As Reported by House Insurance Committee 1
123rd General Assembly 4
Regular Session Am. H. B. No. 714 5
1999-2000 6
REPRESENTATIVES EVANS-NETZLEY-GOODMAN-BRITTON-JONES- 8
SMITH-BENDER-SCHURING-JOLIVETTE-WILLAMOWSKI-CLANCY- 9
GARDNER-HOLLISTER-WINKLER-TIBERI 10
_________________________________________________________________ 11
A B I L L
To amend section 1753.01 and to enact sections 13
1753.31 to 1753.43 of the Revised Code to apply, 14
with modifications, the National Association of 15
Insurance Commissioners' Risk-Based Capital for
Insurers Model Act to health insuring 16
corporations.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO: 18
Section 1. That section 1753.01 be amended and sections 20
1753.31, 1753.32, 1753.33, 1753.34, 1753.35, 1753.36, 1753.37, 21
1753.38, 1753.39, 1753.40, 1753.41, 1753.42, and 1753.43 of the 22
Revised Code be enacted to read as follows: 23
Sec. 1753.01. As used in this chapter: 32
(A) "Economic profiling" means a health insuring 34
corporation's use of economic performance data and economic 35
information in determining whether to contract with a provider 36
for the provision of covered health care services to enrollees as 38
a participating provider.
(B) "Basic health care services," "enrollee," "health care 40
facility," "health care services," "health insuring corporation," 41
"medical record," "PERSON," "PRIMARY CARE PROVIDER," "provider," 43
and "SUBSCRIBER," AND "supplemental health care services" have 45
the same meanings as in section 1751.01 of the Revised Code. 47
Sec. 1753.31. AS USED IN SECTIONS 1753.31 TO 1753.43 OF 49
THE REVISED CODE: 51
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(A) "ADJUSTED RBC REPORT" MEANS AN RBC REPORT THAT HAS 54
BEEN ADJUSTED BY THE SUPERINTENDENT OF INSURANCE IN ACCORDANCE 55
WITH DIVISION (C) OF SECTION 1753.32 OF THE REVISED CODE. 56
(B) "AUTHORIZED CONTROL LEVEL RBC" MEANS THE NUMBER 58
DETERMINED UNDER THE RISK-BASED CAPITAL FORMULA IN ACCORDANCE 60
WITH THE RBC INSTRUCTIONS. 61
(C) "COMPANY ACTION LEVEL RBC" MEANS THE PRODUCT OF 2.0 63
AND A HEALTH INSURING CORPORATION'S AUTHORIZED CONTROL LEVEL RBC. 64
(D) "CORRECTIVE ORDER" MEANS AN ORDER ISSUED BY THE 66
SUPERINTENDENT OF INSURANCE SPECIFYING CORRECTIVE ACTIONS THAT 67
THE SUPERINTENDENT DETERMINES ARE REQUIRED. 68
(E) "DOMESTIC HEALTH INSURING CORPORATION" MEANS A HEALTH 70
INSURING CORPORATION DOMICILED IN THIS STATE. 71
(F) "FOREIGN HEALTH INSURING CORPORATION" MEANS A HEALTH 73
INSURING CORPORATION HOLDING A CERTIFICATE OF AUTHORITY UNDER 74
CHAPTER 1751. OF THE REVISED CODE THAT IS DOMICILED OUTSIDE OF 75
THIS STATE.
(G) "MANDATORY CONTROL LEVEL RBC" MEANS THE PRODUCT OF .70 77
AND A HEALTH INSURING CORPORATION'S AUTHORIZED CONTROL LEVEL RBC. 78
(H) "NAIC" MEANS THE NATIONAL ASSOCIATION OF INSURANCE 80
COMMISSIONERS. 81
(I) "NET WORTH" MEANS STATUTORY CAPITAL AND SURPLUS. 83
(J) "RBC" MEANS RISK-BASED CAPITAL. 85
(K) "RBC INSTRUCTIONS" MEANS THE RBC REPORT, INCLUDING 88
RISK-BASED CAPITAL INSTRUCTIONS, AS ADOPTED BY THE NAIC AND AS 89
AMENDED BY THE NAIC FROM TIME TO TIME IN ACCORDANCE WITH THE 90
PROCEDURES ADOPTED BY THE NAIC. "RBC INSTRUCTIONS" ALSO INCLUDES 91
ANY MODIFICATIONS ADOPTED BY THE SUPERINTENDENT OF INSURANCE, AS 92
THE SUPERINTENDENT CONSIDERS TO BE NECESSARY. 94
(L) "RBC LEVEL" MEANS A HEALTH INSURING CORPORATION'S 96
ACTION LEVEL RBC, REGULATORY ACTION LEVEL RBC, AUTHORIZED CONTROL 99
LEVEL RBC, OR MANDATORY CONTROL LEVEL RBC. 100
(M) "RBC PLAN" MEANS A COMPREHENSIVE FINANCIAL PLAN 102
CONTAINING THE ELEMENTS SPECIFIED IN DIVISION (B) OF SECTION 103
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1753.33 OF THE REVISED CODE. 104
(N) "RBC REPORT" MEANS THE REPORT REQUIRED BY SECTION 106
1753.32 OF THE REVISED CODE. 107
(O) "REGULATORY ACTION LEVEL RBC" MEANS THE PRODUCT OF 1.5 109
AND A HEALTH INSURING CORPORATION'S AUTHORIZED CONTROL LEVEL RBC. 110
(P) "REVISED RBC PLAN" MEANS AN RBC PLAN REJECTED BY THE 112
SUPERINTENDENT OF INSURANCE AND THEN REVISED BY A HEALTH INSURING 113
CORPORATION WITH OR WITHOUT INCORPORATING THE SUPERINTENDENT'S 114
RECOMMENDATIONS. 115
(Q) "TOTAL ADJUSTED CAPITAL" MEANS THE SUM OF BOTH OF THE 117
FOLLOWING: 118
(1) A HEALTH INSURING CORPORATION'S NET WORTH AS 120
DETERMINED IN ACCORDANCE WITH THE STATUTORY ACCOUNTING APPLICABLE 121
TO THE ANNUAL FINANCIAL STATEMENTS REQUIRED TO BE FILED UNDER 122
SECTION 1751.32 OF THE REVISED CODE;
(2) SUCH OTHER ITEMS, IF ANY, AS THE RBC INSTRUCTIONS MAY 124
