April 14, 2020
On April 6, 2020, the Office of Insurance Regulation (OIR) issued Informational Memorandum OIR-20-06M, which provides telehealth and pharmacy audit guidance in relation to the state’s coronavirus (COVID-19) response. The memo is directed at health insurers and other health entities regulated by the OIR, and all pharmacy benefit managers registered in the state.
As background, prior Executive Orders 20-51 and 20-52 established COVID-19 protocols and declared a state of emergency in the state. The purpose of the current memo is to encourage the health care industry to use technology to help combat the spread of COVID-19.
This communication follows actions taken by the CMS to expand access to telehealth services for Medicare beneficiaries. Additionally, the Florida Department of Health temporarily suspended certain restrictions on the use of telehealth services by health care professionals licensed both in and out of state who are providing care to state residents.
The current memo encourages all health insurers, health maintenance organizations, and other health entities to broaden access to telehealth services and to remove any existing impediments for residents seeking to use such services. Furthermore, it requests that these entities change to an electronic pharmacy audit process in order to avoid unnecessary exposure and maintain social distancing.
Although the memo is directed at insurers and pharmacy benefit managers, employers may wish to be aware of these developments.
Informational Memorandum OIR-20-06M »
Premium Payment Leniency Requested
April 14, 2020
On March 25, 2020, the Office of Insurance Regulation (OIR) issued Informational Memorandum OIR-20-04M, which provides continued guidance in relation to the coronavirus (COVID-19) emergency. The memo, which is directed at health insurers and other health entities regulated by the OIR, addresses the treatment of policyholders in the state.
As background, prior Executive Orders 20-51 and 20-52 established COVID-19 protocols and declared a state of emergency in the state. The current memo outlines certain measures and accommodations to support the state’s COVID-19 response efforts.
The memo recognizes that social distancing guidelines have resulted in worker displacement and business disruptions. As a result, insurers are encouraged to be flexible with premium payments in order to prevent a lapse in coverage. Suggested measures include relaxing due dates, extending grace or reinstatement periods, waiving late fees and penalties and allowing payment plans. Insurers are urged to consider policy cancellation only if all other possible alternatives have been expended.
The guidance addresses other COVID-19 considerations, including the acceptance of electronic communications from policyholders where handwritten statements would normally be required. It also provides a 30-day extension for annual statements due to be filed with OIR by regulated entities, including insurance administrators and multiple-employer welfare arrangements, on or before May 1, 2020.
Although the memo is directed at insurers, employers may want to be aware of these developments.
Informational Memorandum OIR 20-04M »
Early Prescription Refill Mandate
March 17, 2020
On March 10, 2020, the Office of Insurance Regulation issued Informational Memorandum OIR-20-02M in response to Executive Order #2020-52, which declared a public health emergency in the state with respect to the coronavirus (COVID-19) outbreak. The memo is directed at all health insurers, health maintenance organizations and other health entities authorized to do business in Florida.
As background, Florida statutes permit early prescription refills in the event that the governor issues an executive order declaring a state of emergency. As a result, insureds are able to fill prescriptions in advance as part of their emergency preparedness.
Accordingly, the memo reminds insurers and other health entities to waive otherwise applicable time restrictions on prescription medication refills and to authorize payment to pharmacies for at least a 30-day supply of any prescription medication, regardless of the date on which the prescription had most recently been filled. Certain limitations and conditions apply, in accordance with the applicable provisions of the Florida statutes.
Employers should be aware of the memo and direct any related question to their carriers.
Informational Memorandum OIR 20-02M »
March 17, 2020
On March 6, 2020, the Office of Insurance Regulation released Informational Memorandum OIR-20-01M in response to Executive Order #2020-51, which was issued by Gov. DeSantis to establish coronavirus (COVID-19) protocols. The memo is directed at all health insurers authorized to do business in Florida.
As background, the communication was released as part of the state’s effort to protect Floridians during the COVID-19 public health emergency. The memo recognizes the integral role of insurers in addressing the pandemic.
Accordingly, these entities are instructed to work with public officials and take all possible measures at the prevention level. Specifically, insurers are directed to devote resources to disseminating information to policyholders, agents and providers regarding COVID-19 prevention and treatment. They should also be prepared to respond to insureds’ questions regarding covered benefits and related inquiries.
Additionally, insurers are directed to reduce barriers to cost sharing for COVID-19 testing and treatment during the public health emergency. Emergency services for an emergency medical condition must be covered at the in-network level regardless of which provider performs the service. General preparedness plans should also be reviewed.
Although the memo is issued to insurers, employers should be aware of this development.
Informational Memorandum OIR-20-01M »
Civil Air Patrol Leave
September 06, 2017
On June 9, 2017, Florida Gov. Rick Scott approved S.B. 370 into law. The new law requires employers with 15 or more employees to provide at least 15 days of unpaid Civil Air Patrol leave per year. To be eligible for the leave, the employee must have been employed by the employer for at least 90 days. Additionally, the employee must be a Civil Air Patrol member, which is defined as a senior member of the Florida Wing of the Civil Air Patrol with an emergency services qualification. The leave may be related to training or a mission.
