Life and Health Hot Topics
Life and Health Bulletins, Advisory Notices, and ACA Related Hot Topics
Bulletin 24-B-16 Additional Relief for Insureds Affected by Tropical Storm Helene
This advisory is for all insurance companies and other entities licensed under Chapter 58 of the North Carolina General Statutes offering health benefit plans to North Carolina resident and supplements the advisory 24-B-15.
On September 28, 2024, President Biden approved a major disaster declaration for North Carolina. The Federal Emergency Management Agency (FEMA) issued North Carolina Tropical Storm Helene Disaster Declaration (DR-4827-NC) for the following counties:
Alexander, Alleghany, Ashe, Avery, Buncombe, Burke, Caldwell, Catawba, Clay, Cleveland, Gaston, Haywood, Henderson, Jackson, Lincoln, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Transylvania, Watauga, Wilkes, Yancey and the Eastern Band of the Cherokee Indians of North Carolina.
The Department is continuing to hear of problems in the affected counties caused by the damage to homes, businesses, and infrastructure from Tropical Storm Helene. As part of its continuing effort to help those affected by the storm, the Department is encouraging insurers and other licensed entities that offer health benefit plans to North Carolina residents to take additional immediate measures for insureds and providers in the counties covered by the major disaster declaration.
Bulletin 24-B-15 Relief for Insureds Affected by Tropical Storm Helene
This advisory is for all insurance companies and other entities licensed under Chapter 58 of the North Carolina General Statutes offering health benefit plans to North Carolina residents.
On September 28, 2024, President Biden approved a major disaster declaration for North Carolina. The Federal Emergency Management Agency (FEMA) issued North Carolina Tropical Storm Helene Disaster Declaration (DR-4827-NC) for the following counties:
Alexander, Alleghany, Ashe, Avery, Buncombe, Burke, Caldwell, Catawba, Clay, Cleveland, Gaston, Haywood, Henderson, Jackson, Lincoln, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Transylvania, Watauga, Wilkes, Yancey and the Eastern Band of the Cherokee Indians of North Carolina.
Tropical Storm Helene has had a dramatic impact on the western part of our State. To help those affected by the storm, which includes both insureds and health care providers, I am encouraging insurers and other licensed entities that offer health benefit plans to North Carolina residents to take immediate measures for insureds in the counties covered by the major disaster declaration.
Bulletin 24-B-13 Commissioner of Insurance Order - Tropical Storm Helene
Re: Automatic Stay of Proof of Loss Requirements, Premium and Debt Deferrals During State of Emergency
On September 28, 2024, President Biden approved a major disaster declaration for North Carolina. The Federal Emergency Management Agency (FEMA) issued North Carolina Tropical Storm Helene Disaster Declaration (DR-4827-NC) for the following counties: Alexander, Alleghany, Ashe, Avery, Buncombe, Burke, Caldwell, Catawba, Clay, Cleveland, Gaston, Haywood, Henderson, Jackson, Lincoln, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Transylvania, Watauga, Wilkes, Yancey. The Disaster Declaration also applies to the Eastern Band of the Cherokee Indians of North Carolina.
On September 30, 2024 Insurance Commissioner Causey issued an order that activated the state of disaster automatic stay of proof of loss requirements, and premium and debt deferrals as authorized under the provisions of NCGS § 58-2-46 for residents of Alexander, Alleghany, Ashe, Avery, Buncombe, Burke, Caldwell, Catawba, Clay, Cleveland, Gaston, Haywood, Henderson, Jackson, Lincoln, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Transylvania, Watauga, Wilkes, Yancey counties and to the Eastern Band of the Cherokee Indians of North Carolina.
Pursuant to NCGS § 58-2-46, this bulletin pertains to all insurance companies, including hospital service corporations, HMOs, MEWAs, surplus lines insurers, the underwriting associations defined in NCGS § 58-45-5(1) and NCGS § 58-46-5, premium finance companies, collections agencies, and other persons subject to Chapter 58 of North Carolina General Statutes.
Bulletin 24-B-12 - Extra Rx During State of Emergency
Re: Extra Prescriptions
On September 25, 2024, Governor Cooper issued EXECUTIVE ORDER NO. 315, for the State of North Carolina due Tropical Storm Helene and its likely significant impacts to the State and the southeastern United States. Executive Order 315 declares a state of emergency as defined in N.C.G.S. § 166A-19.3(6) exists in the State of North Carolina and that the emergency area is the entire State of North Carolina.
