reglab/statecodes huggingface dataset:
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 154 - QUALITY HEALTH CARE ACCOUNTABILITY AND PROTECTION › REQUIRED PROVISIONS AND ENROLLEE DISCLOSURES › Section 154.14 - Emergency services

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Managed
				  care plans are prohibited from requiring that enrollees or health care
				  providers obtain prior authorization for emergency services as defined by
				  section 2102 of the act (40 P. S. §
											991.2102).
(b) Plans are required to pay all reasonably
				  necessary costs for enrollees meeting the prudent layperson definition of
				  emergency services provided during the period of the emergency, including
				  evaluation, testing, and if necessary, the stabilization of the condition of
				  the enrollee.
(c) Sudden and
				  unexpected medical events involving a chronic condition which meet the prudent
				  layperson requirements of the act shall be considered emergency services
				  subject to the act and this chapter.
(d) Plans are required to consider the
				  presenting symptoms as documented by the claim file, and the services provided,
				  when processing claims for emergency services.
(e) The emergency health care provider shall
				  notify the enrollee's managed care plan of the provision of emergency services
				  and the condition of the enrollee.
(1) If the
				  enrollee is admitted to a hospital or other health care facility, the emergency
				  health care provider shall notify the enrollee's managed care plan of the
				  emergency services delivered within 48 hours or on the next business day,
				  whichever is later. An exception to this requirement will be made where the
				  medical condition of the patient precludes the provider from accurately
				  determining the identity of the enrollee's managed care plans within 48 hours
				  of admission.
(2) If the enrollee
				  is not admitted to a hospital or other health care facility, the claim for
				  reimbursement for emergency services provided shall serve as notice to the
				  enrollee's managed care plan of the emergency services provided by the
				  emergency health care provider.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 154 - QUALITY HEALTH CARE ACCOUNTABILITY AND PROTECTION › REQUIRED PROVISIONS AND ENROLLEE DISCLOSURES › Section 154.15 - Continuity of care

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Managed care
				  plans are required to provide the option of continuity of care for enrollees
				  when one of the following applies:
(1) A
				  managed care plan terminates a contract with a participating provider for
				  reasons other than for cause as set forth in section 2117(b) of the act
				  (40
				  P. S. §
												991.2117(b))
				  and the enrollee is then in an ongoing course of treatment with that
				  provider.
(2) A new enrollee enters
				  a managed care plan and is then in an ongoing course of treatment with a
				  nonparticipating provider which is not otherwise covered by the terminated
				  coverage.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 154 - QUALITY HEALTH CARE ACCOUNTABILITY AND PROTECTION › REQUIRED PROVISIONS AND ENROLLEE DISCLOSURES › Section 154.16 - Information for enrollees

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Managed
				  care plans shall provide the written information in section 2136(a) of the act
				  (40
				  P. S. §
											991.2136(a)),
				  which relates required disclosures, to enrollees and, on written request, to
				  prospective enrollees and health care providers.
(1) Managed care plans may determine the
				  format for disclosure of the required information. If the information is
				  disclosed through materials such as subscriber contracts, schedules of benefits
				  and enrollee handbooks, the information shall be easily identifiable within the
				  materials provided.
(2) The written
				  information to be provided by managed care plans to enrollees, prospective
				  enrollees and health care providers shall be subject to the filing requirements
				  under the Accident and Health Filing Reform Act (40 P. S. §§
												3801-3813) and all other applicable statutes
				  and regulations.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 154 - QUALITY HEALTH CARE ACCOUNTABILITY AND PROTECTION › REQUIRED PROVISIONS AND ENROLLEE DISCLOSURES › Section 154.17 - Complaints

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Under the
				  complaint process established by sections 2141-2143 of the act (40 P. S.
				  §§
											991.2141-991.2143), the
				  Department will consider complaints including those regarding issues of
				  contract exclusions, noncovered benefit disputes and potential violation of
				  insurance statutes, including the Unfair Insurance Practices Act (40 P. S.
				  §§
											1171.1-1171.15). The enrollee
				  may be represented by an attorney or other individual before the Department.
				  The Department of Health will focus on complaint issues including those
				  involving enrollee quality of care and quality of service. The grievance
				  process, which is administered by the Department of Health, includes review of
				  the medical necessity and appropriateness of services otherwise covered by the
				  managed care plan. Examples of the types of complaints which may be filed with
				  the Department include:
(1) Denial of payment
				  by the plan based upon contractual limitation rather than on medical
				  necessity-for example, denial of payment for a visit by an enrollee on the
				  basis that the enrollee failed to meet the contractual requirement of obtaining
				  a referral from a primary care provider. However, a primary care provider's
				  refusal to make an enrollee referral to a specialist, on the basis that the
				  referral is not medically necessary, would be considered a grievance.
(2) Disputes involving a noncovered benefit
				  or contract exclusion-for example, a request for additional physical therapy
				  services, even if medically necessary, beyond the number specified in the
				  enrollee contract.
(3) Problems
				  relating to one or more of the following:
(i)
				  Coordination of benefits.
(ii)
				  Subrogation.
(iii) Conversion
				  coverage.
(iv) Alleged nonpayment
				  of premium.
(v) Dependent
				  coverage.
(vi) Involuntary
				  disenrollment.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 154 - QUALITY HEALTH CARE ACCOUNTABILITY AND PROTECTION › REQUIRED PROVISIONS AND ENROLLEE DISCLOSURES › Section 154.18 - Prompt payment

