Current through Register Vol. 63, No. 9, September 1, 2024
(1) "Regulatory Action Level Event" means,
with respect to a health care service contractor, any of the following events:
(a) The filing of an RBC report by the health
care service contractor that indicates that the health care service
contractor's total adjusted capital is greater than or equal to its Authorized
Control Level RBC but less than its Regulatory Action Level RBC;
(b) Notification by the Director to a health
care service contractor of an adjusted RBC report that indicates the event in
subsection (a) of this section, if the health care service contractor does not
challenge the adjusted RBC report under OAR
836-011-0535;
(c) If, pursuant to OAR
836-011-0535, the 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;
(d) The failure of the health care service
contractor to file an RBC report by the filing date, unless the health care
service contractor has provided an explanation for the failure that is
satisfactory to the Director and has cured the failure within ten days after
the filing date;
(e) The failure of
the health care service contractor to submit an RBC plan to the Director within
the time period set forth in OAR
836-011-0515;
(f) Notification by the Director to the
health care service contractor that:
(A) The
RBC plan or revised RBC plan submitted by the health care service contractor
is, in the judgment of the Director, unsatisfactory; and
(B) Notification constitutes a Regulatory
Action Level Event with respect to the health care service contractor, if the
health care service contractor has not challenged the determination under OAR
836-011-0535;
(g) If, pursuant to OAR
836-011-0535, the health care
service contractor challenges a determination by the Director under subsection
(f) of this section, the notification by the Director to the health care
service contractor that the Director has, after a hearing, rejected the
challenge;
(h) Notification by the
Director to the health care service contractor that the health care service
contractor 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
care service contractor to eliminate the Company Action Level Event in
accordance with its RBC plan or revised RBC plan and the Director has so stated
in the notification, if the health care service contractor has not challenged
the determination under OAR
836-011-0535; or
(i) If, pursuant to OAR
836-011-0535, the health care
service contractor challenges a determination by the Director under subsection
(h) of this section, the notification by the Director to the health care
service contractor that the Director has, after a hearing, rejected the
challenge.
(2) In the
event of a Regulatory Action Level Event the Director shall:
(a) Require the health care service
contractor to prepare and submit an RBC plan or, if applicable, a revised RBC
plan;
(b) Perform such examination
or analysis as the Director deems necessary of the assets, liabilities and
operations of the health care service contractor including a review of its RBC
plan or revised RBC plan; and
(c)
Subsequent to the examination or analysis, issue an order specifying such
corrective actions as the Director shall determine are required (a "corrective
order").
(3) In
determining corrective actions, the Director may take into account factors the
Director deems relevant with respect to the health care service contractor
based upon the Director's examination or analysis of the assets, liabilities
and operations of the health care service contractor, 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:
(a) Within 45 days after the occurrence of
the Regulatory Action Level Event;
(b) If the health care service contractor
challenges an adjusted RBC report pursuant to OAR
836-011-0535 and the challenge
is not frivolous in the judgment of the Director within 45 days after the
notification to the health care service contractor that the Director has, after
a hearing, rejected the health care service contractor's challenge;
or
(c) If the health care service
contractor challenges a revised RBC plan pursuant to OAR
836-011-0535 and the challenge
is not frivolous in the judgment of the Director, within 45 days after the
notification to the health care service contractor that the care service
contractor has, after a hearing, rejected the health care service contractor's
challenge.
(4) The
Director may retain actuaries and investment experts and other consultants as
may be necessary in the judgment of the Director to review the health care
service contractor's RBC plan or revised RBC plan, examine or analyze the
assets, liabilities and operations (including contractual relationships) of the
health care service contractor and formulate the corrective order with respect
to the health care service contractor. The fees, costs and expenses relating to
consultants shall be borne by the affected health care service contractor or
such other party as directed by the Director.
Stat. Auth.: ORS
731.244, ORS
750.045
Stats. Implemented: ORS
731.574, ORS
733.210, ORS
750.045
