Certified Managed Care Plans

Effective January 1, 2011, all informal or voluntary PPO networks will be illegal in Texas. The only available network option for Texas employers that subscribe to the WC Act will be “workers compensation health care networks” certified by the Texas Department of Insurance, per Texas Labor Code Sec. 413.0115 added by HB 473 in 2007.

The Genex HCN program offers a qualified panel of primary treating physicians who perform health care services following evidence-based guidelines to facilitate quicker return to work for injured employees.

Certified to provide health care services under the Texas Workers' Compensation Act, Genex offers the most comprehensive and customizable network in the marketplace. Given our size, scope and experience as an industry leader, Genex is well-positioned to assist the insurance community with the new rules accompanying the transition from TWCC to TDI.

In order to maintain superior services for our customers in Texas, Genex has closely followed the genesis and development of HB7. Access the Genex HB7 brochure to get further information and answers from Genex regarding the implementation of HB7.

With the broadest provider networks available, we are capable of providing our customers with multiple provider network alternatives that can meet the specific needs of local markets and varying geographical requirements. Not limited to a single national network, Genex can offer the best available network, or networks, custom-designed to precisely fit the unique parameters of individual organizations.

Network Requirements

Employer Requirements

• Employers are required to provide their employees with the terms and conditions for obtaining health care through a network, as well as an acknowledgment that employees must sign
• This information must be in English, Spanish, and any other language common to the employees, and must include contact information, a list of providers, a description of the complaint process, and any other necessary information
• The employer must also notify an injured worker of the network requirements at the time the employer receives notice of the injury
• Employers must post notice of network requirements at each place of employment

Employee Requirements

• Employees who live within a network service area are required to choose their treating doctor from the list of network providers
• If an injured worker does not select a treating doctor within 14 days, the network will assign a treating doctor
• An injured worker may retain their treating doctor if they are in a HMO plan and if they agree to abide by the network requirements

Other than using an HMO doctor as outlined above, employees must select a network treating doctor and all care must be within the network. There are also exceptions for emergency care and for health care provided by an out-of-network provider pursuant to a referral from a treating doctor for medically necessary services that are not available in the network. The out-of-network referral must be approved by the network. The employee won't be billed for network services but unapproved non-network care will be employee's responsibility.