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Licensed
				  insurers and managed care plans shall pay clean claims and the uncontested
				  portions of a contested claim under subsection (d) submitted by a health care
				  provider for services provided on or after January 1, 1999, within 45 days of
				  the licensed insurer's or managed care plan's receipt of the claim from the
				  health care provider. The prompt payment provision applies only to claims
				  submitted under health insurance policies, excluding areas such as automobile
				  and worker's compensation policies.
(b) For purposes of prompt payment, a claim
				  shall be deemed to have been "paid" upon one of the following:
(1) A check is mailed by the licensed insurer
				  or managed care plan to the health care provider.
(2) An electronic transfer of funds is made
				  from the licensed insurer or managed care plan to the health care
				  provider.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 160 - STANDARDS TO DEFINE INSURERS DEEMED TO BE IN HAZARDOUS FINANCIAL CONDITION › Section 160.1 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
This chapter sets forth the standards which the Commissioner
				  may use for identifying insurers found to be in a condition that renders the
				  continuance of their business financially hazardous to the general public,
				  holders of their policies or certificates of insurance, or
				  creditors.
The provisions of this §
											160.1 amended under sections 206,
					 506, 1501 and 1502 of The Administrative Code of 1929 (71 P.S.
					 §§
												66,
					 186,
					 411 and
					 412); sections
					 5.1 and 10 of the Health
					 Maintenance Organization Act (40 P.S. §§
												1555.1 and
					 1560); and sections 2456 and
					 2457 of The Insurance Company Law of 1921 (40 P.S. §§
												991.2456 and
					 991.2457).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 160 - STANDARDS TO DEFINE INSURERS DEEMED TO BE IN HAZARDOUS FINANCIAL CONDITION › Section 160.2 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
In addition to the terms defined in section 503 of the act
				  (40
				  P.S. §
										221.3), the following words and
				  terms, when used in this chapter, have the following meanings, unless the
				  context clearly indicates otherwise:
Act
-The Insurance Department Act of 1921
				  (40
				  P.S. §§
										1-326.7).
Commissioner
-The Insurance Commissioner of
				  the Commonwealth.
Department
-The Insurance Department of the
				  Commonwealth.
NAIC
-The National Association of Insurance
				  Commissioners or successor organization.
Statutory accounting practices
-Practices and
				  procedures prescribed by the Accounting Practices and Procedures Manuals
				  published by the NAIC, or as otherwise prescribed or provided by specific
				  statutes, regulations, orders or rulings of the Commonwealth or the
				  Department.
Surplus
-The amount in excess of admitted
				  assets over total liabilities.
The provisions of this §
											160.2 amended under sections 206,
					 506, 1501 and 1502 of The Administrative Code of 1929 (71 P.S.
					 §§
												66,
					 186,
					 411 and
					 412); sections
					 5.1 and 10 of the Health
					 Maintenance Organization Act (40 P.S. §§
												1555.1 and
					 1560); and sections 2456 and
					 2457 of The Insurance Company Law of 1921 (40 P.S. §§
												991.2456 and
					 991.2457).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 160 - STANDARDS TO DEFINE INSURERS DEEMED TO BE IN HAZARDOUS FINANCIAL CONDITION › Section 160.4 - Commissioner's authority

