2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle D - Provider Plans › Chapter 1305 - Workers' Compensation Health Care Networks › Subchapter A. General Provisions › Section 1305.005. Participation in Network; Notice of Network Requirements

Sec. 1305.005.  PARTICIPATION IN NETWORK; NOTICE OF NETWORK REQUIREMENTS.  (a)  An employer that elects to provide workers' compensation insurance coverage under the Texas Workers' Compensation Act may receive workers' compensation health care services for the employer's injured employees through a workers' compensation health care network.
(b)  An insurance carrier may establish or contract with networks certified under this chapter to provide health care services under the Texas Workers' Compensation Act.  If an employer elects to contract with an insurance company for the provision of health care services through a network, or if a self-insured employer under Chapter 407, Labor Code, a group of employers certified to self-insure under Chapter 407A, Labor Code, or a public employer under Subtitle C, Title 5, Labor Code, elects to establish or contract with a network, the employer's employees who live within the network's service area are required to obtain medical treatment for a compensable injury within the network, except as provided by Sections 1305.006(1) and (3).
(c)  Notwithstanding Subsection (b), the State Office of Risk Management shall have exclusive authority to establish or contract with networks certified under this chapter to provide health care services under Chapter 501, Labor Code.
(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.  The employer shall:
(1)  obtain a signed acknowledgment from each employee, written in English, Spanish, and any other language common to the employer's employees, that the employee has received information concerning the network and the network's requirements; and
(2)  post notice of the network requirements at each place of employment.
(e)  The employer shall provide to each employee hired after the notice is given under Subsection (d) the notice 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.
(g)  The employer shall notify an injured employee of the 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.
(i)  The commissioner may adopt rules as necessary to implement this section.
Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 4.02, eff. September 1, 2005.