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COMMISSIONER'S BULLETIN # B-0040-08

July 24, 2008


To: ALL INSURERS LICENSED TO WRITE LIFE AND ACCIDENT AND HEALTH INSURANCE, HEALTH MAINTENANCE ORGANIZATIONS, AGENTS, THIRD PARTY ADMINISTRATORS, UTILIZATION REVIEW AGENTS, PREMIUM FINANCE COMPANIES; ANDMEWAS LICENSED IN TEXAS


Re: Hurricane Dolly - State of Emergency - An Extraordinary Event - Out-of-Network Services Claim Filing Deadlines and Catastrophic Events Preauthorized Health Care, Referrals, Notification of Hospital Admissions, Medical Necessity Reviews

On July 22, 2008, Governor Rick Perry issued a proclamation declaring a disaster due to the effects of Tropical Storm Dolly, certifying that Tropical Storm Dolly poses a threat of imminent disaster to Aransas, Bexar, Brooks, Calhoun, Cameron, Hidalgo, Jim Wells, Kenedy, Kleberg, Nueces, Refugio, San Patricio, Victoria and Willacy counties beginning July 22, 2008, and directing that all necessary measures both public and private as authorized under §418.017 of the Texas Government Code be implemented to meet that threat. The proclamation also states that, as provided in §418.016 of the Texas Government Code, all rules and regulations that may inhibit or prevent prompt response to this threat are suspended for the duration of the incident.

Tropical Storm Dolly made landfall as a Category 2 hurricane. Because of the potential storm damage to local, regional and state-wide utilities and infrastructure, many insureds, and enrollees could be forced to evacuate their residence locations and health care service areas. Restrictions on insureds and enrollees will result in many storm victims being without necessary health care or dental services. Insureds and enrollees should not be left without their necessary health care or dental services during a disaster or threat of imminent disaster. Under these circumstances, it is the opinion of the Texas Department of Insurance that all health insurance companies and health maintenance organizations should waive penalties and restrictions on insureds, certificate holders, or enrollees, when these insureds, certificate holders, or enrollees obtain necessary emergency and non-emergency health and dental services out-of-network as a result of the disaster through the duration of the Governor's disaster proclamation. Further, the Texas Department of Insurance determines that health insurance companies and health maintenance organizations should not deny payment for necessary emergency and non-emergency health and dental services that are obtained out-of-network as a result of the threat of imminent disaster through the duration of the Governor's disaster proclamation.

The storm damage will also impact physicians and providers, both in the areas that are subject to evacuation requirements and in the areas to which evacuees are relocated, thus affecting the provision of health care services and the submission of claims for those services. Insureds, certificate holders, and enrollees should have access to necessary health care and dental services during a disaster and physicians and providers should be able to provide such care and services without concern for applicable claim filing deadlines. Under these circumstances, the Texas Department of Insurance is of the opinion that all health insurance companies and health maintenance organizations, preferred provider plans, and dental plans should extend, as necessary, through the duration of the Governor's disaster proclamation, any claim filing deadlines for providers, insureds, certificate holders, or enrollees, including those set forth in Insurance Code §§1301.102 and 843.337(a) and 28 Texas Administrative Code §21.2806(a).

The Texas Department of Insurance also reminds insurance companies and health maintenance organizations subject to the prompt payment of claims provisions of the Texas Insurance Code and the Texas Administrative Code relating to catastrophic events. These provisions allow payors that experience a catastrophic event to toll applicable prompt payment deadlines upon communicating to the department the occurrence and circumstances of a catastrophic event. The payor's initial notice should be in writing and addressed to the Filings Intake Division - Mail Code 106-1E, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78701-9104.

In addition, the damage to infrastructure and the increased need for health care services may frustrate the ability of insureds or enrollees to comply with health plan contractual provisions, which could result in many hurricane victims being without the health care or dental services necessary for their health. Insureds and enrollees should not be left without their necessary health care or dental services during a disaster. Under these circumstances, the Texas Department of Insurance is of the opinion that all insurance companies and health maintenance organizations should waive contractual restrictions that require insureds, certificate holders, or enrollees to obtain preauthorization, referrals, notification of hospital admissions, and medical necessity reviews for specified health care or dental services through the duration of the Governor's disaster proclamation.

Questions regarding this bulletin may be directed to the following:

Life/Health Division at (512) 322-3409 or e-mail: life_health@tdi.state.tx.us

Health and WC Network Certification & QA Division at (512) 322-4266 or e-mail: hmogrp@tdi.state.tx.us

Mike Geeslin

Commissioner of Insurance



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Last updated: 09/15/2014

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