Current through Register Vol. 54, No. 28, July 13, 2024
For the purpose of making a determination of an insurer's
				  financial condition under this chapter, the Commissioner may restate the value
				  of assets and liabilities to conform to statutory accounting practices,
				  including the following:
(1)
				Disregarding a credit or amount receivable resulting from transactions with a
				reinsurer which is insolvent, impaired or otherwise subject to a delinquency
				proceeding.
(2) Making appropriate
				adjustments to asset values attributable to investments in or transactions with
				controlling persons, subsidiaries or affiliates.
(3) Refusing to recognize the stated value of
				accounts receivable if the ability to collect receivables is highly speculative
				in view of the age of the account or the financial condition of the
				debtor.
(4) Increasing the
				insurer's liability in an amount equal to a contingent liability, pledge or
				guarantee not otherwise included if there is a substantial risk that the
				insurer will be called upon to meet the obligation undertaken within the next
				12-month period.
(5) Making
				appropriate adjustments to liability values attributable to losses and loss
				adjustment expenses due to considerations, such as those elaborated in the
				"Statement of Principles Regarding Property and Casualty Loss and Loss
				Adjustment Expense Reserves" which is promulgated by the Casualty Actuarial
				Society.
(6) Making appropriate
				adjustments to liability values due to considerations elaborated in the
				accident and health reserve standards in sections 301.1 and 311.1 of the act
				(40
				P. S. §§
										71.1 and
				93).
(7) Making appropriate adjustments to
				liability values in accordance with the life insurance reserve standards in
				section 301 of the act.
The provisions of this §
											160.4 amended under sections 206,
					 506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S.
					 §§
												66,
					 186,
					 411 and
					 412); sections
					 5.1 and 10 of the Health
					 Maintenance Organization Act (40 P. S. §§
												1555.1 and
					 1560); and sections 2456 and
					 2457 of The Insurance Company Law of 1921 (40 P. S. §§
												991.2456 and
					 991.2457).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 160 - STANDARDS TO DEFINE INSURERS DEEMED TO BE IN HAZARDOUS FINANCIAL CONDITION › Section 160.5 - Commissioner's summary orders

Current through Register Vol. 54, No. 28, July 13, 2024
(a) If
				the Commissioner has reasonable cause to believe that the continued operation
				of an insurer transacting insurance business in this Commonwealth is
				financially hazardous to the general public, holders of policies or
				certificates of insuance, or creditors, the Commissioner may, upon the
				Commissioner's determination, issue an order under Article V of the act
				(40
				P. S. §§
										211 and
				221.1-221.63) or notice of
				deficiency under sections 2456 and 2457 of The Insurance Company Law of 1921
				(40
				P. S. §§
										991.2456 and
				991.2457). The order or
				notice may list the requirements for the insurer to abate the determination,
				including the following:
(1) Reducing the
				total amount of present and potential liability for policy benefits by
				reinsurance.
(2) Reducing,
				suspending or limiting the volume of business being accepted or
				renewed.
(3) Reducing general
				insurance and commission expenses by specified methods.
(4) Increasing the insurer's capital or
				surplus, or both.
(5) Suspending or
				limiting the declaration and payment of dividends by an insurer to its
				stockholders or to its policyholders.
(6) Filing reports in a form acceptable to
				the Commissioner concerning the market value of an insurer's assets and the
				value of its loss reserves or policy reserves, or both.
(7) Limiting or withdrawing from certain
				investments or discontinuing certain investment practices to the extent the
				Commissioner deems necessary.
(8)
				Documenting the adequacy of premium rates in relation to the risks
				insured.
(9) Documenting the
				adequacy of the return on invested assets in relation to the current interest
				credits in interest sensitive policies.
(10) Filing, in addition to regular annual
				statements, interim financial reports on a form approved by the
				Commissioner.
(11) Filing
				comprehensive business plans utilizing a format approved by the Commissioner
				and completed in accordance with instructions. Business plans filed under this
				paragraph will be given confidential treatment, will not be subject to subpoena
				and will not be made public by the Commissioner or another person without the
				prior written consent of the insurer to which it pertains.
(12) Correcting deficiencies in corporate
				governance practices and adopting and utilizing governance practice acceptable
				to the Commissioner.
(13) Adjusting
				premium rates for non-life insurance products written by the insurer as the
				Commissioner deems necessary to improve the insurer's financial condition,
				notwithstanding other provisions of law that limit the frequency or amount of
				premium rate adjustments.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 160 - STANDARDS TO DEFINE INSURERS DEEMED TO BE IN HAZARDOUS FINANCIAL CONDITION › Section 160.6 - Judicial review