PROVIDE. 125
Sec. 1753.32. (A) EACH DOMESTIC HEALTH INSURING 127
CORPORATION SHALL, ON OR PRIOR TO THE FIRST DAY OF MARCH OF EVERY 128
YEAR, PREPARE AND SUBMIT TO THE SUPERINTENDENT OF INSURANCE A 129
REPORT ON ITS RBC LEVELS AS OF THE END OF THE CALENDAR YEAR JUST 130
ENDED, IN A FORM AND CONTAINING SUCH INFORMATION AS IS REQUIRED 131
BY THE RBC INSTRUCTIONS. IN ADDITION, A DOMESTIC HEALTH INSURING 133
CORPORATION SHALL FILE ITS RBC REPORT AS FOLLOWS:
(1) WITH THE NAIC, IN ACCORDANCE WITH THE RBC 136
INSTRUCTIONS;
(2) WITH THE INSURANCE REGULATORY AUTHORITY OF ANY OTHER 138
STATE IN WHICH THE HEALTH INSURING CORPORATION IS AUTHORIZED TO 139
DO BUSINESS, IF THE INSURANCE REGULATORY AUTHORITY OF THAT STATE 140
HAS SENT A WRITTEN REQUEST TO THE HEALTH INSURING CORPORATION FOR 141
THE RBC REPORT. THE HEALTH INSURING CORPORATION SHALL FILE AN 142
RBC REPORT WITH THE REQUESTING STATE NO LATER THAN THE LATER OF: 143
(a) FIFTEEN DAYS AFTER THE HEALTH INSURING CORPORATION'S 145
RECEIPT OF THE INSURANCE REGULATORY AUTHORITY'S REQUEST FOR THE 146
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RBC REPORT; 147
(b) PRIOR TO THE FIRST DAY OF MARCH. 149
(B) A HEALTH INSURING CORPORATION'S RBC LEVELS SHALL BE 151
DETERMINED IN ACCORDANCE WITH THE FORMULA SET FORTH IN THE RBC 152
INSTRUCTIONS. THE FORMULA SHALL TAKE THE FOLLOWING RISKS INTO 153
ACCOUNT, AND MAY ADJUST FOR THE COVARIANCE BETWEEN THESE RISKS, 154
AS DETERMINED IN EACH CASE BY APPLYING THE FACTORS IN THE MANNER
SET FORTH IN THE RBC INSTRUCTIONS: 155
(1) ASSET RISK; 157
(2) CREDIT RISK; 159
(3) UNDERWRITING RISK; 161
(4) ALL OTHER BUSINESS RISKS AND SUCH OTHER RELEVANT RISKS 163
AS ARE SET FORTH IN THE RBC INSTRUCTIONS. 164
(C) IF A DOMESTIC HEALTH INSURING CORPORATION FILES AN RBC 167
REPORT THAT IN THE JUDGMENT OF THE SUPERINTENDENT IS INACCURATE, 168
THE SUPERINTENDENT SHALL ADJUST THE RBC REPORT TO CORRECT THE 169
INACCURACY AND THEN SHALL PROVIDE A COPY OF THE ADJUSTED RBC 170
REPORT TO THE HEALTH INSURING CORPORATION. THE SUPERINTENDENT 171
SHALL ALSO PROVIDE THE HEALTH INSURING CORPORATION WITH A 173
STATEMENT OF THE REASONS FOR ANY ADJUSTMENT.
(D) IN ENACTING SECTIONS 1753.31 TO 1753.43 OF THE REVISED 176
CODE, THE GENERAL ASSEMBLY FINDS ALL OF THE FOLLOWING: 177
(1) AN EXCESS OF CAPITAL OVER THE AMOUNT PRODUCED BY THE 179
RISK-BASED CAPITAL REQUIREMENTS OF SECTIONS 1753.31 TO 1753.43 OF 180
THE REVISED CODE, AND THE FORMULAS, SCHEDULES, AND INSTRUCTIONS 181
REFERENCED IN SECTIONS 1753.31 TO 1753.43 OF THE REVISED CODE, IS 182
DESIRABLE IN THE BUSINESS OF INSURANCE. 183
(2) HEALTH INSURING CORPORATIONS, ACCORDINGLY, SHOULD SEEK 185
TO MAINTAIN CAPITAL ABOVE THE RBC LEVELS REQUIRED BY SECTIONS 186
1753.31 TO 1753.43 OF THE REVISED CODE. 187
(3) ADDITIONAL CAPITAL IS USED AND IS USEFUL IN THE 189
BUSINESS OF INSURANCE, HELPING TO SECURE A HEALTH INSURING 190
CORPORATION AGAINST VARIOUS RISKS INHERENT IN, OR AFFECTING, THE 191
BUSINESS OF INSURANCE, WHICH RISKS ARE NOT ACCOUNTED FOR OR ARE 192
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ONLY PARTIALLY MEASURED BY THE RISK-BASED CAPITAL REQUIREMENTS OF 193
SECTIONS 1753.31 TO 1753.43 OF THE REVISED CODE. 194
Sec. 1753.33. (A) FOR PURPOSES OF SECTIONS 1753.31 TO 196
1753.43 OF THE REVISED CODE, A "COMPANY ACTION LEVEL EVENT" IS 197
ANY OF THE FOLLOWING EVENTS: 198
(1) A HEALTH INSURING CORPORATION'S FILING OF AN RBC 200
REPORT THAT INDICATES THAT THE HEALTH INSURING CORPORATION'S 201
TOTAL ADJUSTED CAPITAL IS GREATER THAN OR EQUAL TO ITS REGULATORY 202
ACTION LEVEL RBC BUT LESS THAN ITS COMPANY ACTION LEVEL RBC; 203
(2) THE NOTIFICATION BY THE SUPERINTENDENT OF INSURANCE TO 205
A HEALTH INSURING CORPORATION OF AN ADJUSTMENT TO THE HEALTH 206
INSURING CORPORATION'S RBC REPORT, WHICH ADJUSTED RBC REPORT 207
SHOWS THE HEALTH INSURING CORPORATION'S TOTAL ADJUSTED CAPITAL 208
WITHIN THE RANGE DESCRIBED IN DIVISION (A)(1) OF THIS SECTION, 209
PROVIDED THAT THE HEALTH INSURING CORPORATION DOES NOT CHALLENGE 210
THE ADJUSTED RBC REPORT UNDER SECTION 1753.37 OF THE REVISED 212
CODE;
(3) THE NOTIFICATION BY THE SUPERINTENDENT TO A HEALTH 214
INSURING CORPORATION, FOLLOWING THE HEARING REQUIRED UNDER 215
SECTION 1753.37 OF THE REVISED CODE, THAT THE SUPERINTENDENT HAS 216
REJECTED THE HEALTH INSURING CORPORATION'S CHALLENGE TO AN 217
ADJUSTED RBC REPORT SHOWING THE HEALTH INSURING CORPORATION'S 218
TOTAL ADJUSTED CAPITAL WITHIN THE RANGE DESCRIBED IN DIVISION 219
(A)(1) OF THIS SECTION.
