justicedao/ipfs_state_laws huggingface dataset:
836-011-0390 Foreign Insurers (1) A foreign insurer shall, upon the written request of the Director, submit to the Director an RBC report as of the end of the calendar year just ended on the later of: (a) The date by which an RBC report would be required to be filed by a domestic insurer under OAR 836-011-0300 to 836-011-0390; or (b) The 15th day after the request is received by the foreign insurer. (2) A foreign insurer shall, at the written request of the Director, promptly submit to the Director a copy of any RBC plan that is filed with the insurance commissioner of any other state. (3) In the event of a company action level event, regulatory action level event or authorized control level event with respect to any foreign insurer as determined under the statute or rule governing risk based capital reporting applicable in the state of domicile of the insurer (or, if no such statute or rule is in force in that state, under the provisions of OAR 836-011-0300 to 836-011-0390), if the insurance commissioner of the state of domicile of the foreign insurer fails to require the foreign insurer to file an RBC plan in the manner specified under that state's statute or rule governing risk-based capital reporting (or, if no such statute or rule is in force in that state, under 836-011-0320), the Director may require the foreign insurer to file an RBC plan with the Director. In such event, the failure of the foreign insurer to file an RBC plan with the Director shall be grounds to order the insurer to cease and desist from writing new insurance business in this state. (4) In the event of a mandatory control level event with respect to any foreign insurer, if a domiciliary receiver has not been appointed with respect to the foreign insurer under the rehabilitation and liquidation statute applicable in the state of domicile of the foreign insurer, the Director may apply for an order under ORS 734.190 with respect to the conservation of property of foreign insurers found in this state, and the occurrence of the mandatory control level event shall be considered adequate grounds for the application under 734.150(1) or (4). Statutory/Other Authority: ORS 731.244, 731.554 & 733.210 Statutes/Other Implemented: ORS 731.554 & 731.574 History: ID 14-2011, f. & cert. ef. 10-31-11 ID 7-1995, f. & cert. ef. 11-15-95
836-011-0430 Scope and Authority (1) OAR 836-011-0430 to 836-011-0460 apply to all domestic insurers and to all domestic health care service contractors under ORS 750.055 and multiple employer welfare arrangements under 750.333. For purposes of OAR 836-011-0430 to 836-011-0460, “insurer” includes health care service contractors and multiple employer welfare arrangements. (2) OAR 836-011-0430 to 836-011-0460 are adopted under the authority of ORS 731.244, 731.574 and 733.210. Statutory/Other Authority: ORS 731.244 & 731.574 Statutes/Other Implemented: ORS 731.574 & 733.210 History: ID 7-1995, f. & cert. ef. 11-15-95
836-011-0440 Report (1) Every domestic insurer shall file a report with the Director of the Department of Consumer and Business Services disclosing material acquisitions and dispositions of assets or material nonrenewals, cancellations or revisions of ceded reinsurance agreements unless the acquisitions and dispositions of assets or material nonrenewals, cancellations or revisions of ceded reinsurance agreements have been submitted to the Director for review, approval or information purposes pursuant to other provisions of the Insurance Code, laws, rules or other requirements. (2) The report required in section (1) of this rule is due not later than the 15th day after the end of the calendar month in which any of the transactions described in section (1) of this rule occurs. (3) One complete copy of the report, including any exhibits or other attachments, shall be filed with: (a) The insurance department of the insurer’s state of domicile; and (b) The National Association of Insurance Commissioners. Statutory/Other Authority: ORS 731.244 & 731.574 Statutes/Other Implemented: ORS 731.574 & 733.210 History: ID 7-1995, f. & cert. ef. 11-15-95
836-011-0450 Acquisitions and Dispositions of Assets (1) Materiality. No acquisitions or dispositions of assets need be reported pursuant to OAR 836-011-0440 if the acquisitions or dispositions are not material. For purposes of 836-011-0430 to 836-011-0460, a material acquisition (or the aggregate of any series of related acquisitions during any 30-day period) or disposition (or the aggregate of any series of related dispositions during any 30-day period) is one that is non-recurring and not in the ordinary course of business and involves more than five percent of the reporting insurer’s total allowed assets as reported in its most recent statutory statement filed with the insurance department of the insurer’s state of domicile. (2) Scope. OAR 836-011-0430 to 836-011-0460 apply to the following asset acquisitions and asset dispositions: (a) Asset acquisitions subject to OAR 836-011-0430 to 836-011-0460 include every purchase, lease, exchange, merger, consolidation, succession or other acquisition other than the construction or development of real property by or for the reporting insurer or the acquisition of materials for such purpose. (b) Asset dispositions subject to OAR 836-011-0430 to 836-011-0460 include every sale, lease, exchange, merger, consolidation, mortgage, hypothecation, assignment (whether for the benefit of creditors or