Current through Register Vol. 54, No. 28, July 13, 2024
An order or decision of the Commissioner will be subject to
				  judicial review in accordance with
				  2
				  Pa.C.S. §§
										501-508 and
				  701-704 (relating to the
				  Administrative Agency Law).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 161 - REQUIREMENTS FOR QUALIFIED AND CERTIFIED REINSURERS › Section 161.1 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This chapter
				sets forth requirements to be met for a licensed ceding insurer to receive
				credit for reinsurance in its financial statements. This chapter specifies the
				conditions which shall be met by an unlicensed reinsurer to be considered by
				the Commissioner for inclusion on a list of qualified or certified reinsurers
				published and periodically reviewed by the Commissioner, as well as, the
				requirements for receiving reinsurance credit for joint underwriting or joint
				reinsurance pooling arrangements.
(b) This chapter does not apply to
				reinsurance agreements between or among affiliates which meet the conditions
				for exemption in section 319.2 of the act (40 P. S. §
										442.2) or to the ability of licensed ceding
				insurers to receive credit for reinsurance by compliance with the conditions
				specified in 319.1(b) of the act (40 P. S. §
										442.1(b)).
The provisions of this §
											161.1 amended under sections 206,
					 506, 1501 and 1502 of The Administrative Code of 1929 (71 P.S.
					 §§
												66,
					 186,
					 411 and
					 412); and section
					 319.1 of The Insurance Company Law
					 of 1921 (40 P.S. §
												442.1).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 161 - REQUIREMENTS FOR QUALIFIED AND CERTIFIED REINSURERS › Section 161.2 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this chapter,
				  have the following meanings, unless the context clearly indicates otherwise:
Accredited state
-A state which is accredited
				  by NAIC for compliance with the NAIC Financial Regulation Standards or
				  successor standards.
Act
-The Insurance Company Law of 1921
				  (40
				  P. S. §§
										341-991).
Alien insurer
-An insurer incorporated or
				  organized under the laws of a foreign nation or of a province or territory
				  other than a state of the United States, the Commonwealth of Puerto Rico or the
				  District of Columbia.
Commissioner
-The Insurance Commissioner of
				  the Commonwealth.
Department
-The Insurance Department of the
				  Commonwealth.
Foreign insurer
-An insurer, other than an
				  alien insurer, not incorporated or organized under the laws of the
				  Commonwealth. For purposes of this chapter, the term also includes a United
				  States branch of an alien assuming insurer which branch is not entered through
				  and licensed to transact insurance or reinsurance in this Commonwealth.
NAIC
-National Association of Insurance
				  Commissioners.
Qualified United States financial
				  institution
-
(i) An
				institution which meets the following qualifications. The institution:
(A) Is organized or, in the case of a United
				States office of a foreign banking organization, licensed, under the laws of
				the United States or a state thereof.
(B) Is regulated, supervised and examined by
				Federal or state authorities having regulatory authority over banks and trust
				companies.
(C) Has been determined
				by either the Commissioner or the Securities Valuation Office of the NAIC or a
				successor thereto to meet the standards of financial condition and standing
				considered necessary and appropriate to regulate the quality of financial
				institutions whose letters of credit will be acceptable to the
				Commissioner.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 161 - REQUIREMENTS FOR QUALIFIED AND CERTIFIED REINSURERS › Section 161.3 - Credit for reinsurance

Current through Register Vol. 54, No. 28, July 13, 2024
A licensed domestic ceding insurer will be allowed credit for
				  reinsurance as either an asset or a deduction from liability on account of
				  reinsurance ceded only when the reinsurer meets the requirements of this
				  section or as otherwise provided in §
									161.7 (relating to credit for
				  joint underwriting or pooling arrangements).
(1) Credit will be allowed when the
				reinsurance is ceded to an assuming insurer which is licensed to transact
				insurance or reinsurance in this Commonwealth.
(2) Credit will be allowed when the
				reinsurance is ceded to an assuming foreign insurer which has met the
				conditions specified in this paragraph and has been deemed to be a qualified
				reinsurer by the Commissioner. To be considered for qualification, an assuming
				foreign insurer shall meet the following conditions. The insurer shall:
(i) File evidence of its submission to the
				Commonwealth's jurisdiction with the Commissioner.
(ii) Submit to the Commonwealth's authority
				to examine its books and records.
(iii) Be licensed to transact insurance or
				reinsurance in at least one state, or in the case of a United States branch of
				an alien assuming insurer be entered through and licensed to transact insurance
				or reinsurance in at least one state. After 1994, one of the states in which
				the insurer is licensed shall be an accredited state.
(iv) File with the application for
				qualification and annually thereafter a copy of its annual statement filed with
				the insurance department of its state of domicile and a copy of its most recent
				audited financial statement.
(v)
				Demonstrate to the satisfaction of the Commissioner that it has adequate
				financial capacity to meet its reinsurance obligations and is otherwise
				qualified to assume reinsurance from domestic insurers. An assuming insurer is
				deemed to meet this requirement as of the time of its application if it
				maintains a surplus as regards policyholders in an amount not less than $20
				million and its qualification has not been denied by the Commissioner within 90
				days after submission of its application.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 161 - REQUIREMENTS FOR QUALIFIED AND CERTIFIED REINSURERS › Section 161.3b - Calculation of credit for reinsurance regarding obligations secured with certified reinsurers

