An HCN is an organization created to provide health care services to injured workers, and is certified by the Texas Department of Insurance. The HCN must be certified in accordance with Chapter 1305, Texas Insurance Code, and 28 TAC §§10.20 -10.27 and established by, or operating under contract with, an insurance carrier.

The Zenith Health Care Network was certified by the Texas Department of Insurance on December 29th, 2006.

The ZHCN is only available to Texas employers that have at least one policy location in a covered service area. A service area is a geographic region within which health care services are readily available and accessible to employees living in that area. The service area is designated by zip code.

The current service area for the Texas ZHCN includes the greater Houston, Dallas/Fort Worth, Austin, San Antonio and El Paso areas. Zenith plans to expand its service area over the next few months. For a complete listing of the covered zip codes, please visit www.TheZenith.com/ZHCN.

The specialties that have been designated "primary treating doctors" are: Occupational Medicine, Internal Medicine, Family Practice and General Practice. An injured worker must select a treating doctor from one of these four specialties.

In order for an injured worker to be required to treat with a network doctor, they must live in a covered service area and they must have been notified by the employer of the network requirements. (Click here to view the employer responsibilities).

The law allows the injured worker the right to use their primary treating physician under their HMO plan as their treating doctor for their workers' compensation injury. The employee and their doctor must complete the "Pre-Designated Physician Form". This form should be kept in the employee's personnel file and submitted to the insurance carrier once an injury occurs. (Click here for the Pre-Designated Physician Form)

All of the necessary information required to administer the ZHCN is available at www.TheZenith.com/ZHCN.

An employer participating in the network has four basic responsibilities:

• They must communicate, and document the communication, to their current employees and all new hires that the company participates in the ZHCN. This is done through the distribution of the Notice of Network Requirements (Notice).
  
• The employer must also post a copy of the Notice of Network Requirements at each company location.
  
• Once an injury occurs, they must provide the Notice once more to the injured worker.
  
• And finally, they must collect a signed acknowledgement form from each employee and maintain it in their personnel file.

Once an employer elects to participate in the ZHCN, a packet containing the Notice of Network Requirements will be mailed to the employer. The Notice is also available on line at www.thezenith.com/zhcn.

The carrier is required to make the Notice available in English, Spanish and any other language that 10% of more of our policyholder's employees speak. We recommend that the notice be distributed to your employees in the language in which they are most comfortable.

It is very important to document the date and the method by which the Notice was delivered. This provides the appropriate documentation in the event that an employee does not return the Acknowledgement form or refuses to sign the Acknowledgement form. Without the signed form or proof that the Notice was delivered, the employee will not be required to treat with a network provider.

If an employee refuses to sign the Acknowledgement form you must document the method and date of delivery and note that he refused to sign. An employee, who refuses to sign the form, does not mean that he or she will not be required to treat with a network doctor.

In order for a claim to be handled as a "network" claim the injured worker's home address must be in the service area and the employee must have received the Notice of Network Requirements. If both of these criteria are not met, the claim will be handled as a non-network claim. Most employers will have both network and non-network claims on their policy.

You can search our Service Area by visiting our website at www.TheZenith.com/ZHCN and entering in an appropriate zip code for your employee's residence.

An employee can select a treating doctor by searching the ZHCN provider directory located at www.TheZenith.com/ZHCN. They must select a treating doctor that is one of four specialties: Occupational Medicine, Internal Medicine, Family Practice or General Practitioner.

An injured worker has the right to select a first-alternate treating doctor at any time throughout the life of their claim. If they are not satisfied with the selection of the second doctor, they must go through the ZHCN to gain approval to switch to another doctor.

If an injured worker lives in the service are and has been notified of the Notice of Network Requirements, they are required to treat with a network doctor. There are exceptions for emergency care and for treatment provided by an out-of-network provider based on referral.

If an injured worker lives in a valid service area and has been notified of the network requirements, the injured worker is required to select a treating doctor from the ZHCN. If they do not select a ZHCN provider they may be liable for their medical bills.

In order to be seen by a specialist, an injured worker's treating doctor must make a referral to a specialty provider in the ZHCN. If the specialty treatment is not available in the ZHCN, the treating doctor will refer the injured worker to a provider outside of the network.

Zenith Insurance Company may elect to transfer some legacy claims into the ZHCN. Once the injured worker is notified that their claim is being transferred, they will have 14 days to select a new ZHCN treating doctor. If a selection is not made within 14 days, a treating doctor may be selected for them. Our claims examiners and nursing staff will facilitate the transition for the injured worker.