otherwise), abandonment, destruction or other disposition. (3) Information to be reported: (a) The following information is required to be disclosed in any report of a material acquisition or disposition of assets: (A) Date of the transaction; (B) Manner of acquisition or disposition; (C) Description of the assets involved; (D) Nature and amount of the consideration given or received; (E) Purpose of, or reason for, the transaction; (F) Manner by which the amount of consideration was determined; (G) Gain or loss recognized or realized as a result of the transaction; and (H) Name or names of the person or persons from whom the assets were acquired or to whom they were disposed. (b) An insurer is required to report material acquisitions and dispositions on a non-consolidated basis unless the insurer is part of a consolidated group of insurers that utilizes a pooling arrangement or 100 percent reinsurance agreement that affects the solvency and integrity of the insurer’s reserves and the insurer ceded substantially all of its direct and assumed business to the pool. An insurer is deemed to have ceded substantially all of its direct and assumed business to a pool if the insurer has less than $1,000,000 total direct plus assumed written premiums during a calendar year that are not subject to a pooling arrangement and the net income of the business not subject to the pooling arrangement represents less than five percent of the insurer’s capital and surplus. Statutory/Other Authority: ORS 731.244 & 731.574 Statutes/Other Implemented: ORS 731.574 & 733.210 History: ID 7-1995, f. & cert. ef. 11-15-95
836-011-0500 Application; Statutory Authority; Statutes Implemented (1) OAR 836-011-0500 to 836-011-0550 apply to health care service contractors. (2) OAR 836-011-0500 to 836-011-0550 are adopted pursuant to the authority of ORS 731.244 and 750.045 for the purpose of implementing ORS 731.574, 733.210 and 750.045. Statutory/Other Authority: ORS 731.244 & 750.045 Statutes/Other Implemented: ORS 731.574, 733.210 & 750.045 History: ID 22-2002, f. & cert. ef. 11-27-02
836-011-0505 Definitions As used in OAR 836-011-0500 to 836-011-0550: (1) "Adjusted RBC report" means an RBC report that has been adjusted by the Director in accordance with OAR 836-011-0510(4). (2) "Corrective order" means an order issued by the Director specifying corrective actions that the Director has determined are required. (3) "Domestic health care service contractor" means a health care service contractor domiciled in this state. (4) "Foreign health care service contractor" means a health care service contractor that is authorized to transact business in this state as a health care service contractor but is not domiciled in this state. (5) "NAIC" means the National Association of Insurance Commissioners. (6) "RBC instructions" means the RBC report including risk-based capital instructions adopted by the NAIC, as the RBC instructions may be amended by the NAIC from time to time in accordance with the procedures adopted by the NAIC. (7) "RBC level" means a health care service contractor’s Company Action Level RBC, Regulatory Action Level RBC, Authorized Control Level RBC or Mandatory Control Level RBC, defined as follows: (a) "Company Action Level RBC" means, with respect to any health care service contractor, the product of 2.0 and its Authorized Control Level RBC; (b) "Regulatory Action Level RBC" means the product of 1.5 and its Authorized Control Level RBC; (c) "Authorized Control Level RBC" means the number determined under the risk-based capital formula in accordance with the RBC Instructions; (d) "Mandatory Control Level RBC" means the product of .70 and the Authorized Control Level RBC. (8) "RBC plan" means a comprehensive financial plan containing the elements specified in OAR 836-011-0515(2). If the Director rejects the RBC plan and it is revised by the health care service contractor with or without the Director’s recommendation, the plan shall be called the "revised RBC plan." (9) "RBC report" means the report required in OAR 836-011-0510. (10) "Total adjusted capital" means the sum of: (a) A health care service contractor’s statutory capital and surplus (i.e. net worth) as determined in accordance with the statutory accounting applicable to the annual financial statements required to be filed under ORS 731.574; and (b) Such other items, if any, as the RBC instructions may provide. Statutory/Other Authority: ORS 731.244 & 750.045 Statutes/Other Implemented: ORS 731.574, 733.210 & 750.045 History: ID 22-2002, f. & cert. ef. 11-27-02
836-011-0510 RBC Reports (1) A domestic health care service contractor shall, on or prior to each March 1 (the "filing date"), prepare and submit to the Director a report of its RBC levels as of the end of the calendar year just ended, in a form and containing such information as is required by the RBC instructions. In addition, a domestic health care service contractor shall file its RBC report: (a) With the NAIC in accordance with the RBC instructions; and (b) With the insurance commissioner in any state in which the health care service contractor is authorized to do business, if the insurance commissioner has notified the health care service contractor of its request in writing, in which case the health care service contractor shall file its RBC report not later than the later of: (A) 15 days from the receipt of notice to file its RBC report with that state; or (B) The filing date. (2) A health care service contractor’s RBC shall be