Current through Register Vol. 54, No. 28, July 13, 2024
(a) For a
				domestic ceding insurer to qualify for full financial statement credit for
				reinsurance ceded to a certified reinsurer, the certified reinsurer shall
				maintain security in a form acceptable to the Commissioner and consistent with
				section 319.1(b) of the act (40 P. S. §
										442.1(b)) or in a
				multibeneficiary trust in accordance with §
									161.3(3)(vii)(B)
				(relating to credit for reinsurance) except that:
(1) If a certified reinsurer maintains a
				trust to fully secure its obligations subject to §
										161.3(3)(vii) and
				chooses to secure its obligations incurred as a certified reinsurer in the form
				of a multibeneficiary trust, the certified reinsurer shall maintain separate
				trust accounts for its obligations incurred under reinsurance agreements issued
				or renewed as a certified reinsurer with reduced security as permitted by this
				paragraph or comparable laws of other United States jurisdictions and for its
				obligations subject to §
										161.3(3)(vii)(B).
				It shall be a condition to the grant of certification under this subsection
				that the certified reinsurer shall have bound itself, by the language of the
				trust and agreement with the chief regulatory official with principal
				regulatory oversight of each trust account, to fund, upon termination of a
				trust account, out of the remaining surplus of the trust any deficiency of
				another trust account.
(2) The
				minimum trusteed surplus requirements provided in §
										161.3(3)(vii)are
				not applicable with respect to a multibeneficiary trust maintained by a
				certified reinsurer for the purpose of securing obligations incurred under this
				paragraph, except that the trust must maintain a minimum trusteed surplus of
				$10 million.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 161 - REQUIREMENTS FOR QUALIFIED AND CERTIFIED REINSURERS › Section 161.3c - Concentration risk

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A ceding
				insurer shall take steps to manage its reinsurance recoverables proportionate
				to its own book of business. A domestic ceding insurer shall notify the
				Commissioner within 30 days after reinsurance recoverables from a single
				assuming insurer, or group of affiliated assuming insurers, exceed 50% of the
				domestic ceding insurer's last reported surplus to policyholders, or after it
				is determined that reinsurance recoverables from a single assuming insurer or
				group of affiliated assuming insurers is likely to exceed this limit. The
				notification must demonstrate that the exposure is safely managed by the
				domestic ceding insurer.
(b) A
				ceding insurer shall take steps to diversify its reinsurance program. A
				domestic ceding insurer shall notify the Commissioner within 30 days after
				ceding to a single assuming insurer, or group of affiliated assuming insurers,
				more than 20% of the ceding insurer's gross written premium in the prior
				calendar year, or after it has determined that the reinsurance ceded to a
				single assuming insurer, or group of affiliated assuming insurers is likely to
				exceed this limit. The notification must demonstrate that the exposure is
				safely managed by the domestic ceding insurer.
The provisions of this §
											161.3c issued under sections 206,
					 506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S.
					 §§
												66,
					 186,
					 411 and
					 412); and section
					 319.1 of The Insurance Company Law
					 of 1921 (40 P. S. §
												442.1).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 161 - REQUIREMENTS FOR QUALIFIED AND CERTIFIED REINSURERS › Section 161.4 - Trust fund requirements

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A trust
				required under §
									161.3(3) or (4)
				(relating to credit for reinsurance) shall be established and maintained in a
				form approved by the Commissioner. The trust instrument shall provide that
				contested claims shall be valid and enforceable out of funds in trust to the
				extent remaining unsatisfied 30 days after entry of the final order of a court
				of competent jurisdiction in the United States. The trust shall vest legal
				title to its assets in the trustees of the trust for the benefit of the
				grantor's United States policyholders and ceding insurers, their assigns and
				successors in interest. The trust and the assuming insurer shall be subject to
				examination as determined by the Commissioner. The trust described in this
				section shall remain in effect for as long as the assuming insurer or a member
				or former member of a group of insurers shall have outstanding obligations due
				under reinsurance agreements subject to the trust.
(b) By February 28 of each year, the trustees
				of a trust established to comply with §
									161.3(3) or (4)
				shall report to the Commissioner in writing setting forth the balance of the
				trust and listing the trust's investments at the preceding year's end and shall
				certify the date of termination of the trust, if so planned, or certify that
				the trust will not expire prior to the next following December 31. The assuming
				insurer shall annually submit a financial exhibit which quantifies the
				liabilities attributable to business directly written or assumed in the United
				States.
(c) An amendment to the
				trust will not be effective unless reviewed and approved in advance by the
				Commissioner.
This section cited in 31 Pa. Code §
											161.6 (relating to revocation of
					 reinsurer qualification or
					 certification).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 161 - REQUIREMENTS FOR QUALIFIED AND CERTIFIED REINSURERS › Section 161.5 - Determination of reinsurer qualification

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Applications for designation as a
				qualified reinsurer shall be submitted by the assuming insurer and shall be
				accompanied by a properly executed Form QR-1 as provided in Appendix A
				(relating to Form QR-1 Certificate of Assuming Insurer).
(b) If the Department is satisfied that an
				assuming insurer has met the conditions for qualification and determines to
				designate the assuming insurer as a qualified reinsurer, the Department will
				issue written notice of the designation to the assuming insurer and include the
				insurer on a list of qualified reinsurers published and periodically reviewed
				by the Commissioner.
(c) If the
				Department determines that qualification will be denied, the Department will
				issue written notice of denial to the assuming insurer. The assuming insurer
				may request a hearing to review the Department's denial. The hearing will be
				held in accordance with
				2
				Pa.C.S. §§
										501-508 and
				701-704 (relating to the
				Administrative Agency Law) and 1 Pa. Code Part II (relating to the general
				rules of administrative practice and procedure).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 161 - REQUIREMENTS FOR QUALIFIED AND CERTIFIED REINSURERS › Section 161.6 - Revocation of reinsurer qualification or certification

