Life Insurance Coverage for Living Organ Donors
April 12, 2022
On April 6, 2022, Gov. DeSantis signed HB 1099 into law, which prohibits group life insurance policies from discriminating against living organ donors in terms of coverage, premiums or any other condition of the policy. The new law is effective July 1, 2022. Employer plan sponsors should work with their insurer to understand the new prohibition and update documents accordingly.
HB 1099 »
Coverage for Newborn Hearing Loss Screening
April 12, 2022
On April 6, 2022, Gov. DeSantis signed SB 292 into law. As background, Florida law currently requires group health insurance policies to provide coverage for a screening to detect hearing loss in newborns. The test must be administered prior to discharge from the hospital or other facility.
The new law, effective January 1, 2023, will require group health insurance policies to provide additional testing to newborns who fail the initial screening. Policies must cover testing to screen for congenital cytomegalovirus within 21 days from birth or prior to hospital discharge, whichever occurs earlier.
Employer plan sponsors should work with their insurers to understand the changes and communicate to participants accordingly.
SB 292 »
Step Therapy Protocols Restricted
April 12, 2022
On April 6, 2022, Gov. DeSantis signed HB 459 into law, which restricts step therapy protocols. Step therapy protocol is a medical management process that requires a plan participant to take a certain prescription drug (other than the drug or other course of treatment recommended by his health care provider) or take prescription drugs in a certain order before the plan provides coverage for the recommended treatment.
Under existing Florida law, an insurer may not require a step-therapy protocol for a prescription drug requested by a participant if the participant has previously been approved to receive the prescription drug through the completion of a step therapy protocol under a separate health plan. The other plan must have provided benefits for the prescription drug within the 90 days preceding the participant’s current request and when the participant provides supporting documentation.
The new law, effective July 1, 2022, requires health insurers to publish on their website and provide to participants upon request, the insurers’ procedures to request an exemption to the protocol or appeal a denial. The procedures must include:
- The instructions and form for requesting an exemption
- The timeline for such a request
- The manner and timeframe in which the insurer approves or denies the request
Employer plan sponsors should work with their insurer to understand the availability of the step therapy protocol exemption and communicate to participants accordingly.
HB 459 »
January 04, 2022
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 »