determined in accordance with the formula set forth in the RBC instructions. The formula shall take the following into account (and may adjust for the covariance between) determined in each case by applying the factors in the manner set forth in the RBC instructions: (a) Asset risk; (b) Credit risk; (c) Underwriting risk; and (d) All other business risks and such other relevant risks as are set forth in the RBC instructions. (3) An excess of capital (i.e. net worth) over the amount produced by the risk-based capital requirements contained in OAR 836-011-0500 to 836-011-0550 and the formulas, schedules and instructions referenced in 836-011-0500 to 836-011-0550 is desirable in the business of a health care service contractor. Accordingly, health care service contractors should seek to maintain capital above the RBC levels required by 836-011-0500 to 836-011-0550. Additional capital is used and useful in the insurance business and helps to secure a health care service contractor against various risks inherent in, or affecting, the business of a health care service contractor and not accounted for or only partially measured by the risk-based capital requirements contained in 836-011-0500 to 836-011-0550. (4) If a domestic health care service contractor files an RBC report that in the judgment of the Director is inaccurate, then the Director shall adjust the RBC report to correct the inaccuracy and shall notify the health care service contractor of the adjustment. The notice shall contain a statement of the reason for the adjustment. An RBC report as so adjusted is referred to as an "adjusted RBC report." Statutory/Other Authority: ORS 731.244 & 750.045 Statutes/Other Implemented: ORS 731.574, 733.210 & 750.045 History: ID 22-2002, f. & cert. ef. 11-27-02
836-011-0525 Authorized Control Level Event (1) "Authorized Control Level Event" means 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 Mandatory Control Level RBC but less than its Authorized Control Level RBC; (b) The notification by the Director to the 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, 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 respond, in a manner satisfactory to the Director, to a corrective order (if the health care service contractor has not challenged the corrective order under OAR 836-011-0535); or (e) If the health care service contractor has challenged a corrective order under OAR 836-011-0535 and the Director has, after a hearing, rejected the challenge or modified the corrective order, the failure of the health care service contractor to respond, in a manner satisfactory to the Director, to the corrective order subsequent to rejection or modification by the Director. (2) In the event of an Authorized Control Level Event with respect to a health care service contractor, the Director shall: (a) Take such actions as are required under OAR 836-011-0520 regarding a health care service contractor with respect to which an Regulatory Action Level Event has occurred; or (b) If the Director deems it to be in the best interests of the policyholders and creditors of the health care service contractor and of the public, take such actions as are necessary to cause the health care service contractor to be placed under regulatory control under ORS 734.059 to 734.440. In the event the Director takes such actions, the Authorized Control Level Event shall be deemed sufficient grounds for the Director to take action under 734.059 to 734.440, and the Director shall have the rights, powers and duties with respect to the health care service contractor as are set forth in 734.059 to 744.440. In the event the Director takes actions under this subsection pursuant to an adjusted RBC report, the health care service contractor shall be entitled to such protections as are afforded to health care service contractors under the provisions of 734.059 to 734.440. Statutory/Other Authority: ORS 731.244 & 750.045 Statutes/Other Implemented: ORS 731.574, 733.210 & 750.045 History: ID 22-2002, f. & cert. ef. 11-27-02
836-011-0530 Mandatory Control Level Event (1) "Mandatory Control Level Event" means any of the following events: (a) The filing of an RBC report that indicates that the health care service contractor’s total adjusted capital is less than its Mandatory Control Level RBC; (b) Notification by the Director to the 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; or (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, 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. (2) In the event of a Mandatory Control Level Event, the Director shall take such actions as are necessary to place the health care service contractor under regulatory control under ORS 734.059 to 734.440. In that event, the Mandatory Control Level Event shall be deemed sufficient grounds for the Director to take action under 734.059 to 734.440, and the Director shall have the rights, powers and duties with respect to the health care service contractor as are set forth in 734.059 to 734.440. If the Director takes actions pursuant to an adjusted RBC report, the health care service contractor shall be entitled to the protections of 734.059 to 734.440. Notwithstanding the provisions of this rule, the Director may forego action for up to 90 days after the Mandatory Control Level Event if the Director finds there is a reasonable expectation that the Mandatory Control Level Event may be eliminated within the 90 day period. Statutory/Other Authority: ORS 731.244 & 750.045 Statutes/Other Implemented: ORS 731.574, 733.210 & 750.045 History: ID 22-2002, f. & cert. ef. 11-27-02