An eligible employee may elect to use accrued paid leave amounts, but may not be required to use such during the Civil Air Patrol leave period. An employer may not discharge, reprimand or otherwise penalize an eligible employee who takes such leave. At the end of the leave, the employee shall return to work unless certain conditions are met such as the employment would cause undue hardship on the employer or the employer has legally sufficient cause to terminate the employee.
The law’s been effective since July 1, 2017.
S.B. 370 »
May 3, 2016
May 03, 2016
On March 25, 2016, Gov. Scott signed Senate Bill No. 422 into law. This law addresses the provision of abuse-deterrent drugs. Specifically, plans that provide coverage for abuse-deterrent opioid analgesic drug products:
- Can only require prior authorization for abuse-deterrent opioid analgesic drug products if they require the same prior authorization for each opioid analgesic drug product that does not have an abuse-deterrence labeling claim, and
- Cannot require plan participants to use opioid analgesic drug products that do not have an abuse-deterrence labeling claim before authorizing the use of abuse-deterrent opioid analgesic drug products.
The law is effective on Jan. 1, 2017. Employers that sponsor plans that provide such drug products should work with their insurers to ensure compliance with this law.
Senate Bill No. 422 »
May 3, 2016
May 03, 2016
On April 14, 2016, Gov. Scott signed House Bill No. 221 into law. This law requires plans to provide coverage for treatment of down syndrome when the participant is younger than age 18 or older than age 18 and attending high school, if they were diagnosed as having developmental disabilities before reaching age eight.
The law also requires issuers to provide coverage for emergency services regardless of whether those services are performed by participating or nonparticipating health-care providers. Additionally, issuers cannot require prior authorization for emergency services. This portion of the law is very similar to PPACA’s requirement that emergency services be covered without regard to whether provided in or out of network; note though, that this requirement would apply to plans insured in Florida whether the plan is grandfathered under PPACA or not.
This law is effective July 1, 2016.
House Bill No. 221 »
FL State Updates - 2015 Jan 16 No.01
June 16, 2015
Beginning July 1, 2015, Florida employers with 15 or more employees cannot discriminate on the basis of pregnancy. This prohibition comes after the Florida Supreme Court ruled in 2014 in Delva v. Cont’l Group, Inc., 137 So. 3d 371 (Fla. 2014) that pregnancy discrimination is a form of sex discrimination under Florida employment law. As a result, employers cannot fail or refuse to hire, discharge or otherwise discriminate in compensation or terms, conditions and privileges of employment on the basis of pregnancy. The law does allow employers to take an action based on pregnancy if such action is justified based on a bona fide occupational qualification that is necessary for job performance. The law also allows employers to abide by the terms of bona fide employee benefit plans that measure earnings by production as long as the terms are not designed to evade the pregnancy discrimination laws.
Fla. Stat. 760.10 »
Delva v. Cont’l Group, Inc. »
FL State Updates - 2015 Jan 28 No.01
January 28, 2015
On Jan. 13, 2015, the DOL and the state of Florida signed a memorandum of understanding announcing that they will work together to prevent the improper classification of employees as independent contractors or other nonemployee workers. The agreement states that the two entities will share information and coordinate enforcement in an effort to protect employee rights by reducing the practice of misclassification of employees.
The agreement arose as part of the DOL Misclassification Initiative. Sixteen other states have signed similar agreements: Alabama, California, Colorado, Connecticut, Hawaii, Illinois, Iowa, Louisiana, Maryland, Massachusetts, Minnesota, Missouri, Montana, New York, Utah and Washington. Employers should be aware of the increased attention given to the misclassification issue by the DOL and by state agencies. This is an important issue for all size employers, but specifically large employers who are subject to the employer mandate must identify full-time employees and offer them affordable, minimum value coverage, or else pay a penalty. Misclassification of employees can significantly impact the potential liability under the employer mandate for these employers.
DOL News Release »
DOL Misclassification Initiative Web Page »
FL State Updates - 2015 Jan 13 No.01
January 13, 2015
On Jan. 5, 2015, the stay on enforcement of same-sex marriages in Florida expired, making same-sex marriage legal in Florida as of Jan. 6, 2015. As background, in August of 2014, Federal District Court Judge Hinkle ruled in Brenner v. Scott (999 F. Supp. 2d 1278, 2014) that the Florida same-sex marriage ban is unconstitutional. However, at that time, he issued a stay on enforcement of same-sex marriage, pending appeal. Florida appealed this decision to the 11th Circuit, and on Dec.3, 2014, the 11th Circuit denied a request to extend the stay. On Dec. 19, 2014, the Supreme Court also refused to issue an injunction that would lift the stay. On Jan. 1, 2015, Judge Hinkle directed clerks in Florida to issue same-sex marriage licenses beginning Jan. 6, 2014.
Brenner v. Scott »