Here’s a summary of rules and procedures for the administration of the QCARE program:
QCARE Committee and Program Administrator. ARAWC has established a QCARE Committee for the purpose of certifying Texas injury benefit programs that satisfy the requirements of the QCARE designation. Such committee is comprised of individual representatives from any three (3) employer ARAWC members in good standing, appointed by the ARAWC Executive Committee. ARAWC members who are service providers (such as insurance companies or program managers, attorneys, consultants, third party claim administrators, insurance brokers or agents, etc.) are not eligible to serve on the QCARE Committee. The QCARE Committee has delegated certain administration functions to Virtual, Inc. as Program Administrator. Virtual provides management services for ARAWC and 90 other trade associations nationwide, including administration of several other designation and designation programs, through team of over 200 employees. The Virtual service center processes over 100,000 applications each year, including, but not limited to, the evaluation and determination for licensure for various occupations and professions (i.e. nurses, engineers, pharmacists, regulatory professions, etc.).
Authority. The QCARE Committee has authority to develop submission processes, review applications, communicate with applicants seeking the QCARE designation, and grant a QCARE designation that all requirements of QCARE are satisfied.
Application. ARAWC has established this website for the purpose of facilitating the application, submission and communication of a QCARE designation. An Authorized Representative of an employer sponsoring a Texas injury benefit program may submit an application that:
Provides basic contact information,
Certifies to the employer’s knowledge and belief that all 10 requirements of QCARE are satisfied,
Indicates whether to be included on the QCARE Employer Registry, and
Agrees to the QCARE Standard Terms and Conditions, like compliance with the QCARE Trademark and Branding Guidelines, notification to ARAWC of any cessation in compliance with the QCARE designation requirements, compliance with any reasonable request of the QCARE Committee for additional information for the limited purpose of confirming compliance with the basic QCARE requirements.
Authorized Representative. An employer sponsoring a Texas injury benefit program can authorize one of its employees or an insurance, legal or other service representative to apply for a QCARE designation on behalf of such employer.
Review. The Program Administrator reviews the information submitted for the employer’s program and can approve or reject an application for or suspend or withdraw a QCARE designation at any time based upon credible information regarding the program sponsor’s satisfaction of the QCARE requirements or as otherwise deemed by the Committee to be appropriate in protecting the QCARE brand.
Verification. Not every employer that provides Texas injury benefit coverage will satisfy the 10 QCARE standards. A three-level verification system helps to ensure QCARE standards are met.
Level 1: Verify DWC Notice. Level 1 verification focuses on number 2 of the 10 Standards for QCARE Designation. For every QCARE applicant, verification will confirm the applicant has complied with the Texas Labor Code requiring all Texas employers without workers’ compensation coverage to annually file Form DWC-5 with the Texas Department of Insurance.
Level 2: Verify Insurance and Claims Administrator. Level 2 verification focuses on numbers 9 and 10 of the 10 Standards for QCARE Designation. For a random sample of QCARE applicants, the applicant or its authorized representative will be asked to: Verify insurance coverage either by providing a current designation of insurance or contact information for the insurance agent responsible for such coverage. ARAWC is not seeking to gather any actual policy forms or endorsements, policy renewal dates, limits of coverage, premium-related information, claims information, or any other employer or program data. Any such information included on a designation of insurance can be redacted. Verify claims administrator contact information. Claims administration may be performed by an insurance company, licensed third party administrator approved by the insurance company, or other insurance company-approved claim adjusters. The sole purpose of requesting this contact information shall be to confirm the applicant is a current client of, or has been approved by the insurance company as, the approved claims administrator. No such contact information is needed if the applicant affirms that the day-to-day approved claims administrator is the insurance company shown on the above designation of insurance.
Level 3: Verify Benefits. Level 3 verification focuses on numbers 3 through 8 of the 10 Standards for QCARE Designation. For a random sample of QCARE applicants, the applicant or its authorized representative will be asked to provide all Level 2 verification information, plus a copy of the official plan document or summary plan description (SPD) for its Texas injury benefit plan. The Program Administrator shall review such plan document or SPD solely for the purpose of confirming it complies with numbers 3 through 8 in the Detail on 10 Standards for QCARE Designation. Confidential information (if any) can be redacted.
Guidance. Applicants are encouraged to review the QCARE and ARAWC websites and seek insurance, legal or other professional support on compliance with QCARE requirements, as needed.
Content of designation. The QCARE designation shall identify only the name of the injury benefit program, program sponsor, and effective and expiration dates of the designation.
Duration of Certification. The designation shall remain in effect for a term of 1 year, subject to any suspension or withdrawal of the QCARE qualification, as mentioned above.
Revocation. In the event of the expiration of a QCARE designation or a denial, suspension, termination or withdrawal of QCARE designated status prior to the end of the designation term, the covered employer name(s) shall be removed from the Employer Registry.
Employer Decision to Terminate. An employer that has received a QCARE designation for its Texas injury benefit program may request the QCARE Committee to terminate such designation at any time.
Confidentiality and Non-Solicitation. All information submitted by employers and their authorized representatives (including, but not limited to, any insurance agent or broker) will be kept confidential and only be used for QCARE designation purposes. ARAWC will not construct or maintain any database or similar aggregation of information submitted by or on behalf of program sponsors other than the Employer Registry and basic, publicly available employer contact information supplied in the application process. The Program Administrator, each member of the QCARE Committee and the QCARE webmaster have each entered into written Confidentiality Agreements with ARAWC. Neither ARAWC, the Program Administrator, any member of the QCARE Committee nor the QCARE webmaster shall use any information submitted through the QCARE program for the purpose of solicitation of business or any other purpose beyond administration of the QCARE program; provided, that ARAWC may request a program sponsor and its Authorized Representative to become a member of ARAWC and provide the same industry and current event information provided to other ARAWC members and prospects; provided, further, that joining ARAWC shall not be a condition of granting a QCARE designation. No injury claims or other protected health information will be collected by the QCARE program at any time.