(B) IN THE CASE OF A COMPANY ACTION LEVEL EVENT, THE 221
HEALTH INSURING CORPORATION SHALL PREPARE AND SUBMIT TO THE 222
SUPERINTENDENT AN RBC PLAN THAT SHALL DO ALL OF THE FOLLOWING: 223
(1) IDENTIFY THE CONDITIONS THAT CONTRIBUTED TO THE 225
COMPANY ACTION LEVEL EVENT; 226
(2) CONTAIN PROPOSALS OF CORRECTIVE ACTIONS THAT THE 228
HEALTH INSURING CORPORATION INTENDS TO TAKE TO ELIMINATE THE 229
CONDITIONS CONTRIBUTING TO THE COMPANY ACTION LEVEL EVENT; 230
(3) PROVIDE PROJECTIONS OF THE HEALTH INSURING 232
CORPORATION'S FINANCIAL RESULTS IN THE CURRENT YEAR AND AT LEAST 233
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THE TWO SUCCEEDING YEARS, BOTH IN THE ABSENCE OF THE PROPOSED 234
CORRECTIVE ACTIONS AND GIVING EFFECT TO THE PROPOSED CORRECTIVE 235
ACTIONS. THE PROJECTIONS SHALL INCLUDE PROJECTIONS OF STATUTORY 236
BALANCE SHEETS, OPERATING INCOME, NET INCOME, CAPITAL, SURPLUS,
AND RBC LEVELS. PROJECTIONS FOR BOTH NEW AND RENEWAL BUSINESS 238
MAY INCLUDE SEPARATE PROJECTIONS FOR EACH MAJOR LINE OF BUSINESS, 239
AND MAY SEPARATELY IDENTIFY EACH SIGNIFICANT INCOME, EXPENSE, AND 240
BENEFIT COMPONENT OF THE PROJECTION.
(4) IDENTIFY THE KEY ASSUMPTIONS IMPACTING THE HEALTH 242
INSURING CORPORATION'S PROJECTIONS MADE PURSUANT TO DIVISION 243
(B)(3) OF THIS SECTION, AND DESCRIBE THE SENSITIVITY OF THE 244
PROJECTIONS TO THE ASSUMPTIONS; 245
(5) IDENTIFY THE QUALITY OF, AND PROBLEMS ASSOCIATED WITH, 247
THE HEALTH INSURING CORPORATION'S BUSINESS, INCLUDING, BUT NOT 248
LIMITED TO, ITS ASSETS, ANTICIPATED BUSINESS GROWTH AND 249
ASSOCIATED SURPLUS STRAIN, EXTRAORDINARY EXPOSURE TO RISK, MIX OF 250
BUSINESS, AND THE USE OF REINSURANCE, IF ANY, IN EACH CASE. 251
(C) THE RBC PLAN SHALL BE SUBMITTED WITHIN FORTY-FIVE DAYS 253
AFTER A COMPANY ACTION LEVEL EVENT. HOWEVER, IF A HEALTH 254
INSURING CORPORATION HAS CHALLENGED AN ADJUSTED RBC REPORT 255
PURSUANT TO SECTION 1753.37 OF THE REVISED CODE, AN RBC PLAN NEED 256
NOT BE SUBMITTED UNLESS THE SUPERINTENDENT REJECTS THE CHALLENGE 257
FOLLOWING THE HEARING REQUIRED UNDER SECTION 1753.37 OF THE 258
REVISED CODE. IF THE SUPERINTENDENT REJECTS THE HEALTH INSURING 259
CORPORATION'S CHALLENGE, THE RBC PLAN SHALL BE SUBMITTED WITHIN 260
FORTY-FIVE DAYS AFTER THE SUPERINTENDENT'S NOTIFICATION TO THE 261
HEALTH INSURING CORPORATION OF THE SUPERINTENDENT'S REJECTION OF 262
THE CHALLENGE.
(D)(1) WITHIN SIXTY DAYS AFTER A HEALTH INSURING 264
CORPORATION SUBMITS AN RBC PLAN TO THE SUPERINTENDENT, THE 265
SUPERINTENDENT SHALL EITHER REQUIRE THE HEALTH INSURING 266
CORPORATION TO IMPLEMENT THE RBC PLAN OR NOTIFY THE HEALTH 267
INSURING CORPORATION THAT THE RBC PLAN IS UNSATISFACTORY IN THE 268
JUDGMENT OF THE SUPERINTENDENT. IF THE SUPERINTENDENT HAS 269
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DETERMINED THAT THE RBC PLAN IS UNSATISFACTORY, THE NOTIFICATION 270
TO THE HEALTH INSURING CORPORATION SHALL SET FORTH THE REASONS 272
FOR THE DETERMINATION, AND MAY SET FORTH PROPOSED REVISIONS THAT
WILL RENDER THE RBC PLAN SATISFACTORY IN THE JUDGMENT OF THE 274
SUPERINTENDENT. UPON ITS RECEIPT OF SUCH NOTIFICATION FROM THE
SUPERINTENDENT, THE HEALTH INSURING CORPORATION SHALL PREPARE AND 276
SUBMIT A REVISED RBC PLAN, WHICH MAY INCORPORATE BY REFERENCE ANY 277
REVISIONS PROPOSED BY THE SUPERINTENDENT. 278
(2) IF A HEALTH INSURING CORPORATION CHALLENGES, UNDER 280
SECTION 1753.37 OF THE REVISED CODE, A NOTIFICATION BY THE 281
SUPERINTENDENT THAT THE HEALTH INSURING CORPORATION'S RBC PLAN OR 282
A REVISED RBC PLAN IS UNSATISFACTORY, SUBMISSION OF A REVISED RBC 283
PLAN NEED NOT BE MADE UNLESS THE SUPERINTENDENT REJECTS THE 284
HEALTH INSURING CORPORATION'S CHALLENGE AND NOTIFIES THE HEALTH 285
INSURING CORPORATION OF THIS REJECTION. A HEALTH INSURING 286
CORPORATION SHALL SUBMIT A REVISED RBC PLAN TO THE SUPERINTENDENT 287
WITHIN FORTY-FIVE DAYS AFTER RECEIVING NOTIFICATION FROM THE 288
SUPERINTENDENT THAT ITS RBC PLAN IS UNSATISFACTORY, OR THAT ITS 289
CHALLENGE TO A NOTIFICATION MADE UNDER DIVISION (D)(1) OF THIS 290
SECTION HAS BEEN REJECTED, AS APPLICABLE.
