Office of Insurance Regulation Issues Emergency Order following Hurricane Ian
October 11, 2022
On September 28, 2022, the Office of Insurance Regulation (OIR) issued an emergency order regarding the suspension of rules due to the state of emergency created by Hurricane Ian. The order is directed at entities regulated by the OIR, including life and health insurers.
The order extends the time limit for an insured to perform any required act or transmit information or funds regarding certain health or life insurance contracts, which required action on or after September 28, 2022, to November 28, 2022. The order also prohibits the accrual or assessment of interest, penalties, or other charges resulting from the extensions. The extensions do not apply to new policies effective on or after September 28, 2022.
The order also prohibits insurers from canceling or failing to renew certain health or life insurance policies or contracts except at the written request or concurrence of the policyholder during the time period between September 28, 2022, and November 28, 2022. Furthermore, insurers must withdraw all notices of cancellation that affect a state resident and are issued or mailed within ten calendar days preceding September 28, 2022, and reissue these notices on or after November 28, 2022. In such situations, the order requires the insurer to extend the coverage through November 28, 2022 (or a later date specified by the insurer). According to the order, the premium for such an extended term of coverage shall be the appropriate pro rata portion of the premium for the entire term of the policy. This rule does not apply to new policies effective on or after September 28, 2022.
The order is directed at insurers, but employers may want to be aware of the temporary relief measures and should contact their insurers for further information.
OIR Emergency Order Following Hurricane Ian »
Early Prescription Refill Reminder Issued
September 27, 2022
On September 23, 2022, the Office of Insurance Regulation issued a notice following Executive Order #22-218, in which Gov. DeSantis declared a state of emergency in 24 counties in the potential path of Hurricane Ian. The notice 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 if the governor issues an executive order declaring a state of emergency. As a result, insureds in affected areas of the state can 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 questions to their carriers.
NOTICE TO INDUSTRY: Florida Law Reminder for Early Prescription Refills »
Employers’ Right to Request a Loss Run Statement
August 16, 2022
On June 26, 2022, Gov. DeSantis approved SB 156 into law. The new law requires group health insurers to provide a loss run statement to an employer plan sponsor within 15 days of request. For this purpose, a loss run statement is defined as a report that contains: the premiums paid, the number of insureds on a monthly basis and the dependent status, policy number, the period of coverage, the number of claims, the paid losses on all claims and the date of each loss. The law was effective upon signature.
Employers with plans regulated by the state should be aware of their ability to access this information.
SB 156 »
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 »