Or. Admin. Code § 836-011-0520

Current through Register Vol. 63, No. 11, November 1, 2024

Section 836-011-0520 - Regulatory Action Level Event

(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.

Or. Admin. Code § 836-011-0520

ID 22-2002, f. & cert. ef. 11-27-02

Stat. Auth.: ORS 731.244, ORS 750.045

Stats. Implemented: ORS 731.574, ORS 733.210, ORS 750.045