(E) NOTWITHSTANDING DIVISION (D) OF THIS SECTION, IF THE 292
SUPERINTENDENT NOTIFIES A HEALTH INSURING CORPORATION THAT ITS 293
RBC PLAN OR REVISED RBC PLAN IS UNSATISFACTORY, THE 294
SUPERINTENDENT MAY, AT THE SUPERINTENDENT'S DISCRETION BUT 295
SUBJECT TO THE HEALTH INSURING CORPORATION'S RIGHT TO A HEARING 296
UNDER SECTION 1753.37 OF THE REVISED CODE, SPECIFY IN THE
NOTIFICATION THAT THE NOTIFICATION CONSTITUTES A REGULATORY 297
ACTION LEVEL EVENT. 298
(F) EVERY DOMESTIC HEALTH INSURING CORPORATION THAT 300
SUBMITS AN RBC PLAN OR REVISED RBC PLAN TO THE SUPERINTENDENT 301
SHALL FILE A COPY OF THE RBC PLAN OR REVISED RBC PLAN WITH THE 302
INSURANCE REGULATORY AUTHORITY OF EVERY STATE IN WHICH THE HEALTH 303
INSURING CORPORATION IS AUTHORIZED TO DO BUSINESS UPON RECEIVING
THE INSURANCE REGULATORY AUTHORITY'S WRITTEN REQUEST FOR A COPY 304
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OF THE PLAN, IF THE STATE HAS A CONFIDENTIALITY LAW SUBSTANTIALLY 305
SIMILAR TO SECTION 1753.38 OF THE REVISED CODE. THE HEALTH 306
INSURING CORPORATION SHALL FILE THE COPY IN THAT STATE NO LATER 307
THAN THE LATER OF: 308
(1) FIFTEEN DAYS AFTER RECEIVING THE REQUEST FOR A COPY OF 310
THE PLAN; 311
(2) THE DATE ON WHICH THE RBC PLAN OR REVISED RBC PLAN IS 313
FILED PURSUANT TO DIVISION (C) OR (D) OF THIS SECTION. 314
Sec. 1753.34. (A) FOR PURPOSES OF SECTIONS 1753.31 TO 316
1753.43 OF THE REVISED CODE, A "REGULATORY ACTION LEVEL EVENT" IS 317
ANY OF THE FOLLOWING EVENTS: 318
(1) THE FILING OF AN RBC REPORT BY A HEALTH INSURING 320
CORPORATION THAT INDICATES THAT THE HEALTH INSURING CORPORATION'S 321
TOTAL ADJUSTED CAPITAL IS GREATER THAN OR EQUAL TO ITS AUTHORIZED
CONTROL LEVEL RBC BUT LESS THAN ITS REGULATORY ACTION LEVEL RBC; 322
(2) THE NOTIFICATION BY THE SUPERINTENDENT OF INSURANCE TO 324
A HEALTH INSURING CORPORATION OF AN ADJUSTMENT TO THE HEALTH 325
INSURING CORPORATION'S RBC REPORT, WHICH ADJUSTED RBC REPORT 326
SHOWS THE HEALTH INSURING CORPORATION'S TOTAL ADJUSTED CAPITAL 327
WITHIN THE RANGE DESCRIBED IN DIVISION (A)(1) OF THIS SECTION, 328
PROVIDED THAT THE HEALTH INSURING CORPORATION DOES NOT CHALLENGE 329
THE ADJUSTED RBC REPORT UNDER SECTION 1753.37 OF THE REVISED 331
CODE;
(3) THE NOTIFICATION BY THE SUPERINTENDENT TO A HEALTH 333
INSURING CORPORATION, FOLLOWING THE HEARING REQUIRED UNDER 334
SECTION 1753.37 OF THE REVISED CODE, THAT THE SUPERINTENDENT HAS 335
REJECTED THE HEALTH INSURING CORPORATION'S CHALLENGE TO AN 336
ADJUSTED RBC REPORT SHOWING THE HEALTH INSURING CORPORATION'S 337
TOTAL ADJUSTED CAPITAL WITHIN THE RANGE DESCRIBED IN DIVISION 338
(A)(1) OF THIS SECTION;
(4) THE FAILURE OF A HEALTH INSURING CORPORATION TO FILE 340
AN RBC REPORT BY THE FIRST DAY OF MARCH OF EVERY YEAR, UNLESS THE 341
HEALTH INSURING CORPORATION HAS PROVIDED AN EXPLANATION FOR SUCH 342
FAILURE THAT IS SATISFACTORY TO THE SUPERINTENDENT AND HAS CURED 343
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THE FAILURE WITHIN TEN DAYS AFTER THE FILING DATE; 344
(5) THE FAILURE OF A HEALTH INSURING CORPORATION TO SUBMIT 346
AN RBC PLAN TO THE SUPERINTENDENT WITHIN THE TIME PERIOD SET 347
FORTH IN DIVISION (C) OF SECTION 1753.33 OF THE REVISED CODE; 348
(6) THE NOTIFICATION BY THE SUPERINTENDENT TO A HEALTH 350
INSURING CORPORATION OF BOTH OF THE FOLLOWING: 351
(a) THE RBC PLAN OR REVISED RBC PLAN SUBMITTED BY THE 353
HEALTH INSURING CORPORATION IS UNSATISFACTORY IN THE JUDGMENT OF 354
THE SUPERINTENDENT; 355
(b) THE NOTIFICATION BY THE SUPERINTENDENT CONSTITUTES A 357
REGULATORY ACTION LEVEL EVENT WITH RESPECT TO THE HEALTH INSURING 358
CORPORATION, PROVIDED THAT THE HEALTH INSURING CORPORATION DOES 360
NOT CHALLENGE THE DETERMINATION UNDER SECTION 1753.37 OF THE 361
REVISED CODE.
(7) THE NOTIFICATION BY THE SUPERINTENDENT TO A HEALTH 363
INSURING CORPORATION, FOLLOWING THE HEARING REQUIRED UNDER 364
SECTION 1753.37 OF THE REVISED CODE, THAT THE SUPERINTENDENT HAS 365
REJECTED THE HEALTH INSURING CORPORATION'S CHALLENGE TO THE 367
SUPERINTENDENT'S DETERMINATION UNDER DIVISION (A)(6) OF THIS 368
SECTION;
(8) THE NOTIFICATION BY THE SUPERINTENDENT TO A HEALTH 370
INSURING CORPORATION THAT THE SUPERINTENDENT HAS DETERMINED THAT 371
THE HEALTH INSURING CORPORATION HAS FAILED TO ADHERE TO ITS RBC 372
PLAN OR REVISED RBC PLAN, AND THIS FAILURE HAS HAD A SUBSTANTIAL 373
ADVERSE EFFECT ON THE ABILITY OF THE HEALTH INSURING CORPORATION 374
TO ELIMINATE THE CONDITIONS LEADING TO THE COMPANY ACTION LEVEL 375
EVENT IN ACCORDANCE WITH ITS RBC PLAN OR REVISED RBC PLAN, 376
PROVIDED THAT THE HEALTH INSURING CORPORATION DOES NOT CHALLENGE 377
THIS DETERMINATION UNDER SECTION 1753.37 OF THE REVISED CODE; 378
(9) THE NOTIFICATION BY THE SUPERINTENDENT TO A HEALTH 380
INSURING CORPORATION, FOLLOWING THE HEARING REQUIRED UNDER 381
SECTION 1753.37 OF THE REVISED CODE, THAT THE SUPERINTENDENT HAS 382
REJECTED THE HEALTH INSURING CORPORATION'S CHALLENGE TO THE 383
SUPERINTENDENT'S DETERMINATION UNDER DIVISION (A)(8) OF THIS 384
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SECTION.