Current through Register Vol. 54, No. 28, July 13, 2024
(a) If the Department determines that a
				reinsurer has failed to continue to meet one or more of the conditions for
				qualification or certification, the Commissioner may upon written notice and
				hearing revoke its qualification or certification and remove it from the
				published list of qualified or certified reinsurers.
(b) If an assuming insurer's qualification
				has been revoked by the Commissioner after notice, a ceding insurer shall be
				allowed to continue to take credit for reinsurance ceded to the assuming
				insurer until the end of the contract year or 1 year from the date of the
				revocation, whichever time is less, but in no event less than 6 months. If an
				assuming insurer's certification has been revoked by the Commissioner, the
				assuming insurer shall post security in accordance with section 319.1(b) of the
				act (40 P. S. §
										442.1(b)) for the ceding
				insurer to continue to take credit for reinsurance ceded to the assuming
				insurer. If funds continue to be held in trust in accordance with §
									161.4 (relating to trust fund
				requirements) the Commissioner may allow additional credit equal to the ceding
				insurer's pro rata share of the funds, discounted to reflect the risk of
				uncollectability and anticipated expenses of trust administration.
				Notwithstanding the change of a certified reinsurer's rating or revocation of
				its certification, a domestic insurer that has ceded reinsurance to that
				certified reinsurer may not be denied credit for reinsurance for 3 months for
				reinsurance ceded to that certified reinsurer, unless the reinsurance is found
				by the Commissioner to be at high risk of uncollectability.
(c) If a modification, amendment or revision
				to an existing reinsurance agreement, which increases the risk reinsured, takes
				place after an assuming insurer's qualification or certification has been
				revoked, credit will not be allowed a ceding insurer for additional risks ceded
				after the date and directly resulting from the modification, amendment or
				revision.
(d) Notwithstanding the
				provisions of subsections (b) and (c), a ceding insurer may continue to take
				credit for reinsurance ceded before the date of the revocation of the assuming
				insurer's qualification with respect to a risk covered by the reinsurance
				agreement during the time the assuming insurer's qualification was in
				effect.
The provisions of this §
											161.6 amended under sections 206,
					 506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S.
					 §§
												66,
					 186,
					 411,
					 412); and section
					 319.1 of The Insurance Company Law
					 of 1921 (40 P. S. §
												42.1).
This section cited in 31 Pa. Code §
											161.3a (relating to requirements
					 for certified reinsurers).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 161 - REQUIREMENTS FOR QUALIFIED AND CERTIFIED REINSURERS › Section 161.7 - Credit for joint underwriting or pooling arrangements

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Domestic ceding insurers which are
				participating in a joint underwriting or joint reinsurance pooling arrangement,
				in which the insurers participating in the arrangement are not qualified or
				certified reinsurers, may request specific approval by the Commissioner to take
				reserve credit for reinsurance ceded under those arrangements.
(b) The Commissioner may specify what
				information is required to be filed with respect to the participants in the
				arrangement to determine whether credit shall be allowed.
(c) In determining whether credit will be
				allowed under this section, the Commissioner will consider:
(1) The amount of risk ceded under the
				arrangement to reinsurers which are either qualified reinsurers under this
				chapter or which are licensed to transact insurance or reinsurance in this
				State.
(2) The financial condition
				and state of domicile of the participants.
(3) The length of time the agreement has been
				in force and the effect of the agreement on the participants.
(4) The type of risk being reinsured by the
				pool and the maximum per risk exposure of the pool.
(5) The management and control of the
				operations of the pool.
(6) Other
				information the Commissioner may prescribe.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 161 - REQUIREMENTS FOR QUALIFIED AND CERTIFIED REINSURERS › Section 161.8 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
											161.8 reserved under sections 206,
					 506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S.
					 §§
												66,
					 186,
					 411 and
					 412); and section
					 319.1 of The Insurance Company Law
					 of 1921 (40 P. S. §
												442.1).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 161 - REQUIREMENTS FOR QUALIFIED AND CERTIFIED REINSURERS › Section 161.8a - Reinsurance contracts

