Department of Financial Services, OIR - Insurance Regulation  


  • Office of Insurance Regulation Emergency Orders Tropical Storm Fay

    Notice of Emergency Orders

    Issued Pursuant to Section 252.63, Florida Statutes

    The Commissioner of Insurance has issued two Emergency Orders, Case No.: 97286-08-EO and Case No.: 97309-08-EO on August 19, 2008. The Orders apply to all Health Insurers and Health Maintenance Organizations. The provisions of the Orders apply statewide in accordance with Governor Charlie Crist’s Executive Order 08-170.

    Order 97286-08-EO requires the referenced entities to comply with Section 252.358, Florida Statutes, which requires early prescription refills until September 18, 2008.

    Order 97309-08-EO extends the open enrollment period required by Section 627.6699, Florida Statutes (Employee Health Care Access Act), by fifteen (15) days. The open enrollment period will be from August 1, 2008 until September 15, 2008.

    The Orders are narrowly tailored to address those persons and entities which were adversely affected by Tropical Storm Fay. Further, these Orders are of limited duration, and directly address the emergency conditions declared by the Governor. The Orders will facilitate the recovery from the emergency by allowing those adversely affected to have adequate supplies of prescription medications and insureds have adequate time to obtain health insurance in accordance with the Employee Health Care Access Act.

    The Orders read as follows:

    IN THE MATTER OF:

    Emergency – Natural Disaster

    Extension of Open Enrollment for Employee

    Health Care Access Act

    CASE NO.: 97309-08-EO

    Tropical Storm/Hurricane Fay

    ________________________________________/

                                    EMERGENCY ORDER

    TO: All Health Insurers and Health Maintenance Organizations

    THIS CAUSE having come before the Commissioner of the Office of Insurance Regulation as a result of the state of emergency created by Tropical Storm/Hurricane Fay, and being fully informed in the premises,

    NOW THEREFORE, the Commissioner hereby FINDS as follows:

    JURISDICTION AND FINDINGS OF FACT

    1.     The Office of Insurance Regulation (the “Office”) has the duty, pursuant to Section 624.307(2), Florida Statutes, to enforce the provisions of the Insurance Code (Chapters 624-632, 634,635, 636, 641, 642, 648 and 651, F.A.C., henceforth, the “Code”). The Office shall have the powers and authority expressly conferred upon it by, or reasonably implied from, the provisions of the Code, pursuant to Section 624.307(2), Florida Statutes.

    2.     Section 120.569(2)(n), Florida Statutes, provides that “if an agency head finds that an immediate danger to the public health, safety or welfare requires an immediate final order, it shall recite with particularity the facts underlying such finding in the final order…”

    3.     This Emergency Order is being issued pursuant to Sections 120.569(2)(n), 252.46 and 252.63, Florida Statutes, because the facts as stated herein demonstrate that there is an immediate threat to the public health, safety and welfare, as a result of the direct effects of the statewide impact of Tropical Storm/Hurricane Fay. Further, this Emergency Order is being issued pursuant to Section 7 of Governor Charlie Crist’s Executive Order Number 08-170, declaring a state of emergency in Florida on August 16, 2008.   Executive Order Number 08-170 is attached as Exhibit 1.

    4.     Tropical Storm/Hurricane Fay is threatening the state, and resulting in large scale evacuations.

    5.     Section 627.6699, Florida Statutes provides for an open enrollment period form August 1st through August 31st each year. Due to the state of emergency, potential enrollees may not be able to timely enroll during this open enrollment period. Accordingly, in order to protest the enrollment rights of potential enrollees, the open enrollment period applicable to the Employee Health Care Access Act is extended for a period of fifteen (15) days.

    6.     The issuance of this Emergency Order and the procedural safeguards set forth herein are fair under the circumstances due to the potential grave harm described above. As indicated in the Notice of Rights herein, Respondents are afforded an opportunity for a review of this Order. Procedures set forth therein will afford the Respondents an opportunity to challenge these actions.

    WHEREFORE, pursuant to the Florida Insurance Code and other applicable statutes, including, Sections 120.569(2)(n), 252.46(2) and 252.63 Florida Statutes, and Governor Charlie Crist’s Executive Order Number 08-170, the Office finds that as a result of the direct effects of the statewide impact of Tropical Storm/Hurricane Fay, an immediate danger to the public health, safety and welfare exists so as to require the issuance of this Emergency Order.

    Accordingly, IT IS HEREBY ORDERED:

    (1) The open enrollment period applicable to the Employee Health Care Access Act as set forth in Section 627.6699, Florida Statutes, will be from August 1, 2008 through September 15, 2008. The effective date for coverage for those enrolling in the extension period, September 1, 2008 to September 15, 2008, will be no later than November 1, 2008.

    (2) The provisions of this Emergency Order shall be liberally construed to effectuate the intent and purposes expressed therein and to afford maximum consumer protection.

    DONE and ORDERED this 19th day of August, 2008.

                                                                                                                                    ________________________

                                                                                                                                    Kevin M. McCarty

                                                                                                                                    Commissioner

                                                                                                                                    Office of Insurance Regulation

    EXHIBIT:

    Executive Order Number 08-170, August 16, 2008

    NOTICE OF RIGHTS

    Any party to these proceedings adversely affected by this Order is entitled to seek review of this Order pursuant to Section 120.68, Florida Statutes, and Rule 9.110, Fla.R.App.P. Review proceedings must be instituted by filing a petition or notice of appeal with the General Counsel, acting as the Agency Clerk, 612 Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0333, and a copy of the same with the appropriate district court of appeal, within thirty (30) days of rendition of this Order.