(B) IN THE CASE OF A REGULATORY ACTION LEVEL EVENT, THE 386
SUPERINTENDENT SHALL DO ALL OF THE FOLLOWING: 387
(1) REQUIRE THE HEALTH INSURING CORPORATION TO PREPARE AND 389
SUBMIT AN RBC PLAN OR, IF APPLICABLE, A REVISED RBC PLAN; 390
(2) PERFORM SUCH EXAMINATIONS AND ANALYSES AS THE 392
SUPERINTENDENT CONSIDERS NECESSARY OF THE ASSETS, LIABILITIES, 393
AND OPERATIONS OF THE HEALTH INSURING CORPORATION, INCLUDING A 394
REVIEW OF THE HEALTH INSURING CORPORATION'S RBC PLAN OR REVISED 395
RBC PLAN AND THE RESULTS OF ANY SENSITIVITY TESTS UNDERTAKEN 397
PURSUANT TO THE RBC INSTRUCTIONS;
(3) ISSUE A CORRECTIVE ORDER, BASED UPON THE EXAMINATIONS 399
AND ANALYSES PERFORMED UNDER DIVISION (B)(2) OF THIS SECTION. 400
(C)(1) THE RBC PLAN OR REVISED RBC PLAN REQUIRED BY 403
DIVISION (B)(1) OF THIS SECTION SHALL BE SUBMITTED TO THE 405
SUPERINTENDENT WITHIN FORTY-FIVE DAYS AFTER THE REGULATORY ACTION 406
LEVEL EVENT, EXCEPT BY A HEALTH INSURING CORPORATION THAT FILES A 407
CHALLENGE TO AN ADJUSTED RBC REPORT OR REVISED RBC PLAN PURSUANT 408
TO SECTION 1753.37 OF THE REVISED CODE. IF THE SUPERINTENDENT 409
DETERMINES THE CHALLENGE IS FRIVOLOUS, THE TIME LIMIT FOR THE 410
SUBMISSION OF THE RBC PLAN OR REVISED RBC PLAN SHALL NOT BE 411
ALTERED BY THE FILING OF THE CHALLENGE.
(2) IF A HEALTH INSURING CORPORATION FILES A NONFRIVOLOUS 413
CHALLENGE TO AN ADJUSTED RBC REPORT OR REVISED RBC PLAN, THE RBC 414
PLAN OR REVISED RBC PLAN REQUIRED BY DIVISION (B)(1) OF THIS 415
SECTION SHALL ONLY BE SUBMITTED TO THE SUPERINTENDENT IF THE 416
SUPERINTENDENT REJECTS THE CHALLENGE FOLLOWING THE HEARING
REQUIRED UNDER SECTION 1753.37 OF THE REVISED CODE. IF THE 417
SUPERINTENDENT REJECTS THE HEALTH INSURING CORPORATION'S 418
CHALLENGE, THE RBC PLAN OR REVISED RBC PLAN SHALL BE SUBMITTED 419
WITHIN FORTY-FIVE DAYS AFTER THE SUPERINTENDENT'S NOTIFICATION TO 420
THE HEALTH INSURING CORPORATION OF THE SUPERINTENDENT'S REJECTION 421
OF THE CHALLENGE.
(D) THE SUPERINTENDENT MAY RETAIN ACTUARIES, INVESTMENT 423
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EXPERTS, AND SUCH OTHER CONSULTANTS, AS MAY BE NECESSARY IN THE 424
SUPERINTENDENT'S JUDGMENT, TO REVIEW A HEALTH INSURING 425
CORPORATION'S RBC PLAN OR REVISED RBC PLAN, TO EXAMINE OR ANALYZE 426
THE ASSETS, LIABILITIES, AND OPERATION OF THE HEALTH INSURING 427
CORPORATION, AND TO FORMULATE A CORRECTIVE ORDER FOR THE HEALTH
INSURING CORPORATION. THE FEES, COSTS, AND EXPENSES RELATING TO 428
THESE CONSULTANTS SHALL BE BORNE BY THE AFFECTED HEALTH INSURING 429
CORPORATION. 430
Sec. 1753.35. (A) FOR PURPOSES OF SECTIONS 1753.31 TO 432
1753.43 OF THE REVISED CODE, AN "AUTHORIZED CONTROL LEVEL EVENT" 433
IS ANY OF THE FOLLOWING EVENTS: 434
(1) THE FILING OF AN RBC REPORT BY A HEALTH INSURING 436
CORPORATION THAT INDICATES THAT THE HEALTH INSURING CORPORATION'S 437
TOTAL ADJUSTED CAPITAL IS GREATER THAN OR EQUAL TO ITS MANDATORY
CONTROL LEVEL RBC BUT LESS THAN ITS AUTHORIZED CONTROL LEVEL RBC; 438
(2) THE NOTIFICATION BY THE SUPERINTENDENT OF INSURANCE TO 440
A HEALTH INSURING CORPORATION OF AN ADJUSTMENT TO THE HEALTH 441
INSURING CORPORATION'S RBC REPORT, WHICH ADJUSTED RBC REPORT 442
SHOWS THE HEALTH INSURING CORPORATION'S TOTAL ADJUSTED CAPITAL 443
WITHIN THE RANGE DESCRIBED IN DIVISION (A)(1) OF THIS SECTION, 444
PROVIDED THAT THE HEALTH INSURING CORPORATION DOES NOT CHALLENGE 445
THE ADJUSTED RBC REPORT UNDER SECTION 1753.37 OF THE REVISED 447
CODE;
(3) THE NOTIFICATION BY THE SUPERINTENDENT TO A HEALTH 449
INSURING CORPORATION, FOLLOWING THE HEARING REQUIRED UNDER 450
SECTION 1753.37 OF THE REVISED CODE, THAT THE SUPERINTENDENT HAS 451
REJECTED THE HEALTH INSURING CORPORATION'S CHALLENGE TO AN 452
ADJUSTED RBC REPORT SHOWING THE HEALTH INSURING CORPORATION'S 453
TOTAL ADJUSTED CAPITAL WITHIN THE RANGE DESCRIBED IN DIVISION 454
(A)(1) OF THIS SECTION;
(4) THE FAILURE OF A HEALTH INSURING CORPORATION TO 456
RESPOND, IN A MANNER SATISFACTORY TO THE SUPERINTENDENT, TO A 457
CORRECTIVE ORDER ISSUED UNDER DIVISION (B)(3) OF SECTION 1753.34 458
OF THE REVISED CODE, PROVIDED THAT THE HEALTH INSURING 460
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CORPORATION DOES NOT CHALLENGE THE CORRECTIVE ORDER UNDER SECTION 462
1753.37 OF THE REVISED CODE; 463
(5) THE FAILURE OF A HEALTH INSURING CORPORATION TO 465
RESPOND, IN A MANNER SATISFACTORY TO THE SUPERINTENDENT, TO A 466
