Required Insurance Carrier Certification Under §10.20(2)

Home Bulletins Bulletins for 2005 b-0074-05.html December 21, 2005 To:   WORKERS' COMPENSATION SYSTEM PARTICIPANTS Re:   Required Insurance Carrier Certification Under 28 TAC §10.20(2) The purpose of this bulletin is to provide guidance and clarification with regards to the department´s rule at 28 TAC §10.20(2) relating to workers´ compensation health care network certification requirements. The rule as adopted states that: "A person, including an insurance carrier, who provides or arranges to provide workers´ compensation health care network services to injured employees within a service area by contracting with more than one person, must be certified as a workers´ compensation health care network under Insurance Code Chapter 1305 and this chapter." As providing or arranging to provide services is essentially the primary activity of a workers´ compensation health care network as defined in Chapter 1305 and the rule, the phrase: "[a] person, including an insurance carrier, who provides or arranges to provide workers´ compensation health care network services to injured employees within a service area" is intended to refer to persons, including insurance carriers, who establish their own networks under Insurance Code Chapter 1305. As a whole §10.20 requires a person, including an insurance carrier, who establishes its own network to be certified. It is the Department´s view that §10.20(2) does not require an insurance carrier that contracts with more than one certified workers´ compensation health care network in a service area to itself be certified as a network, provided that it does not establish or create its own network. Questions regarding this bulletin may be submitted to the following TDI electronic mailbox: WCNet@tdi.state.tx.us or to Margaret Lazaretti, Deputy Commissioner, HMO Division, Texas Department of Insurance, at 512-322-4266. Mike Geeslin Commissioner of Insurance Last updated: 1/30/2018