Current through Register Vol. 49, No. 6, March 15, 2024
PURPOSE: This rule effectuates or aids in the
interpretation of sections
354.470,
375.537,
375.539,
375.881, 375.1160, 375.1165, and 375.1175, RSMo, and in the administration of
sections
354.080
and
354.355,
RSMo.
(1) Each insurance
company shall make and file statements of its assets, liabilities, capital and
surplus, income and expenses, including all schedules and exhibits used in
connection with such statements, which statements the director may use to
determine any of the following according to the applicable accounting guidance,
standards, and principles approved by the National Association of Insurance
Commissioners (NAIC), published in the Accounting Practices and Procedures
Manual, Annual Statement Instructions, Valuation of Securities, Examiner's
Handbook, and Financial Analysis Handbook, except where the applicable
provisions of Chapters 374- 385, RSMo or other specific rules expressly provide
otherwise:
(A) Whether an insurance company
is impaired under section
375.537,
RSMo;
(B) Whether any standards are
implicated under section 375.539.2, RSMo;
(C) Whether an insurance company is insolvent
under section
375.881(1)
or
375.1175.1(2),
RSMo;
(D) Whether an insurance
company fails to comply with the requirements for admission under section
375.881(2),
RSMo;
(E) Whether an insurance
company is in such a financial condition that its further transaction of
business in this state would be hazardous to policyholders and creditors in
this state and to the public under section
375.881(3),
RSMo;
(F) Whether an insurance
company's condition renders the continuance of its business hazardous to the
public or to its insureds under section 375.1160.2(1)(a), RSMo;
(G) Whether an insurance company is in such
condition that the further transaction of business would be hazardous
financially to its policyholders, creditors, or the public under section
375.1165(1),
RSMo; and
(H) Whether an insurance
company is found to be in such condition that the further transaction of
business would be hazardous, financially or otherwise, to its policyholders,
its creditors or the public under section 375.1175.1(3),
RSMo.
(2) Each health
services corporation shall make and file statements of its assets, liabilities,
capital and surplus, income and expenses, including all schedules and exhibits
used in connection with such statements, which statements the director may use
to determine any of the following according to the applicable accounting
guidance, standards, and principles approved by the NAIC, published in the
Accounting Practices and Procedures Manual, Annual Statement Instructions,
Valuation of Securities, Examiner's Handbook, and Financial Analysis Handbook,
except where the applicable provisions of Chapters 354 and 374-385, RSMo or
other specific rules expressly provide otherwise:
(A) Whether a health services corporation is
maintaining reserves in accordance with section
354.080,
RSMo;
(B) Whether a health services
corporation is in such condition that its further transaction of business will
be hazardous to its policyholders or to its creditors or to the public under
section
354.355(3),
RSMo;
(C) Whether a health services
corporation is impaired under section
375.537,
RSMo;
(D) Whether any standards are
implicated under section 375.539.2, RSMo;
(E) Whether a health services corporation's
condition renders the continuance of its business hazardous to the public or to
its insureds under section 375.1160.2(1)(a), RSMo;
(F) Whether a health services corporation is
in such condition that the further transaction of business would be hazardous
financially to its policyholders, creditors, or the public under section
375.1165(1),
RSMo;
(G) Whether a health services
corporation is insolvent under section 375.1175.1(2), RSMo; and
(H) Whether a health services corporation is
found to be in such condition that the further transaction of business would be
hazardous, financially or otherwise, to its policyholders, its creditors, or
the public under section 375.1175.1(3), RSMo.
(3) Each health maintenance organization
shall make and file statements of its assets, liabilities, capital and surplus,
income and expenses, including all schedules and exhibits used in connection
with such statements, which statements the director may use to determine any of
the following according to the applicable accounting guidance, standards, and
principles approved by the NAIC, published in the Accounting Practices and
Procedures Manual, Annual Statement Instructions, Valuation of Securities,
Examiner's Handbook, and Financial Analysis Handbook, except where the
applicable provisions of Chapters 354 and 374-385, RSMo or other specific rules
expressly provide otherwise:
(A) Whether a
health maintenance organization is no longer financially responsible and may
reasonably be expected to be unable to meet its obligations to enrollees or
prospective enrollees under section 354.470.1(4), RSMo;
(B) Whether the continued operation of a
health maintenance organization would be hazardous to its enrollees under
section 354.470.1(8), RSMo;
(C)
Whether a health maintenance organization is impaired under section
375.537,
RSMo;
(D) Whether any standards are
implicated under section 375.539.2, RSMo;
(E) Whether a health maintenance
organization's condition renders the continuance of its business hazardous to
the public or to its insureds under section 375.1160.2(1)(a), RSMo;
(F) Whether a health maintenance organization
is in such condition that the further transaction of business would be
hazardous financially to its policyholders, creditors, or the public under
section
375.1165(1),
RSMo;
(G) Whether a health
maintenance organization is insolvent under section 375.1175.1(2), RSMo;
and
(H) Whether a health
maintenance organization is found to be in such condition that the further
transaction of business would be hazardous, financially or otherwise, to its
policyholders, its creditors, or the public under section 375.1175.1(3),
RSMo.
*Original authority: 354.120, RSMo 1973, amended 1983,
1993, 1995; 354.485, RSMo 1983; and 374.045, RSMo 1967, amended 1993,
1995.
