Current through Register Vol. 63, No. 9, September 1, 2024
(1) "Company Action Level Event" means any of
the following events:
(a)
(A) The filing of an RBC report by a health
care service contractor that indicates that the health care service
contractor's total adjusted capital is greater than or equal to its Regulatory
Action Level RBC but less than its Company Action Level RBC; or
(B) If a health care service contractor has
total adjusted capital that is greater than or equal to its Company Action
Level RBC but less than the product of its Authorized Control Level RBC and 3.0
and triggers the trend test determined in accordance with the trend test
calculation included in the Health RBC instructions;
(b) Notification by the Director to the
health care service contractor of an adjusted RBC report that indicates an
event in subsection (a) of this subsection, if the health care service
contractor does not challenge the adjusted RBC report under OAR
836-011-0535; or
(c) If, pursuant to OAR
836-011-0535, a health care
service contractor challenges an adjusted RBC report that indicates the event
in subsection (a) of this section, the notification by the Director to the
health care service contractor that the Director has, after a hearing, rejected
the health care service contractor's challenge.
(2) In the event of a Company Action Level
Event, the health care service contractor shall prepare and submit to the
Director an RBC plan that shall:
(a) Identify
the conditions that contribute to the Company Action Level Event;
(b) Contain proposals of corrective actions
that the health care service contractor intends to take and that would be
expected to result in the elimination of the Company Action Level
Event;
(c) Provide projections of
the health care service contractor's financial results in the current year and
at least the two succeeding years, both in the absence of proposed corrective
actions and giving effect to the proposed corrective actions, including
projections of statutory balance sheets, operating income, net income, capital
and surplus, and RBC levels. The projections for both new and renewal business
might include separate projections for each major line of business and
separately identify each significant income, expense and benefit
component;
(d) Identify the key
assumptions impacting the health care service contractor's projections and the
sensitivity of the projections to the assumptions; and
(e) Identify the quality of, and problems
associated with, the health care service contractor's business, including but
not limited to its assets, anticipated business growth and associated surplus
strain, extraordinary exposure to risk, mix of business and use of reinsurance,
if any, in each case.
(3) The RBC plan shall be submitted
(a) Within 45 days of the Company Action
Level Event; or
(b) If the health
care service contractor challenges an adjusted RBC report pursuant to OAR
836-011-0535, within 45 days
after notification to the health care service contractor that the Director has,
after a hearing, rejected the health care service contractor's
challenge.
(4) Within 60
days after the submission by a health care service contractor of an RBC plan to
the Director, the Director shall notify the health care service contractor
whether the RBC plan shall be implemented or is, in the judgment of the
Director, unsatisfactory. If the Director determines the RBC plan is
unsatisfactory, the notification to the health care service contractor shall
set forth the reasons for the determination and may set forth proposed
revisions that will render the RBC plan satisfactory, in the judgment of the
Director. Upon notification from the Director, the health care service
contractor shall prepare a revised RBC plan, which may incorporate by reference
any revisions proposed by the Director, and shall submit the revised RBC plan
to the Director:
(a) Within 45 days after the
notification from the Director; or
(b) If the health care service contractor
challenges the notification from the Director under OAR
836-011-0535, within 45 days
after a notification to the health care service contractor that the Director
has, after a hearing, rejected the health care service contractor's
challenge.
(5) In the
event of a notification by the Director to a health care service contractor
that the health care service contractor's RBC plan or revised RBC plan is
unsatisfactory, the Director may at the Director's discretion, subject to the
health care service contractor's right to a hearing under OAR
836-011-0535, specify in the
notification that the notification constitutes a Regulatory Action Level
Event.
(6) Every domestic health
care service contractor that files an RBC plan or revised RBC plan with the
Director shall file a copy of the RBC plan or revised RBC plan with the
insurance commissioner in any state in which the health care service contractor
is authorized to do business if:
(a) The state
has an RBC provision substantially similar to ORS
731.752; and
(b) The insurance commissioner of that state
has notified the health care service contractor of its request for the filing
in writing, in which case the health care service contractor shall file a copy
of the RBC plan or revised RBC plan in that state no later than the later of:
(A) Fifteen days after the receipt of notice
to file a copy of its RBC plan or revised RBC plan with the state; or
(B) The date on which the RBC plan or revised
RBC plan is filed under sections (3) and (4) of this rule.
Stat. Auth.: ORS
731.244 &
750.045
Stats. Implemented: ORS
731.574,
733.210 &
750.045