Current through Register Vol. 54, No. 28, July 13, 2024
A ceding insurer will not be granted a credit or allowed an
				  asset or reduction from liability for reinsurance effected with assuming
				  insurers meeting the requirements of this chapter unless the reinsurance
				  agreement includes the following provisions:
(1) A proper insolvency clause as provided
				for in section 319.1(d) of the act (40 P. S. §
										442.1(d)), which stipulates
				that reinsurance is payable directly to the liquidator or successor without
				diminution regardless of the status of the ceding company.
(2) A reinsurance intermediary clause, if
				applicable, which stipulates that the credit risk for the intermediary is
				carried by the assuming insurer.
(3) A mandatory funding clause requiring the
				certified reinsurer to provide and maintain security in an amount sufficient to
				avoid the imposition of a financial statement penalty on the ceding insurer for
				reinsurance ceded to the certified reinsurer.
The provisions of this §
											161.8a issued under sections 206,
					 506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S.
					 §§
												66,
					 186,
					 411 and
					 412); and section
					 319.1 of The Insurance Company Law
					 of 1921 (40 P. S. §
												442.1).
This section cited in 31 Pa. Code §
											161.3b (relating to calculation of
					 credit for reinsurance regarding obligations secured with certified
					 reinsurers).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 161 - REQUIREMENTS FOR QUALIFIED AND CERTIFIED REINSURERS › Section 161.9 - Application

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Credit will be
				allowed when the reinsurance is ceded to an assuming insurer not meeting the
				requirements of this section or §
									161.3 (relating to credit for
				reinsurance) with respect to the insurance of risks located in jurisdictions if
				the reinsurance is required by applicable law or regulation of that
				jurisdiction. As used in this section, "jurisdiction" means a state, district
				or territory of the United States and a lawful national government.
(b) An insurer which has been designated as a
				qualified reinsurer prior to August 28, 1993, will have until August 28, 1995,
				to achieve compliance with this chapter or have its qualification
				revoked.
The provisions of this §
											161.9 amended under sections 206,
					 506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S.
					 §§
												66,
					 186,
					 411 and
					 412); and section
					 319.1 of The Insurance Company Law
					 of 1921 (40 P. S. §
												42.1).
This appendix cited in 31 Pa. Code §
											161.5 (relating to determination
					 of reinsurer qualification).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 161 - REQUIREMENTS FOR QUALIFIED AND CERTIFIED REINSURERS › Appendix A

Current through Register Vol. 54, No. 28, July 13, 2024
FORM QR-1
CERTIFICATE OF ASSUMING INSURER
I, _________________________ , _________________________
				  (name of officer)...(title of officer) of _________________________ , the
				  assuming insurer (name of assuming insurer) under a reinsurance agreement(s)
				  with one or ore insurers domiciled. _________________________ , hereby certify
				  that (name of state) _________________________ (name of assuming insurer)
				  ("Assuming Insurer"):
1. Submits to the jurisdiction of any court of competent
				  jurisdiction in
______________________________________
(ceding insurer's state of domicile)
for the adjudication of any issues arising out of the
				  reinsurance agreement(s), agrees to comply with all requirements necessary to
				  give such court jurisdiction, and will abide by the final decision of such
				  court or any appellate court in the event of an appeal. Nothing in this
				  paragraph constitutes or should be understood to constitute a waiver of
				  Assuming Insurer's rights to commence an action in any court of competent
				  jurisdiction in the United States, to remove an action to a United States
				  District Court, or to seek a transfer of a case to another court as permitted
				  by the laws of the United States or of any state in the United States. This
				  paragraph is not intended to conflict with or override the obligation of the
				  parties to the reinsurance agreement(s) to arbitrate their disputes if such an
				  obligation is created in the agreement(s).
2. Designates
_________________________
as its lawful
(name of lawful agent)
agent upon whom may be served any lawful process in any
				  action, suit or proceeding arising out of the reinsurance agreement(s)
				  instituted by or on behalf of the ceding insurer.
3. Submits to the authority of the Insurance Commissioner of
				  the Commonwealth of Pennsylvania to examine its books and records and agrees to
				  bear the expense of any such examination.
This appendix cited in 31 Pa. Code §
											161.5 (relating to determination
					 of reinsurer qualification).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 162 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 162.1 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This chapter
				sets forth the conditions whereby a ceding insurer will not be permitted to
				receive credit for reinsurance in financial statements filed with the
				Department if the reinsurance agreement does not transfer all of the
				significant risks inherent in the business being reinsured or, in substance or
				effect, the expected potential liability to the ceding insurer remains
				basically unchanged by the reinsurance transaction, notwithstanding certain
				risk elements in the reinsurance agreement, such as catastrophic mortality or
				extraordinary survival.
(b) In
				addition to specifying the conditions which would result in denial of credit,
				this chapter requires reinsurance agreements which fall within the scope of
				§§
									162.3 and
				162.5 (relating to scope; and
				agreements to be filed with Commissioner), including data detailing the
				financial impact of the agreements, to be filed by the ceding insurer with the
				Department and specifies the accounting methodology to be followed by the
				ceding insurer in reporting any increase in surplus resulting from those
				agreements in financial statements filed with the Department.
(c) This chapter also provides safeguards to
				insure that agreements for which credit has been taken are actually executed
				and effective within a time period that reasonably corresponds to the date of
				the insurer's financial statements.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 162 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 162.2 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this chapter,
				  have the following meanings, unless the context clearly indicates
				  otherwise:
Commissioner
-The Insurance Commissioner of
				  the Commonwealth.
Department
-The Insurance Department of the
				  Commonwealth.
Domestic
-Incorporated or organized under
				  the laws of the Commonwealth.
Foreign
-Incorporated or organized under the
				  laws of a jurisdiction other than the Commonwealth.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 162 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 162.3 - Scope

