Oklahoma § 36-6940 - Company action level event - Definition - Submission of

§ 36-6940. Company action level event - Definition - Submission of

RBC plan - Insurance Commissioner's determination - Notice and

hearing.

A. “Company Action Level Event” means any of the following

events:

1. The filing of an RBC report by a health maintenance

organization that indicates that the health maintenance

organization’s total adjusted capital is greater than or equal to

Oklahoma Statutes - Title 36. Insurance

its Regulatory Action Level RBC, but less than its Company Action

Level RBC;

2. Notification by the Insurance Commissioner to the health

maintenance organization of an adjusted RBC report that indicates an

event in paragraph 1 of this subsection, provided the health

maintenance organization does not challenge the adjusted RBC report

under Section 6944 of this title;

3. If, pursuant to the provisions of Section 6944 of this

title, a health maintenance organization challenges an adjusted RBC

report that indicates the event in paragraph 1 of this subsection,

the notification by the Commissioner to the health maintenance

organization that the Commissioner has, after a hearing, rejected

the health maintenance organization’s challenge; or

4. If a health maintenance organization has total adjusted

capital which 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. In the event of a Company Action Level Event, the health

maintenance organization shall prepare and submit to the

Commissioner an RBC plan that shall:

1. Identify the conditions that contribute to the Company

Action Level Event;

2. Contain proposals of corrective actions that the health

maintenance organization intends to take and that would be expected

to result in the elimination of the Company Action Level Event;

3. Provide projections of the health maintenance organization’s

financial results in the current year and at least the two (2)

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;

4. Identify the key assumptions affecting the health

maintenance organization’s projections and the sensitivity of the

projections to the assumptions; and

5. Identify the quality of, and problems associated with, the

health maintenance organization’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.

C. The RBC plan shall be submitted:

1. Within forty-five (45) days of the Company Action Level

Event; or

Oklahoma Statutes - Title 36. Insurance

2. If the health maintenance organization challenges an

adjusted RBC report pursuant to the provisions of Section 6944 of

this title, within forty-five (45) days after notification to the

health maintenance organization that the Commissioner has, after a

hearing, rejected the health maintenance organization’s challenge.

D. Within sixty (60) days after the submission by a health

maintenance organization of an RBC plan to the Commissioner, the

Commissioner shall notify the health maintenance organization

whether the RBC plan will be implemented or whether, in the judgment

of the Commissioner, the RBC plan is unsatisfactory. If the

Commissioner determines that the RBC plan is unsatisfactory, the

notification to the health maintenance organization shall state the

reasons for the determination, and may list proposed revisions that

will, in the judgment of the Commissioner, render the RBC plan

satisfactory. Upon notification from the Commissioner, the health

maintenance organization shall prepare a revised RBC plan, that may

incorporate by reference any revisions proposed by the Commissioner,

and shall submit the revised RBC plan to the Commissioner:

1. Within forty-five (45) days after the notification from the

Commissioner; or

2. If the health maintenance organization challenges the

notification from the Commissioner pursuant to the provisions of

Section 6944 of this title, within forty-five (45) days after a

notification to the health maintenance organization that the

Commissioner has, after a hearing, rejected the health maintenance

organization’s challenge.

E. In the event of a notification by the Commissioner to a

health maintenance organization that the health maintenance

organization’s RBC plan or revised RBC plan is unsatisfactory, the

Commissioner may, at the Commissioner’s discretion and subject to

the health maintenance organization’s right to a hearing pursuant to

the provisions of Section 6944 of this title, specify in the

notification that the notification constitutes a Regulatory Action

Level Event.

F. Every domestic health maintenance organization that files an

RBC plan or revised RBC plan with the Commissioner shall file a copy

of the RBC plan or revised RBC plan with the Insurance Commissioner

in any state in which the health maintenance organization is

authorized to do business if:

1. The state has an RBC provision substantially similar to

subsection A of Section 6945 of this title; and

2. The Insurance Commissioner of that state has notified the

health maintenance organization of its request for the filing in

writing, in which case the health maintenance organization shall

file a copy of the RBC plan or revised RBC plan in that state no

later than the later of:

Oklahoma Statutes - Title 36. Insurance

a.

fifteen (15) 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 subsections C and D of this section.

Added by Laws 2003, c. 197, § 40, eff. Nov. 1, 2003. Amended by

Laws 2011, c. 278, § 53, eff. Nov. 1, 2011.