g) The employer must obtain a signed employee acknowledgment form from each employee, and a carrier required to provide employee information to an employee under Insurance Code §1305.103(c), concerning Treating Doctor; Referrals, and subsection (b) of this section must obtain a signed employee acknowledgment form from that employee. For purposes of this subsection, an employer or carrier, as applicable, may obtain an acknowledgment of the notice required under this section through electronic means from an employee who makes an electronic signature in accordance with applicable law.
  • (i) An employer or carrier, as applicable, must deliver the notice of network requirements and acknowledgment form to the employer's employees, and document:
    (1) the method of delivery;
    (2) to whom the notice was delivered;
    (3) the location of the delivery; and
    (4) the date or dates of delivery.
  • (j) The failure of an employer or carrier, as applicable, to establish a standardized process for complying with subsection (i) of this section creates a rebuttable presumption that the employee has not received the notice of network requirements and is not subject to network requirements.
  • (k) A dispute regarding whether an employer or carrier provided the information required by this section to an employee may be resolved by requesting a benefit review conference as provided by Chapter 141 of this title (relating to Dispute Resolution--Benefit Review Conference).

Texas HCN Documents for Employer Implementations

Please click on the blue text below to download your Texas HCN documents.

Employer Instructions

HCN Notice - Worksite Poster English & Spanish

Texas HCN Employee Notification Materials - English (initial roll out, new hires, and time of injury)

 

If you would like additional TX HCN information and/or regarding programs and services offered by Gallagher Bassett Services, please contact your GB Account Executive.

 

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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.