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This chapter
				applies to licensed domestic life and accident and health insurers as well as
				to licensed foreign life and accident and health insurers which are not subject
				to a substantially similar regulation in their domiciliary state.
(b) In addition, this chapter similarly
				applies to licensed domestic and foreign property and casualty insurers with
				respect to their accident and health business.
(c) This chapter does not apply to assumption
				reinsurance, yearly renewable term reinsurance or certain nonproportional
				reinsurance such as stop loss or catastrophe reinsurance.
This section cited in 31 Pa. Code §
											162.1 (relating to
					 purpose).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 162 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 162.5 - Agreements to be filed with Commissioner

Current through Register Vol. 54, No. 28, July 13, 2024
Agreements entered into after September 12, 1993, which
				  involve the reinsurance of business issued prior to the effective date of the
				  agreements, along with subsequent amendments thereto, shall be filed by the
				  ceding insurer with the Commissioner within 30 days from the date of execution.
				  Each filing shall include data detailing the financial impact of the
				  transaction.
This section cited in 31 Pa. Code §
											162.1 (relating to purpose); and
					 31 Pa. Code §
											162.6 (relating to statutory
					 financial reporting requirements).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 162 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 162.6 - Statutory financial reporting requirements

Current through Register Vol. 54, No. 28, July 13, 2024
An increase in surplus net of Federal income tax resulting
				  from arrangements described in §
									162.5 (relating to agreements to
				  be filed with Commissioner) shall be identified separately on the insurer's
				  statutory financial statement as a surplus item (aggregate write-ins for gains
				  and losses in surplus in the capital and surplus account) and recognition of
				  the surplus increase as income shall be reflected on a net of tax basis in the
				  "reinsurance ceded" line of the Annual Statement as earnings emerge from the
				  business reinsured.
For example: On the last day of calendar year N, company XYZ
				  pays a $20 million initial commission and expense allowance to company ABC for
				  reinsuring an existing block of business. Assuming a 34% tax rate, the net
				  increase in surplus at inception is $13.2 million ($20 million - $6.8 million)
				  which is reported on the "Aggregate write-ins for gains and losses in surplus"
				  line in the Capital and Surplus account. $6.8 million (34% of $20 million) is
				  reported as income on the "Commissions and expense allowances on reinsurance
				  ceded" line of the Summary of Operations. At the end of year N+1 the business
				  has earned $4 million. ABC has paid $.5 million in profit and risk charges in
				  arrears for the year and has received a $1 million experience refund. Company
				  ABC's annual statement would report $1.65 million (66% of (4 million - $1
				  million - $.5 million) up to a maximum of $13.2 million) on the "Commissions
				  and expense allowance on reinsurance ceded" line of the Summary of Operations,
				  and -$1.65 million on the "Aggregate write-ins for gains and losses in surplus"
				  line of the Capital and Surplus account. The experience refund would be
				  reported separately as a miscellaneous income item in the Summary of
				  Operations.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 162 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 162.7 - Responsibility of valuation actuary

Current through Register Vol. 54, No. 28, July 13, 2024
The ceding insurer's actuary who signs the financial
				  statement actuarial opinion with respect to valuation of reserves shall
				  consider this chapter and applicable actuarial standards of practice when
				  determining the proper credit in financial statements filed with the
				  Department. The actuary should maintain adequate documentation and be prepared
				  upon request to describe the actuarial work performed for inclusion in the
				  financial statements and to demonstrate that the work conforms to this
				  chapter.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 162 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 162.8 - Written agreements

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A
				reinsurance agreement or amendment to an agreement may not be used to reduce
				liability or to establish an asset in a financial statement filed with the
				Department, unless the agreement, amendment or a binding letter of intent has
				been executed by both parties no later than the "as of date" of the financial
				statement.
(b) In the case of a
				letter of intent, a reinsurance agreement or an amendment to a reinsurance
				agreement shall be executed within a reasonable period of time, not exceeding
				90 days from the execution date of the letter of intent, for credit to be
				granted for the reinsurance ceded.
(c) The reinsurance agreement shall contain
				provisions which provide the following:
(1)
				The agreement shall constitute the entire agreement between the parties with
				respect to the business being reinsured thereunder and that there are no
				understandings between the parties other than as expressed in the
				agreement.
(2) A change or
				modification to the agreement shall be void unless made by amendment to the
				agreement and signed by both parties.