Current through Register Vol. 56, No. 24, December 18, 2024
(a) "Regulatory action level event" means,
with respect to a health organization, any of the following events:
1. The filing of an RBC report by the health
organization that indicates that the health organization's total adjusted
capital is greater than or equal to its Authorized Control Level RBC but less
than its Regulatory Action Level RBC;
2. The notification by the Commissioner to a
health organization of an adjusted RBC report that indicates the event in (a)1
above, provided the health organization does not challenge the adjusted RBC
report under
N.J.A.C.
11:2-39A.9;
3. If the health organization, pursuant to
N.J.A.C.
11:2-39A.9, challenges an adjusted RBC report
that indicates the event in (a)1 above, the notification by the Commissioner to
the health organization that the Commissioner has, after a hearing, rejected
the health organization's challenge;
4. The failure of the health organization to
file an RBC report by the filing date, unless the health organization has
provided an explanation for the failure that is satisfactory to the
Commissioner and has cured the failure within 10 days after the filing
date;
5. The failure of the health
organization to submit an RBC plan to the Commissioner within the time period
set forth in
N.J.A.C.
11:2-39A.4(b) and
(c);
6. The notification by the Commissioner to
the health organization that:
i. The RBC plan
or revised RBC plan submitted by the health organization is, in the judgment of
the Commissioner, unsatisfactory; and
ii. Such notification constitutes a
regulatory action level event with respect to the health organization, provided
the health organization has not challenged the determination under
N.J.A.C.
11:2-39A.9;
7. If the health organization, pursuant to
N.J.A.C.
11:2-39A.9, challenges a determination by the
Commissioner under (a)6 above, the notification by the Commissioner to the
health organization that the Commissioner has, after a hearing, rejected the
challenge;
8. Notification by the
Commissioner to the health organization that the health organization has failed
to adhere to its RBC plan or revised RBC plan, but only if the failure has a
substantial adverse effect on the ability of the health organization to
eliminate the company action level event in accordance with its RBC Plan or
Revised RBC Plan and the Commissioner has so stated in the notification,
provided the health organization has not challenged the determination under
N.J.A.C.
11:2-39A.9; or
9. If the health organization, pursuant to
N.J.A.C.
11:2-39A.9, challenges a determination by the
Commissioner under (a)8 above, the notification by the Commissioner to the
health organization that the Commissioner has, after a hearing, rejected the
challenge.
(b) In the
event of a regulatory action level event, the Commissioner shall:
1. Require the health organization to prepare
and submit an RBC plan or, if applicable, a revised RBC plan;
2. Perform such examination or analysis as
the Commissioner deems necessary of the assets, liabilities, and operations of
the health organization, including a review of its RBC plan or revised RBC
plan; and
3. Subsequent to the
examination or analysis, issue an order specifying such corrective actions as
the Commissioner shall determine are required (a "corrective order").
(c) In determining corrective
actions, the Commissioner may take into account factors the Commissioner deems
relevant with respect to the health organization based upon the Commissioner's
examination or analysis of the assets, liabilities, and operations of the
health organization, including, but not limited to, the results of any
sensitivity tests undertaken pursuant to the RBC Instructions. The RBC plan or
revised RBC plan shall be submitted:
1.
Within 45 days after the occurrence of the regulatory action level
event;
2. If the health
organization challenges an adjusted RBC report pursuant to
N.J.A.C.
11:2-39A.9 and the challenge is not frivolous
in the judgment of the Commissioner, within 45 days after the notification to
the health organization that the Commissioner has, after a hearing, rejected
the health organization's challenge; or
3. If the health organization challenges a
revised RBC plan pursuant to
N.J.A.C.
11:2-39A.9 and the challenge is not frivolous
in the judgment of the Commissioner, within 45 days after the notification to
the health organization that the Commissioner has, after a hearing, rejected
the health organization's challenge.
(d) The Commissioner may retain actuaries and
investment experts and other consultants as may be necessary in the judgment of
the Commissioner to review the health organization's RBC plan or revised RBC
plan, examine or analyze the assets, liabilities, and operations (including
contractual relationships) of the health organization and formulate the
corrective order with respect to the health organization. The fees, costs, and
expenses relating to consultants shall be borne by the affected health
organization or such other party as directed by the Commissioner.