CORRECTIVE ORDER ISSUED UNDER DIVISION (B)(3) OF SECTION 1753.34 467
OF THE REVISED CODE SUBSEQUENT TO THE SUPERINTENDENT'S 469
MODIFICATION OF AN EARLIER ORDER OR THE SUPERINTENDENT'S 470
REJECTION OF THE HEALTH INSURING CORPORATION'S CHALLENGE OF THE 471
ORDER UNDER SECTION 1753.37 OF THE REVISED CODE. 472
(B) IN THE CASE OF AN AUTHORIZED CONTROL LEVEL EVENT, THE 474
SUPERINTENDENT SHALL DO THE FOLLOWING: 475
(1) TAKE THE ACTIONS REQUIRED UNDER SECTION 1753.34 OF THE 477
REVISED CODE FOR REGULATORY ACTION LEVEL EVENTS; 480
(2) IF THE SUPERINTENDENT CONSIDERS IT TO BE IN THE BEST 482
INTERESTS OF THE SUBSCRIBERS AND CREDITORS OF THE HEALTH INSURING 483
CORPORATION AND OF THE PUBLIC, TAKE SUCH ACTIONS AS ARE NECESSARY 484
TO PLACE THE HEALTH INSURING CORPORATION UNDER REGULATORY CONTROL 485
UNDER SECTIONS 3903.01 TO 3903.59 OF THE REVISED CODE. THE 486
AUTHORIZED CONTROL LEVEL EVENT SHALL BE DEEMED SUFFICIENT GROUNDS 487
FOR THE SUPERINTENDENT TO TAKE ACTION UNDER SECTIONS 3903.01 TO 488
3903.59 OF THE REVISED CODE. NOTHING IN SECTIONS 1753.31 TO 489
1753.43 OF THE REVISED CODE SHALL IMPAIR OR RESTRICT THE RIGHTS, 490
POWERS, AND PROTECTIONS AFFORDED TO THE SUPERINTENDENT AND TO 491
HEALTH INSURING CORPORATIONS UNDER SECTIONS 3903.01 TO 3903.59 OF 492
THE REVISED CODE. 493
Sec. 1753.36. (A) FOR PURPOSES OF SECTIONS 1753.31 TO 495
1753.43 OF THE REVISED CODE, A "MANDATORY CONTROL LEVEL EVENT" IS 496
ANY OF THE FOLLOWING EVENTS: 497
(1) THE FILING OF AN RBC REPORT BY A HEALTH INSURING 499
CORPORATION THAT INDICATES THAT THE HEALTH INSURING CORPORATION'S 500
TOTAL ADJUSTED CAPITAL IS LESS THAN ITS MANDATORY CONTROL LEVEL 501
RBC;
(2) THE NOTIFICATION BY THE SUPERINTENDENT OF INSURANCE TO 503
A HEALTH INSURING CORPORATION OF AN ADJUSTMENT TO THE HEALTH 504
13
INSURING CORPORATION'S RBC REPORT, WHICH ADJUSTED RBC REPORT 505
SHOWS THE HEALTH INSURING CORPORATION'S TOTAL ADJUSTED CAPITAL AT 506
LESS THAN ITS MANDATORY CONTROL LEVEL RBC, PROVIDED THE HEALTH 507
INSURING CORPORATION DOES NOT CHALLENGE THE ADJUSTED RBC REPORT 508
UNDER SECTION 1753.37 OF THE REVISED CODE; 509
(3) THE NOTIFICATION BY THE SUPERINTENDENT TO THE HEALTH 511
INSURING CORPORATION, FOLLOWING THE HEARING REQUIRED UNDER 512
SECTION 1753.37 OF THE REVISED CODE, THAT THE SUPERINTENDENT HAS 513
REJECTED THE HEALTH INSURING CORPORATION'S CHALLENGE TO AN 514
ADJUSTED RBC REPORT.
(B) IN THE CASE OF A MANDATORY CONTROL LEVEL EVENT, THE 516
SUPERINTENDENT SHALL TAKE SUCH ACTIONS AS ARE NECESSARY TO PLACE 517
THE HEALTH INSURING CORPORATION UNDER REGULATORY CONTROL UNDER 518
SECTIONS 3903.01 TO 3903.59 OF THE REVISED CODE. THE MANDATORY 519
CONTROL LEVEL EVENT SHALL BE DEEMED SUFFICIENT GROUNDS FOR THE 520
SUPERINTENDENT TO TAKE ACTION UNDER SECTIONS 3903.01 TO 3903.59 521
OF THE REVISED CODE. NOTHING IN SECTIONS 1753.31 TO 1753.43 OF 522
THE REVISED CODE SHALL IMPAIR OR RESTRICT THE RIGHTS, POWERS, AND 523
PROTECTIONS AFFORDED TO THE SUPERINTENDENT AND TO HEALTH INSURING
CORPORATIONS UNDER SECTIONS 3903.01 TO 3903.59 OF THE REVISED 524
CODE. HOWEVER, THE SUPERINTENDENT MAY DEFER ACTION UNDER THIS 525
DIVISION FOR UP TO NINETY DAYS AFTER THE MANDATORY CONTROL LEVEL 526
EVENT IF THE SUPERINTENDENT FINDS THAT THERE IS A REASONABLE 527
EXPECTATION THE HEALTH INSURING CORPORATION MAY BE ABLE TO 528
ELIMINATE THE CONDITIONS LEADING TO THE MANDATORY CONTROL LEVEL 529
EVENT WITHIN THE NINETY-DAY PERIOD.
Sec. 1753.37. (A) A HEALTH INSURING CORPORATION HAS THE 531
RIGHT TO A CONFIDENTIAL HEARING UPON RECEIVING ANY OF THE 532
FOLLOWING FROM THE SUPERINTENDENT OF INSURANCE: 533
(1) AN ADJUSTED RBC REPORT; 535
(2) NOTIFICATION THAT THE HEALTH INSURING CORPORATION'S 537
RBC PLAN OR REVISED RBC PLAN IS UNSATISFACTORY AND A STATEMENT 538
THAT THE NOTIFICATION CONSTITUTES A REGULATORY ACTION LEVEL EVENT 539
FOR THE HEALTH INSURING CORPORATION; 540
14
(3) NOTIFICATION THAT THE SUPERINTENDENT HAS DETERMINED 542
THAT THE HEALTH INSURING CORPORATION HAS FAILED TO ADHERE TO ITS 543
RBC PLAN OR REVISED RBC PLAN, WHICH FAILURE HAS A SUBSTANTIAL 544
ADVERSE EFFECT ON THE ABILITY OF THE HEALTH INSURING CORPORATION 545
TO ELIMINATE THE CONDITIONS LEADING TO A COMPANY ACTION LEVEL 547
EVENT IN ACCORDANCE WITH ITS RBC PLAN OR REVISED RBC PLAN; 548
(4) A CORRECTIVE ORDER ISSUED UNDER DIVISION (B)(3) OF 550
SECTION 1753.34 OF THE REVISED CODE. 551