Pursuant to N.C.G.S. § 58-3-228, this bulletin pertains to all health benefit plans as defined in N.C.G.S. § 58-3-167, the State Health Plan for Teachers and State Employees, and any optional plans or programs operating under Part 2 of Article 3 of Chapter 135 of the General Statutes, and other stand-alone prescription medication plans issued by entities that are licensed by the Department of Insurance.
This bulletin is to remind health benefit plans of compliance requirements for operations under a state of emergency for purposes of obtaining extra prescriptions during a state of emergency or disaster.
Bulletin 24-B-10 - Extra Rx During State of Emergency
Re: Extra Prescriptions
On September 17, 2024, Governor Cooper issued EXECUTIVE ORDER NO. 313, for the emergency area of the following counties: Bladen, Brunswick, Columbus, and New Hanover (“the Emergency Area”). Potential Tropical Cyclone Eight has caused significant flooding and impacts to public and private property and critical infrastructure in the Emergency Area. Executive Order 313 declares a state of emergency as defined in N.C.G.S. §§ 166A-19.3(7) and N.C.G.S. §§ 166A-19.20(b) exists in the State of North Carolina. ("the Emergency Area").
Pursuant to N.C.G.S. §§ 58-3-228, this bulletin pertains to all health benefit plans as defined in N.C.G.S. §§ 58-3-167, the State Health Plan for Teachers and State Employees, and any optional plans or programs operating under Part 2 of Article 3 of Chapter 135 of the General Statutes, and other stand-alone prescription medication plans issued by entities that are licensed by the Department of Insurance.
This bulletin is to remind health benefit plans of compliance requirements for operations under a state of emergency for purposes of obtaining extra prescriptions during a state of emergency or disaster.
Bulletin 24-B-08 - Extra Rx During State of Emergency
Re: Extra Prescriptions
On August 5, 2024, Governor Cooper issued EXECUTIVE ORDER NO. 311, for the State of North Carolina due to Tropical Storm Debby and its anticipated significant weather impact to the State of North Carolina. The impact from the Severe Weather could have a significant impact on public and private property and could seriously disrupt essential utility services and systems. Executive Order 311 declares a state of emergency as defined in N.C.G.S. §§ 166A-19.3(7) and N.C.G.S. §§ 166A-19.20(b) exists in the State of North Carolina. ("the Emergency Area").
Pursuant to N.C.G.S. §§ 58-3-228, this bulletin pertains to all health benefit plans as defined in N.C.G.S. §§ 58‑3‑167, the State Health Plan for Teachers and State Employees, and any optional plans or programs operating under Part 2 of Article 3 of Chapter 135 of the General Statutes, and other stand‑alone prescription medication plans issued by entities that are licensed by the Department of Insurance.
This bulletin is to remind health benefit plans of compliance requirements for operations under a state of emergency for purposes of obtaining extra prescriptions during a state of emergency or disaster.
Bulletin 24-B-01 - Extra Rx During State of Emergency
Re: Extra Prescriptions
On January 8, 2024, Governor Cooper issued EXECUTIVE ORDER NO. 300, for the State of North Carolina due to anticipated severe weather event (“Severe Weather Event”) possible impact on the State of North Carolina. The impact from the Severe Weather could have a significant impact on public and private property and could seriously disrupt essential utility services and systems. Executive Order 300 declares a state of emergency as defined in N.C.G.S. §§ 166A-19.3(7) and N.C.G.S. §§ 166A-19.20(b) exists in the State of North Carolina. ("the Emergency Area").
Pursuant to N.C.G.S. §§ 58-3-228, this bulletin pertains to all health benefit plans as defined in N.C.G.S. §§ 58‑3‑167, the State Health Plan for Teachers and State Employees, and any optional plans or programs operating under Part 2 of Article 3 of Chapter 135 of the General Statutes, and other stand‑alone prescription medication plans issued by entities that are licensed by the Department of Insurance.
This bulletin is to remind health benefit plans of compliance requirements for operations under a state of emergency for purposes of obtaining extra prescriptions during a state of emergency or disaster.
