Notice of Emergency Orders
Issued Pursuant to Section 252.63, Florida Statutes
The Commissioner of Insurance has issued two Emergency Orders, Case No.: 97568-08-EO and Case No.: 97570-08-EO on September 5, 2008. The Orders apply to all Health Insurers and Health Maintenance Organizations. The provisions of the Orders apply statewide in accordance with Governor Charlie Crists Executive Order 08-187.
Order 97568-08-EO requires the referenced entities to comply with Section 252.358, Florida Statutes, which requires early prescription refills until September 18, 2008.
Order 97570-08-EO extends the open enrollment period by Section 627.6699, Florida Statutes, (Employee Health Care Access Act) by thirty (30) days. The open enrollment period will be from August 1, 2008 until September 30, 2008.
The Orders are narrowly tailored to address those persons and entities which were adversely affected by Hurricane Ike. Further, these Orders are of limited duration, and directly address the emergency conditions declared by the Governor. The Orders will facilitate 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
Early Prescription Refills
CASE NO.: 97568-08-EO
Hurricane Ike
_________________________________________/
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 Hurricane Ike, 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.S., 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 Hurricane Ike. Further, this Emergency Order is being issued pursuant to Section 4 of Governor Charlie Crists Executive Order Number 08-187, declaring a state of emergency in Florida on September 5, 2008. Executive Order Number 08-187 is attached as Exhibit 1.
4. Hurricane Ike is threatening the state, and may result 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 08-187 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 Crists Executive Order Number 08-187, the Office finds that as a result of the direct effects of the statewide impact of Hurricane Ike, 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, HMOs and other licensees that provide prescription medication coverage as a part of any policy or contract shall, through October 5, 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 _____ day of _______, 2008.
________________________
Kevin M. McCarty
Commissioner
Office of Insurance Regulation
EXHIBIT:
Executive Order Number 08-187, September 5, 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.
__________________________
STEPHEN C. FREDRICKSON
FBN: 350478
Office of Insurance Regulation
Division of Legal Services
200 East Gaines Street, 6th Floor
Tallahassee, Florida 32399-4206
Telephone: (850)413-4144
Facsimile: (850)922-2543
IN THE MATTER OF:
Emergency Natural Disaster
Extension of Open Enrollment for Employee
Health Care Access Act CASE NO.: 97570- 08-EO
Hurricane Ike
__________________________/
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 Hurricane Ike, 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, Florida Statutes, 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 Hurricane Ike. Further, this Emergency Order is being issued pursuant to Section 4 of Governor Charlie Crists Executive Order Number 08-187, declaring a state of emergency in Florida on September 5, 2008. Executive Order Number 08-187 is attached as Exhibit 1.
4. Hurricane Ike is threatening the state, and resulting in large scale evacuations.
5. Section 627.6699, Florida Statutes, provides for an open enrollment period from 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. This enrollment period was previously extended by Emergency Order issued on August 19, 2008, In the Matter of: Emergency-Natural Disaster Tropical Storm/Hurricane Fay, Case No. 97286-08-EO through and to September 15, 2008. Accordingly, in order to protect the enrollment rights of potential enrollees, the open enrollment period applicable to the Employee Health Care Access Act is extended for an additional period of fifteen (15) days through and to September 30, 2008.
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 Crists Executive Order Number 08-187, the Office finds that as a result of the direct effects of the statewide impact of Hurricane Ike, 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 30, 2008. The effective date of coverage for those enrolling in the extension period, September 15, 2008 to September 30, 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 ___ day of September, 2008.
________________________
Kevin M. McCarty
Commissioner
Office of Insurance Regulation
EXHIBIT:
Executive Order Number 08-187, September 5, 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.
_______________________________
STEPHEN C. FREDRICKSON
FBN: 350478
Office of Insurance Regulation
Division of Legal Services
200 East Gaines Street, 6th Floor
Tallahassee, Florida 32399-4206
Telephone: (850)413-4144
Facsimile: (850)922-2543