(B) A HEALTH INSURING CORPORATION SHALL NOTIFY THE 553
SUPERINTENDENT OF ITS REQUEST FOR A HEARING WITHIN FIVE DAYS 554
AFTER ITS RECEIPT OF ANY ITEM LISTED IN DIVISION (A) OF THIS 555
SECTION. UPON THE SUPERINTENDENT'S RECEIPT OF THE HEALTH 556
INSURING CORPORATION'S REQUEST FOR A HEARING, THE SUPERINTENDENT 557
SHALL SET A DATE FOR THE HEARING, WHICH DATE SHALL BE NO LESS 558
THAN TEN DAYS AND NO MORE THAN THIRTY DAYS AFTER THE
SUPERINTENDENT'S RECEIPT OF THE HEALTH INSURING CORPORATION'S 559
REQUEST. 560
(C) A HEALTH INSURING CORPORATION MAY CHALLENGE ANY 562
DETERMINATION OR ACTION TAKEN BY THE SUPERINTENDENT UNDER 563
SECTIONS 1753.31 TO 1753.43 OF THE REVISED CODE AT THE HEARING 564
HELD PURSUANT TO THIS SECTION. 565
Sec. 1753.38. (A) THE SUPERINTENDENT OF INSURANCE SHALL 567
KEEP ALL OF THE FOLLOWING CONFIDENTIAL: 568
(1) AN RBC REPORT, TO THE EXTENT THAT INFORMATION 570
CONTAINED IN THE REPORT IS NOT REQUIRED TO BE INCLUDED IN AN 571
ANNUAL STATEMENT AVAILABLE TO THE PUBLIC; 572
(2) AN RBC PLAN; 574
(3) THE RESULTS OF, OR REPORTS ON, EXAMINATIONS OR 576
ANALYSES CONDUCTED PURSUANT TO DIVISION (B)(2) OF SECTION 1753.34 577
OF THE REVISED CODE, AND A CORRECTIVE ORDER ISSUED PURSUANT TO 579
DIVISION (B)(3) OF SECTION 1753.34 OF THE REVISED CODE. 580
A DISCLOSURE TO THE SUPERINTENDENT OF THESE PLANS, REPORTS, 582
INFORMATION, AND ORDERS DOES NOT CONSTITUTE A WAIVER OF ANY 583
APPLICABLE PRIVILEGE OR CLAIM OF CONFIDENTIALITY IN THE PLANS, 584
15
REPORTS, INFORMATION, AND ORDERS. 585
(B) NOTWITHSTANDING DIVISION (A) OF THIS SECTION: 587
(1) THE PLANS, REPORTS, INFORMATION, AND ORDERS DESCRIBED 589
IN DIVISION (A) OF THIS SECTION MAY BE USED BY THE SUPERINTENDENT 590
IN ACCORDANCE WITH THE INSURANCE LAWS OF THIS STATE. 591
(2) IN THE PERFORMANCE OF THE SUPERINTENDENT'S DUTIES, THE 593
SUPERINTENDENT MAY SHARE THE PLANS, REPORTS, INFORMATION, AND 594
ORDERS WITH STATE, FEDERAL, AND INTERNATIONAL REGULATORY AGENCIES 595
AND LAW ENFORCEMENT AUTHORITIES, AND WITH THE NAIC AND ITS 596
AFFILIATES AND SUBSIDIARIES, PROVIDED THAT THE RECIPIENT AGREES 597
TO MAINTAIN THE CONFIDENTIALITY OF THE PLANS, REPORTS, 598
INFORMATION, AND ORDERS. 599
(C)(1) THE PLANS, REPORTS, INFORMATION, AND ORDERS 601
DESCRIBED IN DIVISION (A) OF THIS SECTION ARE NOT PUBLIC RECORDS 602
FOR PURPOSES OF SECTION 149.43 OF THE REVISED CODE AND SHALL NOT 603
BE SUBJECT TO SUBPOENA. THE PLANS, REPORTS, INFORMATION, AND 605
ORDERS SHALL NOT BE SUBJECT TO DISCOVERY OR ADMISSIBLE IN 606
EVIDENCE IN ANY PRIVATE CIVIL ACTION. 607
(2) NEITHER THE SUPERINTENDENT NOR ANY PERSON WHO RECEIVES 609
THE PLANS, REPORTS, INFORMATION, AND ORDERS WHILE ACTING UNDER 610
THE AUTHORITY OF THE SUPERINTENDENT SHALL BE PERMITTED OR 611
REQUIRED TO TESTIFY IN ANY PRIVATE CIVIL ACTION CONCERNING THESE 612
PLANS, REPORTS, INFORMATION, AND ORDERS. 613
(D) A COMPARISON OF A HEALTH INSURING CORPORATION'S TOTAL 615
ADJUSTED CAPITAL TO ANY OF ITS RBC LEVELS SHALL NOT BE USED TO 616
RANK HEALTH INSURING CORPORATIONS. 617
(E) RBC INSTRUCTIONS, RBC REPORTS, ADJUSTED RBC REPORTS, 620
RBC PLANS, AND REVISED RBC PLANS SHALL NOT BE USED BY THE 621
SUPERINTENDENT FOR RATEMAKING, CONSIDERED OR INTRODUCED AS 622
EVIDENCE IN ANY RATE PROCEEDING, OR USED BY THE SUPERINTENDENT TO 623
CALCULATE OR DERIVE ANY ELEMENTS OF AN APPROPRIATE PREMIUM LEVEL 624
OR RATE OF RETURN FOR ANY LINE OF INSURANCE THAT A HEALTH 625
INSURING CORPORATION OR ANY AFFILIATE IS AUTHORIZED TO WRITE. 626
(F) EXCEPT AS OTHERWISE REQUIRED UNDER CHAPTER 1751. OR 628
16
1753. OF THE REVISED CODE, IT IS AN UNFAIR AND DECEPTIVE ACT OR 630
PRACTICE IN THE BUSINESS OF INSURANCE UNDER SECTIONS 3901.19 TO 632
3901.26 OF THE REVISED CODE FOR ANY PERSON TO MAKE, PUBLISH, 633
DISSEMINATE, CIRCULATE, OR PLACE BEFORE THE PUBLIC, OR TO CAUSE, 635
DIRECTLY OR INDIRECTLY, TO BE MADE, PUBLISHED, DISSEMINATED,
CIRCULATED, OR PLACED BEFORE THE PUBLIC, IN A NEWSPAPER, 636
MAGAZINE, OR OTHER PUBLICATION, IN THE FORM OF A NOTICE, 637
CIRCULAR, PAMPHLET, LETTER, OR POSTER, OR OVER ANY RADIO OR 638
TELEVISION STATION, OR IN ANY OTHER MANNER, AN ADVERTISEMENT, 639
ANNOUNCEMENT, OR STATEMENT, WRITTEN OR ORAL, THAT CONTAINS AN 640
ASSERTION, REPRESENTATION, OR STATEMENT, REGARDING THE RBC LEVELS 641
OF A HEALTH INSURING CORPORATION, OR ANY COMPONENT DERIVED IN THE 642
CALCULATION OF THE RBC LEVELS.