Bulletin 23-B-09 - Extra Rx During State of Emergency
Re: Extra Prescriptions
On November 8, 2023, Governor Cooper issued EXECUTIVE ORDER NO. 293, for the State of North Carolina due to existing and potential wildfires possible impact on the State of North Carolina. The impact from the wildfires could have a significant impact on public and private property and could seriously disrupt essential utility services and systems. Executive Order 293 declares a state of emergency as defined in N.C.G.S. §§ 166A-19.3(7) and N.C.G.S. §§ 166A-19.20(b) exists in the State of North Carolina. ("the Emergency Area").
Pursuant to N.C.G.S. §§ 58-3-228, this bulletin pertains to all health benefit plans as defined in N.C.G.S. §§ 58-3-167, the State Health Plan for Teachers and State Employees, and any optional plans or programs operating under Part 2 of Article 3 of Chapter 135 of the General Statutes, and other stand-alone prescription medication plans issued by entities that are licensed by the Department of Insurance.
This bulletin is to remind health benefit plans of compliance requirements for operations under a state of emergency for purposes of obtaining extra prescriptions during a state of emergency or disaster.
Bulletin 23-B-08 - Extra RX During State of Emergency
Re: Extra Prescriptions
On September 22, 2023, Governor Cooper issued EXECUTIVE ORDER NO. 288, for the State of North Carolina due to Potential Tropical Cyclone Storm Sixteen (“Tropical Storm”) possible impact on the State of North Carolina. The impact from the Tropical Storm could have a significant impact on public and private property and could seriously disrupt essential utility services and systems.
Executive Order 288 declares a state of emergency as defined in N.C.G.S. §§ 166A-19.3(7) and N.C.G.S. §§ 166A-19.20(b) exists in the State of North Carolina. ("the Emergency Area").
Pursuant to N.C.G.S. §§ 58-3-228, this bulletin pertains to all health benefit plans as defined in N.C.G.S. §§ 58-3-167, the State Health Plan for Teachers and State Employees, and any optional plans or programs operating under Part 2 of Article 3 of Chapter 135 of the General Statutes, and other stand-alone prescription medication plans issued by entities that are licensed by the Department of Insurance.
This bulletin is to remind health benefit plans of compliance requirements for operations under a state of emergency for purposes of obtaining extra prescriptions during a state of emergency or disaster.
Bulletin 23-B-06 - Extra RX During State of Emergency
Re: Extra Prescriptions
On August 28, 2023, Governor Cooper issued EXECUTIVE ORDER NO. 284, for the State of North Carolina due to Tropical Storm Idalia’s (“Tropical Storm”) possible impact on the State of North Carolina. The impact from the Tropical Storm could have a significant impact on public and private property and could seriously disrupt essential utility services and systems. Executive Order 284 declares a state of emergency as defined in N.C.G.S. §§ 166A-19.3(7) and N.C.G.S. §§ 166A-19.20(b) exists in the State of North Carolina. ("the Emergency Area").
Executive Order 284 declares a state of emergency as defined in N.C.G.S. §§ 166A-19.3(7) and N.C.G.S. §§ 166A-19.20(b) exists in the State of North Carolina. ("the Emergency Area").
Pursuant to N.C.G.S. § 58-3-228, this bulletin pertains to all health benefit plans as defined in N.C.G.S. § 58-3-167, the State Health Plan for Teachers and State Employees, and any optional plans or programs operating under Part 2 of Article 3 of Chapter 135 of the General Statutes, and other stand-alone prescription medication plans issued by entities that are licensed by the Department of Insurance.
This bulletin is to remind health benefit plans of compliance requirements for operations under a state of emergency for purposes of obtaining extra prescriptions during a state of emergency or disaster.
Bulletin 22- B-11 Extra Prescriptions due to State of Emergency (Released 12-20-2022)
Re: Extra Prescriptions
On December 20, 2022, Governor Cooper issued EXECUTIVE ORDER NO. 274, for the State of North Carolina due to the forecasted threat of a prolonged period of cold weather in the State of North Carolina has increased the demand for drivers of propane and other heating fuels. Due to a shortage of licensed commercial drivers, and the ongoing COVID-19 pandemic and seasonal flu, this state of emergency is essential to enable drivers transporting propane and other heating fuels across the state to do so quickly and efficiently.
