On January 10, 2022, the Department of Insurance (DOI) issued an advisory to encourage insurers that offer health benefit plans to state residents to take certain immediate measures related to the COVID-19 variant surge.

Specifically, the advisory asks insurers to review current policy provisions regarding the delivery of healthcare services via telehealth to ensure their telehealth programs with participating providers will be able to meet any increased demand. Similarly, insurers are requested to verify if their provider networks are adequate to handle increased healthcare service needs if more COVID-19 cases are diagnosed. Insurers are also reminded that insureds cannot be penalized or charged out-of-network benefit levels unless contracting healthcare providers able to meet the health needs of the insureds are available without unreasonable delay.

The DOI reminds insurers to cover COVID-19 tests for diagnostic purposes and without prior authorization consistent with federal guidance. Insurers are also requested to communicate if temporarily waiving prior authorization requirements for post-acute care and the duration of such waiver.

The memo is directed at insurers, but employers may also want to be aware of this advisory.

COVID-19 Variant Surge Advisory »

On April 21, 2020, the Insurance Commissioner issued Bulletin Number 20-B-07 to extend an automatic stay of premium deferrals and other insurance requirements due to the coronavirus disaster declaration. The bulletin was issued to all insurance companies and other entities licensed under the state’s insurance laws.

On March 27, 2020, the commissioner had issued Bulletin Number 20-B-06, which activated an automatic stay of premium and debt deferrals for the state’s residents in accordance with North Carolina General Statutes 58-2-46. The March 27 order expired on April 26, 2020. However, under the extended order, the automatic stay will now expire 30 days from the April 27, 2020, effective date.

As a result, insurance companies are required to continue to provide relief to insureds adversely affected by the pandemic with respect to premium payments, submission of claims and other obligations. Similarly, entities subject to the state’s external review laws shall still allow impacted consumers additional time for their requests or any additional information required to be received and reviewed.

The memo is directed at insurers, but employers may also want to be aware of this extension.

Bulletin Number 20-B-07 »

On March 27, 2020, the Insurance Commissioner Causey issued Bulletin Number 20-B-06 following a major disaster declaration in the state due to the coronavirus (COVID-19) pandemic. The bulletin was issued to all insurance companies and other entities licensed under the state’s insurance laws.

The bulletin follows President Trump’s approval of the major disaster declaration on March 25, 2020. As a result, the Commissioner Causey issued an order that activated an automatic stay of premium and debt deferrals for the state’s residents in accordance with North Carolina General Statutes 58-2-46.

Accordingly, insurance companies are required to provide insureds adversely affected by the pandemic with specific relief with respect to premium payments, submission of claims and other obligations. Additionally, entities subject to the state’s external review laws shall allow those impacted by the disaster additional time for their requests or any additional information required to be received and reviewed.

The memo is directed at insurers, but employers should be aware of this development.

Bulletin Number 20-B-06 »

On March 12, 2020, the Commissioner of Insurance issued Bulletin Number 20-B-05 regarding coverage and cost sharing requirements related to the coronavirus (COVID-19) outbreak. The Bulletin was issued as an advisory to assist insurers regarding the provision of insurance-related services during a public health emergency.

The Bulletin follows Executive Order 116, which was issued by Gov. Cooper in response to the spread of COVID-19. Executive Order 116 declared a state of emergency in the state.

In order to protect the public, insurers are requested to identify and remove barriers to testing and treatment for COVID-19. Additionally, insurers are requested to review their internal procedures and operations, telehealth delivery of services, network adequacy and out of network services to ensure these are capable of handling increase service needs. These entities are further reminded of the importance of making accurate and timely benefit information available to insureds, though website access or other means.

The memo is directed at insurers, but employers should be aware of this development.

Bulletin Number 20-B-05 »

On Sept. 7, 2017, the North Carolina Department of Insurance issued Bulletin 17-B-04 relating to prescription drug procedures during a declared state of emergency. A state of emergency was proclaimed for the entire state of North Carolina on Sept. 7, 2017, in preparation for the arrival of Hurricane Irma. Under NC law, during such a state of emergency, an individual covered under a plan may obtain one refill on a prescription if there are authorized refills remaining, or fill one replacement prescription for one that was recently filled. Insurance companies are required to have a procedure in place to waive time restrictions on filling those prescriptions, and the prescription must be requested within 29 days of the bulletin. Although the bulletin and procedures are directed toward insurers, employers should be aware of the bulletin in case employees have questions on prescription refills relating to the state of emergency.

Bulletin 17-B-04 »

On June 2, 2017, Gov. Cooper signed HB 208 into law, amending North Carolina General Statute 58-50-30. That particular statute addresses a participant’s right to choose services of certain health-care providers. Through the amendment, the type of health-care providers for whom plans must provide coverage is expanded to include licensed occupational therapists. This change is effective for North Carolina policies issued, renewed or amended on or after Oct. 1, 2017.

HB 208 »