CurrentNorth Carolina Department of InsurancePolicy N/A

Additional Relief for Insureds Affected by Tropical Storm Helene

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Advisory to insurance companies and entities licensed under Chapter 58 offering health benefit plans to North Carolina residents, describing temporary relief measures and operational expectations for insurers and providers in counties covered by FEMA's Tropical Storm Helene disaster declaration.

Policy Summary

PayerNorth Carolina Department of Insurance

PolicyAdditional Relief for Insureds Affected by Tropical Storm Helene

Policy CodePolicy N/A

Change TypeOperational advisory (temporary relief measures)

Effective DateOct 9, 2024

Last ReviewNov 14, 2024

Next Review DateN/A

Key ActionDefer prior-authorization time limits for medications under the Commissioner's deferral period (G.S. § 58-246(a)(2)).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

30pharmacy audit suspension (days)

30Medicare Supplement extension (days)

DR-4827-NCFEMA declaration

27+affected counties

Requested Temporary Relief and Operational Expectations

Requested temporary relief and operational steps

Requested insurer actions for affected counties under the FEMA declaration DR-4827-NC:

Apply the Commissioner's deferral period under G.S. § 58-246(a)(2) to defer any statutory, contractual, or policy time limits for insurers, insureds, claimants, or customers located in the declared area; this deferral does not require a request to defer and includes transmittal of information and communications, and insurers must ensure prior authorization timelines for medications are deferred in accordance with the Commissioner's order.

Temporarily extend Medicare Supplement open enrollment by at least 30 days for any Medicare beneficiary whose six-month Medicare Supplement open enrollment period would end on or after September 29, 2024 through October 31, 2024, allowing additional time to enroll without medical underwriting.

Direct contracted pharmacy benefit managers, third-party administrators, or other entities that conduct pharmacy audits to immediately suspend pharmacy audits in the affected counties for at least 30 days to allow providers to focus on insureds and recovery.

Continue to communicate to the Department any actions insurers are taking to help insureds in the affected counties so the Department can respond to consumer inquiries.

Exclude entities licensed as prepaid health plans under Article 93 of Chapter 58 from this advisory; those prepaid health plans should follow guidance from the North Carolina Department of Health and Human Services.

Deferral of Time Limits and Prior Authorizations

Prior Authorization

Deferral of time limits and prior authorizations (G.S. § 58-246(a)(2))

When the Commissioner activates the deferral period under G.S. § 58-246(a)(2), insurers must defer any time limits that would require an insurer, insured, claimant, or customer to perform acts during the declared period without requiring a request to defer. This includes deferring time limits for prior authorizations for medications and transmittal of information or communications tied to insurance policies, premium finance agreements, debt instruments, or policy/contract provisions for individuals located in the designated area.

Do not require insureds, claimants, or customers to submit a request to defer—deferral is automatic for those residing or located in the designated area.
Ensure prior authorization timelines for medications are deferred in accordance with the Commissioner’s order activating G.S. § 58-246(a)(2).
Defer deadlines for transmittal of information and communications related to insurance policies, premium finance agreements, or debt instruments for affected individuals.
Apply the deferral to any time limitations imposed on insurers by policy/contract terms or law for individuals in the declared area.

Defined Terms Used in This Advisory

inv-03: Deferral period (G.S. § 58-246(a)(2))

DefinitionCommissioner-activated deferral period under G.S. § 58-246(a)(2) that automatically defers time limits imposed by statutes, rules, policies, contracts, premium finance agreements, or debt instruments for persons located in the declared area without requiring a request to defer.

Scope — who is coveredApplies to insurers, insureds, claimants, or customers who reside or are located in the designated area of the proclamation or declaration.

Scope — what is deferredAny time limits to perform acts (including transmittal of information and communications) required by statute, rule, policy, or contract, and time limitations imposed on insurers under policy terms or law.

Effect on prior authorizationsInsurers must ensure that prior authorization time limits for medications and similar time-sensitive insurer actions are deferred consistent with the Commissioner’s order activating G.S. § 58-246(a)(2).

No request requiredThe deferral operates automatically for those located in the designated area and does not require the insured or claimant to request the deferral.

inv-04: Medicare Supplement open enrollment

DefinitionSix-month period following enrollment in Medicare Part B during which beneficiaries may enroll in a Medicare Supplement plan without medical underwriting.

Requested temporary extensionFor any beneficiary whose Medicare Supplement open enrollment would end on or after September 29, 2024 through October 31, 2024, the Department requests a temporary extension of the open enrollment period for at least 30 days from the date it would have expired.

PurposeTo allow affected beneficiaries who are currently unable to enroll because of the disaster to complete enrollment without loss of guaranteed-issue protections.

ApplicabilityApplies to Medicare beneficiaries in the declared/affected area whose six-month open enrollment window would otherwise expire during the specified date range.

Policy Summary

PayerNorth Carolina Department of Insurance

PolicyAdditional Relief for Insureds Affected by Tropical Storm Helene

Policy CodePolicy N/A

Change TypeOperational advisory (temporary relief measures)

Effective DateOct 9, 2024

Last ReviewNov 14, 2024

Next Review DateN/A

Key ActionDefer prior-authorization time limits for medications under the Commissioner's deferral period (G.S. § 58-246(a)(2)).

SourceLink

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Additional Relief for Insureds Affected by Tropical Storm Helene

Customize your policy alerts

Sign up for all North Carolina Department of Insurance policy alerts

Know when North Carolina Department of Insurance releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Requested Temporary Relief and Operational Expectations

Requested temporary relief and operational steps

Requested insurer actions for affected counties under the FEMA declaration DR-4827-NC:

Continue to communicate to the Department any actions insurers are taking to help insureds in the affected counties so the Department can respond to consumer inquiries.

Deferral of Time Limits and Prior Authorizations

Prior Authorization

Deferral of time limits and prior authorizations (G.S. § 58-246(a)(2))

Do not require insureds, claimants, or customers to submit a request to defer—deferral is automatic for those residing or located in the designated area.
Ensure prior authorization timelines for medications are deferred in accordance with the Commissioner’s order activating G.S. § 58-246(a)(2).
Defer deadlines for transmittal of information and communications related to insurance policies, premium finance agreements, or debt instruments for affected individuals.
Apply the deferral to any time limitations imposed on insurers by policy/contract terms or law for individuals in the declared area.

Defined Terms Used in This Advisory

inv-03: Deferral period (G.S. § 58-246(a)(2))

Scope — who is coveredApplies to insurers, insureds, claimants, or customers who reside or are located in the designated area of the proclamation or declaration.

No request requiredThe deferral operates automatically for those located in the designated area and does not require the insured or claimant to request the deferral.

inv-04: Medicare Supplement open enrollment

DefinitionSix-month period following enrollment in Medicare Part B during which beneficiaries may enroll in a Medicare Supplement plan without medical underwriting.

PurposeTo allow affected beneficiaries who are currently unable to enroll because of the disaster to complete enrollment without loss of guaranteed-issue protections.

ApplicabilityApplies to Medicare beneficiaries in the declared/affected area whose six-month open enrollment window would otherwise expire during the specified date range.