    IN THE MATTER OF:

    Emergency – Natural Disaster

    Early Prescription Refills

    CASE NO.: 97286- 08-EO

    Tropical Storm/Hurricane Fay

    _________________________________________/

                                    EMERGENCY ORDER

    TO: All Health Insurers, HMOs, and other entities regulated by the Office of Insurance Regulation that may cover prescription medications.

    THIS CAUSE having come before the Commissioner of the Office of Insurance Regulation as a result of the state of emergency created by Tropical Storm/Hurricane Fay, and being fully informed in the premises,

    NOW THEREFORE, the Commissioner hereby FINDS as follows:

    JURISDICTION AND FINDINGS OF FACT

    1.     The Office of Insurance Regulation (the “Office”) has the duty, pursuant to Section 624.307(2), Florida Statutes, to enforce the provisions of the Insurance Code (Chapters 624-632, 634,635, 636, 641, 642, 648 and 651, F.A.C., henceforth, the “Code”). The Office shall have the powers and authority expressly conferred upon it by, or reasonably implied from, the provisions of the Code, pursuant to Section 624.307(2), Florida Statutes.

    2.     Section 120.569(2)(n), Florida Statutes, provides that “if an agency head finds that an immediate danger to the public health, safety or welfare requires an immediate final order, it shall recite with particularity the facts underlying such finding in the final order…”

    3.     This Emergency Order is being issued pursuant to Sections 120.569(2)(n), 252.46 and 252.63, Florida Statutes, because the facts as stated herein demonstrate that there is an immediate threat to the public health, safety and welfare, as a result of the direct effects of the statewide impact of Tropical Storm/Hurricane Fay. Further, this Emergency Order is being issued pursuant to Section 7 of Governor Charlie Crist’s Executive Order Number 08-170, declaring a state of emergency in Florida on August 16, 2008. Executive Order Number 08-170 is attached as Exhibit 1.

    4.     Tropical Storm/Hurricane Fay is threatening the state, and resulting in large scale evacuations.

    5.     In the ordinary course of business of health insurers and health maintenance organizations, contracts that include coverage for prescription medication have restrictions on such coverage so that covered medication is provided in thirty day batches, refillable every 30 days. Because of the storm damage, mass evacuations and the inability of many of the insureds to stay in their homes, these restrictions result in many storm victims being without the medications necessary for their health or their very lives.   This Order provides temporary emergency relief to the insureds so that they are not left without their necessary medications during the remainder of this crisis.

    6.     The issuance of this Emergency Order and the procedural safeguards set forth herein are fair under the circumstances due to the potential grave harm described above. As indicated in the Notice of Rights herein, Respondents are afforded an opportunity for a review of this Order. Procedures set forth therein will afford the Respondents an opportunity to challenge these actions.

    7.     Section 252.358, Florida Statutes provides, in part, that: “All health insurers, managed care organizations, and other entities that are licensed by the Office of Insurance Regulation and provide prescription medication coverage as part of a policy or contract shall waive time restrictions on prescription medication refills, which include suspension of electronic “refill too soon” edits to pharmacies, to enable insureds or subscribers to refill prescriptions in advance, if there are authorized refills remaining, and shall authorize payment to pharmacies for at least a 30-day supply of any prescription medication, regardless of the date upon which the prescription had most recently been filled by a pharmacist…” The issuance of Executive Order 08-170 activates the provisions of Section 252.358, Florida Statutes.

    WHEREFORE, pursuant to the Florida Insurance Code and other applicable statutes, including, Sections 120.569(2)(n), 252.46(2) and 252.63 Florida Statutes, and Governor Charlie Crist’s Executive Order Number 08-170, the Office finds that as a result of the direct effects of the statewide impact of Tropical Storm/Hurricane Fay, an immediate danger to the public health, safety and welfare exists so as to require the issuance of this Emergency Order.

    Accordingly, IT IS HEREBY ORDERED:

    (1) All health insurers, HMO’s and other licensees that provide prescription medication coverage as a part of any policy or contract shall, through September 18, 2008, waive restrictions on prescription medication refills to enable insureds to fill prescriptions in advance, and shall authorize payment to pharmacies for at least a thirty day supply of any prescription medication, regardless of the date upon which the prescription had most recently been filled.

    (2) The provisions of this Emergency Order shall be liberally construed to effectuate the intent and purposes expressed therein and to afford maximum consumer protection.

    DONE and ORDERED this 19th day of August, 2008.

                                                                                                                                    ________________________

                                                                                                                                    Kevin M. McCarty

                                                                                                                                    Commissioner

                                                                                                                                    Office of Insurance Regulation

    EXHIBIT:

    Executive Order Number 08-170, August 16, 2008

    NOTICE OF RIGHTS

    Any party to these proceedings adversely affected by this Order is entitled to seek review of this Order pursuant to Section 120.68, Florida Statutes, and Rule 9.110, Fla.R.App.P. Review proceedings must be instituted by filing a petition or notice of appeal with the General Counsel, acting as the Agency Clerk, 612 Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0333, and a copy of the same with the appropriate district court of appeal, within thirty (30) days of rendition of this Order.

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