Oklahoma § 36-6941 - Regulatory action level event - Definition - Duties of

§ 36-6941. Regulatory action level event - Definition - Duties of

Insurance Commissioner - Challenge to adjusted RBC report or revised

RBC plan - Use of actuaries, investment experts and other

consultants.

A. “Regulatory Action Level Event” means, with respect to a

health maintenance organization, any of the following events:

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

organization that indicates that the health maintenance

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. Notification by the Commissioner to a health maintenance

organization of an adjusted RBC report that indicates a Regulatory

Action Level Event specified in paragraph 1 of this subsection,

provided the health maintenance organization does not challenge the

adjusted RBC report under Section 44 of this act;

3. If, pursuant to the provisions of Section 44 of this act,

the health maintenance organization challenges an adjusted RBC

report that indicates a Regulatory Action Level Event specified

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;

4. The failure of the health maintenance organization to file

an RBC report by the filing date, unless the health maintenance

organization has provided an explanation for the failure that is

satisfactory to the Commissioner and has corrected the failure

within ten (10) days after the filing date;

5. The failure of the health maintenance organization to submit

an RBC plan to the Commissioner within the time period provided in

subsection C of Section 40 of this act;

6. Notification by the Commissioner to the health maintenance

organization that:

a.

the RBC plan or revised RBC plan submitted by the

health maintenance organization is, in the judgment of

the Commissioner, unsatisfactory, and

b.

notification constitutes a Regulatory Action Level

Event with respect to the health maintenance

organization, provided the health maintenance

Oklahoma Statutes - Title 36. Insurance

organization has not challenged the determination

under Section 44 of this act;

7. If, pursuant to the provisions of Section 44 of this act,

the health maintenance organization challenges a determination by

the Commissioner under paragraph 6 of this subsection, the

notification by the Commissioner to the health maintenance

organization that the Commissioner has, after a hearing, rejected

the challenge;

8. Notification by the Commissioner to the health maintenance

organization that the health maintenance 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

maintenance 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

maintenance organization has not challenged the determination under

Section 44 of this act; or

9. If, pursuant to the provisions of Section 44 of this act,

the health maintenance organization challenges a determination by

the Commissioner under paragraph 8 of this subsection, the

notification by the Commissioner to the health maintenance

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 maintenance organization to prepare and

submit an RBC plan or, if applicable, a revised RBC plan;

2. Perform such examination or analysis of the assets,

liabilities and operations of the health maintenance organization as

the Commissioner deems necessary, including a review of the HMO’s

RBC plan or revised RBC plan; and

3. Subsequent to the examination or analysis, issue a

corrective order specifying such corrective actions as the

Commissioner shall determine are required.

C. In determining corrective actions, the Commissioner may take

into account factors the Commissioner deems relevant with respect to

the health maintenance organization based upon the Commissioner’s

examination or analysis of the assets, liabilities and operations of

the health maintenance 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 forty-five (45) days after the occurrence of the

Regulatory Action Level Event;

2. If the health maintenance organization challenges an

adjusted RBC report pursuant to the provisions of Section 44 of this

act and the challenge is not frivolous, in the judgment of the

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

Oklahoma Statutes - Title 36. Insurance

the health maintenance organization that the Commissioner has, after

a hearing, rejected the health maintenance organization’s challenge;

or

3. If the health maintenance organization challenges a revised

RBC plan pursuant to the provisions of Section 44 of this act and

the challenge is not frivolous, in the judgment of the Commissioner,

within forty-five (45) days after the notification to the health

maintenance organization that the Commissioner has, after a hearing,

rejected the health maintenance organization’s challenge.

D. The Commissioner may retain such actuaries, investment

experts and other consultants as may be necessary, in the judgment

of the Commissioner, to review the health maintenance organization’s

RBC plan or revised RBC plan, examine or analyze the assets,

liabilities and operations, including contractual relationships of

the health maintenance organization, and formulate the corrective

order with respect to the health maintenance organization. The

fees, costs and expenses relating to consultants shall be borne by

the affected health maintenance organization or such other party as

directed by the Commissioner.

Added by Laws 2003, c. 197, § 41, eff. Nov. 1, 2003.