836-011-0535 Hearings Upon the occurrence of any of the following events, a health care service contractor may request a hearing, as provided in ORS 731.240, for the purpose of challenging any determination or action by the Director in connection with any event described in this rule. The health care service contractor shall notify the Director of its request for a hearing not later than the fifth day after notification by the Director under any of the events described in this rule. Upon receipt of the health care service contractor’s request for a hearing, the Director shall set a date for the hearing. The date shall be not less than 10 nor more than 30 days after the date of the health care service contractor’s request. The events to which the opportunity for a hearing under this rule relates are as follows: (1) Notification to a health care service contractor by the Director of an adjusted RBC report; (2) Notification to a health care service contractor by the Director that: (a) The health care service contractor’s RBC plan or revised RBC plan is unsatisfactory; and (b) Notification constitutes a Regulatory Action Level Event with respect to the health care service contractor; (3) Notification to a health care service contractor by the Director that the health care service contractor has failed to adhere to its RBC plan or revised RBC plan and that the failure has a substantial adverse effect on the ability of the health care service contractor to eliminate the Company Action Level Event with respect to the health care service contractor in accordance with its RBC plan or revised RBC plan; or (4) Notification to a health care service contractor by the Director of a corrective order with respect to the health care service contractor. Statutory/Other Authority: ORS 731.244 & 750.045 Statutes/Other Implemented: ORS 731.574, 733.210 & 750.045 History: ID 22-2002, f. & cert. ef. 11-27-02
836-011-0540 Supplemental Provisions; Rules; Exemption (1) OAR 836-011-0500 to 836-011-0550 are supplemental to any other provisions of the laws of this state, and shall not preclude or limit any other powers or duties of the Director under such laws, including, but not limited to, ORS 734.059 to 734.440 and OAR 836-011-0100 to 836-011-0120. (2) The Director may exempt from the application of OAR 836-011-0500 to 836-011-0550 a domestic health care service contractor that: (a) Writes direct business only in this state; (b) Assumes no reinsurance in excess of five percent of direct premium written; and (c) Writes direct annual premiums for comprehensive medical business of $2 million or less; or (d) Is a limited health care service contractor that covers less than 500 lives. Statutory/Other Authority: ORS 731.244 & 750.045 Statutes/Other Implemented: ORS 731.574, 733.210 & 750.045 History: ID 22-2002, f. & cert. ef. 11-27-02
836-011-0545 Foreign Health Care Service Contractors (1) A foreign health care service contractor shall, upon the written request of the Director, submit to the Director an RBC report as of the end of the calendar year just ended the later of: (a) The date an RBC report would be required to be filed by a domestic health care service contractor under OAR 836-011-0500 to 836-011-0550; or (b) The 15th day after the request is received by the foreign health care service contractor. (2) A foreign health care service contractor shall, at the written request of the Director, promptly submit to the Director a copy of any RBC plan that is filed with the insurance commissioner of any other state. (3) In the event of a Company Action Level Event, Regulatory Action Level Event or Authorized Control Level Event with respect to a foreign health care service contractor as determined under the RBC statute or other law applicable in the state of domicile of the health care service contractor (or, if no RBC statute or other law is in force in that state, under the provisions of OAR 836-011-0500 to 836-011-0550), if the insurance commissioner of the state of domicile of the foreign health care service contractor fails to require the foreign health care service contractor to file an RBC plan in the manner specified under that state’s RBC statute or other law (or, if no RBC statute or other law is in force in that state, under OAR 836-011-0515), the Director may require the foreign health care service contractor to file an RBC plan with the Director. In such event, the failure of the foreign health care service contractor to file an RBC plan with the Director shall be grounds to order the health care service contractor to cease and desist from writing new insurance business in this state. (4) In the event of a Mandatory Control Level Event with respect to a foreign health care service contractor, if no domiciliary receiver has been appointed with respect to the foreign health care service contractor under the rehabilitation and liquidation statute applicable in the state of domicile of the foreign health organization, the Director may apply for an order under ORS 734.190 with respect to the liquidation of property of foreign health care service contractors found in this state, and the occurrence of the Mandatory Control Level Event shall be considered adequate grounds for the application under 734.150(1) or (4). Statutory/Other Authority: ORS 731.244 & 750.045 Statutes/Other Implemented: ORS 731.574, 733.210 & 750.045 History: ID 22-2002, f. & cert. ef. 11-27-02