Executive Order 247 declares a state of emergency as defined in N.C.G.S. §§ 166A-19.3(7) and N.C.G.S. 166A-19.20(b) exists in the State of North Carolina. ("the Emergency Area").
Pursuant to N.C.G.S. § 58-3-228, this bulletin pertains to all health benefit plans as defined in N.C.G.S. § 58-3-167, the State Health Plan for Teachers and State Employees, and any optional plans or programs operating under Part 2 of Article 3 of Chapter 135 of the General Statutes, and other stand-alone prescription medication plans issued by entities that are licensed by the Department of Insurance.
This bulletin is to remind health benefit plans of compliance requirements for operations under a state of emergency for purposes of obtaining extra prescriptions during a state of emergency or disaster.
Bulletin 22-B-10 - Underwriting for Opioid Antagonist Drugs Such as Naloxone
RE: Underwriting
The N.C. Department of Health and Human Services issued a standing order, most recently on March 24, 2022, authorizing any pharmacist practicing in the State of North Carolina and licensed by the N.C. Board of Pharmacy to dispense Naloxone Hydrochloride (Narcan) to persons who voluntarily request it and are the family member or friend of a person at risk of experiencing an opiate-related overdose, or a person who is in the position to assist a person at risk of experiencing an opiate-related overdose.
The Department of Insurance is issuing this Bulletin to highlight that these prescriptions are different from other prescriptions written, as the medications may be issued to a named individual for use by a different individual or prescribed to specifically prevent illness or disease.
It would negatively affect North Carolina's crucial public health efforts if insurers decline applications, rescind coverage, or charge a person carrying naloxone a higher premium for life insurance, annuity contracts, sickness and accident insurance, and/or disability insurance solely because the applicant had obtained Naloxone Hydrochloride (Narcan) to help respond to opioid overdoses. We expect insurers to carefully consider the reason for and intended user of the prescription prior to issuing an underwriting decision. See N.C. Gen. Stat. § 58-58-35.
Bulletin 22-B-09 - Extra Prescriptions due to a State of Emergency (Released September 28, 2022)
RE: Extra Prescriptions
On September 28, 2022, Governor Cooper issued EXECUTIVE ORDER NO. 270, for the State of North Carolina due to the imminent threat of Hurricane Ian in the State of North Carolina. It is expected that the storm will cause significant damage to public and private property and may seriously disrupt essential utility services and systems in North Carolina. Executive Order 270 declares a state of emergency pursuant to N.C.G.S. §§ 166A-19.10 and N.C.G.S. 166A-19.20 in the entire State of North Carolina. ("the Emergency Area").
Pursuant to N.C.G.S. § 58-3-228, this bulletin pertains to all health benefit plans as defined in N.C.G.S. § 58-3-167, the State Health Plan for Teachers and State Employees, and any optional plans or programs operating under Part 2 of Article 3 of Chapter 135 of the General Statutes, and other stand-alone prescription medication plans issued by entities that are licensed by the Department of Insurance.
This bulletin is to remind health benefit plans of compliance requirements for operations under a state of emergency for purposes of obtaining extra prescriptions during a state of emergency or disaster.
Bulletin 22-B-02 - Extra Prescriptions due to a State of Emergency (Released January 20, 2022)
Re: Extra Prescriptions
On January 19, 2022, Governor Cooper issued EXECUTIVE ORDER NO. 248, for the State of North Carolina due to the imminent threat of a winter storm in the State of North Carolina. It is expected that the storm will cause significant damage to public and private property and may seriously disrupt essential utility services and systems in North Carolina. Executive Order 248 declares a state of emergency as defined in N.C.G.S. §§ 166A-19.3(7) and N.C.G.S. 166A-19.20(b) exists in the entire State of North Carolina. ("the Emergency Area").
Pursuant to N.C.G.S. § 58-3-228, this bulletin pertains to all health benefit plans as defined in N.C.G.S. § 58‑3‑167, the State Health Plan for Teachers and State Employees, and any optional plans or programs operating under Part 2 of Article 3 of Chapter 135 of the General Statutes, and other stand‑alone prescription medication plans issued by entities that are licensed by the Department of Insurance.
This bulletin is to remind health benefit plans of compliance requirements for operations under a state of emergency for purposes of obtaining extra prescriptions during a state of emergency or disaster.