(G) IF ANY MATERIALLY FALSE STATEMENT IS PUBLISHED 644
COMPARING A HEALTH INSURING CORPORATION'S TOTAL ADJUSTED CAPITAL 645
TO ITS RBC LEVELS, OR ANY INAPPROPRIATE COMPARISON OF ANY OTHER 646
AMOUNT TO ANY OF THE HEALTH INSURING CORPORATION'S RBC LEVELS IS 647
PUBLISHED, AND THE HEALTH INSURING CORPORATION IS ABLE TO 648
DEMONSTRATE TO THE SUPERINTENDENT WITH SUBSTANTIAL PROOF THE 649
FALSITY OF THE STATEMENT OR THE INAPPROPRIATENESS OF THE
COMPARISON, THEN THE HEALTH INSURING CORPORATION MAY PUBLISH WITH 650
THE SUPERINTENDENT'S APPROVAL AN ANNOUNCEMENT IN A WRITTEN 651
PUBLICATION TO REBUT THE MATERIALLY FALSE STATEMENT OR 652
INAPPROPRIATE COMPARISON. 653
Sec. 1753.39. (A) EACH FOREIGN HEALTH INSURING 655
CORPORATION SHALL SUBMIT TO THE SUPERINTENDENT OF INSURANCE, UPON 656
RECEIVING THE SUPERINTENDENT'S WRITTEN REQUEST, AN RBC REPORT FOR 657
THE CALENDAR YEAR JUST ENDED. THE HEALTH INSURING CORPORATION 658
SHALL SUBMIT THE RBC REPORT TO THE SUPERINTENDENT NO LATER THAN 659
THE LATER OF:
(1) THE DATE A DOMESTIC HEALTH INSURING CORPORATION WOULD 661
BE REQUIRED TO FILE AN RBC REPORT UNDER SECTION 1753.32 OF THE 663
REVISED CODE;
(2) FIFTEEN DAYS AFTER THE SUPERINTENDENT'S REQUEST IS 665
17
RECEIVED BY THE FOREIGN HEALTH INSURING CORPORATION. 666
(B) EACH FOREIGN HEALTH INSURING CORPORATION SHALL, UPON 668
RECEIVING THE SUPERINTENDENT'S WRITTEN REQUEST, PROMPTLY SUBMIT 669
TO THE SUPERINTENDENT A COPY OF ANY RBC PLAN OR REVISED RBC PLAN 670
FILED WITH THE INSURANCE REGULATORY AUTHORITY OF ANY OTHER STATE. 671
(C) THE SUPERINTENDENT MAY REQUIRE A FOREIGN HEALTH 673
INSURING CORPORATION TO FILE AN RBC PLAN WITH THE SUPERINTENDENT 674
IN THE CASE OF A COMPANY ACTION LEVEL EVENT, REGULATORY ACTION 675
LEVEL EVENT, OR AUTHORIZED CONTROL LEVEL EVENT INVOLVING THE 676
FOREIGN HEALTH INSURING CORPORATION, IF THE INSURANCE REGULATORY 677
AUTHORITY OF THE STATE OF DOMICILE OF THE FOREIGN HEALTH INSURING 678
CORPORATION FAILS TO REQUIRE THE FOREIGN HEALTH INSURING 679
CORPORATION TO FILE AN RBC PLAN IN THE MANNER SPECIFIED UNDER 680
THAT STATE'S RBC LAWS, IF ANY. THE FAILURE OF A FOREIGN HEALTH 681
INSURING CORPORATION TO FILE AN RBC PLAN OR REVISED RBC PLAN WITH 682
THE SUPERINTENDENT AS REQUIRED SHALL BE GROUNDS FOR THE 683
SUPERINTENDENT TO ORDER THE HEALTH INSURING CORPORATION TO CEASE
AND DESIST FROM WRITING NEW BUSINESS IN THIS STATE. 684
(D) IN THE CASE OF A MANDATORY CONTROL LEVEL EVENT 686
INVOLVING A FOREIGN HEALTH INSURING CORPORATION, IF NO 687
DOMICILIARY RECEIVER HAS BEEN APPOINTED FOR THE FOREIGN HEALTH 688
INSURING CORPORATION UNDER THE REHABILITATION AND LIQUIDATION 689
LAWS APPLICABLE IN THE STATE OF DOMICILE OF THE FOREIGN HEALTH 690
INSURING CORPORATION, THE SUPERINTENDENT MAY MAKE APPLICATION TO 691
THE COURT OF COMMON PLEAS AS PERMITTED IN SECTIONS 3903.50 TO 692
3903.59 OF THE REVISED CODE FOR AN ORDER DIRECTING THE 693
SUPERINTENDENT TO LIQUIDATE THE PROPERTY OF THE FOREIGN HEALTH
INSURING CORPORATION FOUND IN THIS STATE. THE OCCURRENCE OF THE 694
MANDATORY CONTROL LEVEL EVENT SHALL BE DEEMED SUFFICIENT GROUNDS 695
FOR THE SUPERINTENDENT TO MAKE APPLICATION TO THE COURT. 696
Sec. 1753.40. THERE SHALL BE NO LIABILITY ON THE PART OF, 698
AND NO CAUSE OF ACTION SHALL ARISE AGAINST, THE SUPERINTENDENT OF 699
INSURANCE, OR THE DEPARTMENT OF INSURANCE, ITS EMPLOYEES, OR ITS 700
AGENTS, FOR ANY ACTION TAKEN IN THEIR PERFORMANCE OF THE POWERS 701
18
AND DUTIES UNDER SECTIONS 1753.31 TO 1753.43 OF THE REVISED CODE. 702
Sec. 1753.41. UNLESS OTHERWISE PROVIDED, ALL NOTICES SENT 704
TO A HEALTH INSURING CORPORATION BY THE SUPERINTENDENT OF 705
INSURANCE THAT MAY RESULT IN REGULATORY ACTION UNDER SECTIONS 706
1753.31 TO 1753.43 OF THE REVISED CODE SHALL BE EFFECTIVE UPON 707
DISPATCH IF TRANSMITTED BY REGISTERED OR CERTIFIED MAIL. ANY 708
OTHER NOTICE TRANSMITTED SHALL BE EFFECTIVE UPON THE HEALTH
INSURING CORPORATION'S RECEIPT OF THE NOTICE. 709
Sec. 1753.42. THE SUPERINTENDENT OF INSURANCE MAY EXEMPT 711
ANY DOMESTIC HEALTH INSURING CORPORATION FROM THE APPLICATION OF 712
SECTIONS 1753.31 TO 1753.43 OF THE REVISED CODE, IF THE HEALTH 713
INSURING CORPORATION MEETS ALL OF THE FOLLOWING REQUIREMENTS: 714
(A) THE HEALTH INSURING CORPORATION WRITES DIRECT BUSINESS 716
IN THIS STATE ONLY. 717
(B) THE HEALTH INSURING CORPORATION ASSUMES NO REINSURANCE 719
IN EXCESS OF FIVE PER CENT OF DIRECT PREMIUM WRITTEN. 720
(C) THE HEALTH INSURING CORPORATION EITHER: 722
(1) WRITES DIRECT ANNUAL PREMIUMS OF TWO MILLION DOLLARS 724
OR LESS FOR BASIC HEALTH CARE SERVICES; 725
(2) COVERS LESS THAN TWO THOUSAND ENROLLEES UNDER 727
POLICIES, CONTRACTS, CERTIFICATES, OR AGREEMENTS FOR SUPPLEMENTAL 728
HEALTH CARE SERVICES. 729
Sec. 1753.43. THE SUPERINTENDENT OF INSURANCE MAY ADOPT 731
RULES IN ACCORDANCE WITH CHAPTER 119. OF THE REVISED CODE AS ARE 732
REASONABLY NECESSARY FOR THE IMPLEMENTATION AND OPERATION OF 733
SECTIONS 1753.31 TO 1753.43 OF THE REVISED CODE. 734
Section 2. That existing section 1753.01 of the Revised 736
Code is hereby repealed. 737
Section 3. The authorized control level RBC, as defined by 739
division (B) of section 1753.31 of the Revised Code, as enacted 740
by this act, shall be adjusted for use in reports filed for 741
periods through December 31, 2001. Notwithstanding division (B) 742
of section 1753.31 of the Revised Code, the authorized control 743
level RBC shall be the product of 0.90 and the number determined 744
19
under the risk-based capital formula in accordance with the RBC 745
instructions. Thereafter, the authorized control level RBC shall 746
be determined in accordance with division (B) of section 1753.31 747
of the Revised Code without this adjustment. 748