Bulletin 22-B-01 - Extra Prescriptions due to a State of Emergency (Released January 14, 2022)
Re: Extra Prescriptions
On January 14, 2022, Governor Cooper issued EXECUTIVE ORDER NO. 247, for the State of North Carolina due to the imminent threat of a winter storm in the State of North Carolina. It is expected that the storm will cause significant damage to public and private property and may seriously disrupt essential utility services and systems in North Carolina. Executive Order 247 declares a state of emergency as defined in N.C.G.S. §§ 166A-19.3(7) and N.C.G.S. 166A-19.20(b) exists in the State of North Carolina. ("the Emergency Area").
Pursuant to N.C.G.S. § 58-3-228, this bulletin pertains to all health benefit plans as defined in N.C.G.S. § 58‑3‑167, the State Health Plan for Teachers and State Employees, and any optional plans or programs operating under Part 2 of Article 3 of Chapter 135 of the General Statutes, and other stand‑alone prescription medication plans issued by entities that are licensed by the Department of Insurance.
This bulletin is to remind health benefit plans of compliance requirements for operations under a state of emergency for purposes of obtaining extra prescriptions during a state of emergency or disaster.
Bulletin 21-B-09 – COVID-19 - Health benefit plans urged to waive prior authorization (Released August 26, 2021)
Re: COVID-19 Delta Variant Surge
Due to the COVID-19 delta variant surge, in-patient admissions due to the virus are increasing. The North Carolina Department of Health and Human Services (NC DHHS) reports that as of August 25, 2021, 3,552 people are currently hospitalized due to COVID-19. NC DHHS has stated that this increase in hospitalizations is placing extreme pressure on hospital capacity in North Carolina. The North Carolina Department of Insurance (the Department) is issuing this advisory to encourage insurers that offer health benefit plans to North Carolina residents to temporarily waive prior authorization requirements for post-acute care.
Advisory Notice - Permitted Compensation Arrangements for Medicare Supplement 08-26-2024
On August 26, 2024, the Department of Insurance provided clarification regarding permitted compensation arrangements for Medicare Supplement coverage provided in the state of North Carolina.
It has come to the attention of the Department of Insurance that there has been some misunderstanding on the part of some insurers issuing Medicare Supplement policies and certificates in North Carolina regarding agent compensation restrictions placed on the sale of such policies and certificates mandated by the insurance laws of North Carolina.
Advisory Notice - Moore County Electric Power Outage - 12-06-2022
On Saturday, December 3, 2022, many residents of Moore County experienced power outage as a result of what has been described as vandalism to multiple electrical substations.
North Carolina Commissioner of Insurance Mike Causey is working with the insurance industry to ensure that appropriate accommodations are being made for those consumers living in the affected areas of Moore County. Commissioner Causey urges insurers to consider relaxing due dates for premiums payments, extending grace periods, waiving late fees and penalties, and allowing payment plans for premiums payments to otherwise avoid a lapse in coverage for those consumers living in the affected areas of Moore County and surrounding areas.
Affected policyholders should notify their insurance carriers and agents and explain their individual situation and difficulties complying with payment schedules.
Advisory Notice - 2023 Annual Certification - On-site Audit of TPA Operations for Calendar Year 2022
The North Carolina Department of Insurance is issuing this advisory to inform insurers that use the services of Third Party Administrators (TPA) that an on-site audit of TPA operations is required in accordance with NCGS 58-56-26(c) for the annual insurer TPA audit certifications for calendar year 2022 which will be due July 1, 2023. Virtual audits will continue to be acceptable for the annual insurer TPA audit certifications for calendar year 2021, which are due July 1, 2022.
Advisory Notice - North Carolina Life and Health Insurance Guaranty Association - Change of Address 03-18-2022
The North Carolina Department of Insurance is issuing this advisory to communicate the recent address change for the North Carolina Life and Health Insurance Guaranty Association, and to facilitate the administrative change to the required Summary Document.
Advisory Notice - COVID-19 Variant Surge - released 01-10-2022
The North Carolina Department of Insurance is issuing this advisory to encourage insurers that offer health benefit plans to North Carolina residents to take immediate measures related to the COVID-19 variant surge.
2022 ACA Related Topics coming latter part of May.