Effective 28 Aug 2014

375.1255. Company action level event, occurrence of, when — effect, duties of insurer or health organization — plan to be submitted, approval of, revision of, when — copies filed with all states in which insurer is authorized to transact business. — 1. "Company action level event" means with respect to any insurer or health organization, any of the following events:

(1) The filing of an RBC report by the insurer or health organization which indicates that:

(a) The insurer's or health organization's total adjusted capital is greater than or equal to its regulatory action level RBC but less than its company action level RBC; or

(b) If a life and health insurer, the insurer has total adjusted capital which is greater than or equal to its company action level RBC but less than the product of its authorized control level RBC and 3.0, and has a negative trend;

(c) If a property and casualty insurer, the insurer has total adjusted capital which is greater than or equal to its company action level RBC but less than the product of its authorized control level RBC and 3.0 and triggers the trend test determined in accordance with the trend test calculation included in the property and casualty RBC report instructions;

(d) If a health organization has total adjusted capital which is greater than or equal to its company action level RBC but less than the product of its authorized control level RBC and 3.0 and triggers the trend test determined in accordance with the trend test calculation included in the health RBC instructions;

(2) The notification by the director to the insurer or health organization of an adjusted RBC report that indicates the event in paragraph (a), (b), (c), or (d) of subdivision (1) of this subsection, if the insurer or health organization does not challenge the adjusted RBC report pursuant to section 375.1265;

(3) If pursuant to section 375.1265 the insurer or health organization challenges an adjusted RBC report that indicates the event described in subdivision (1) of this subsection, the notification by the director to the insurer or health organization that the director has, after a hearing, rejected the insurer's or health organization's challenge.

2. In the event of a company action level event the insurer or health organization shall prepare and submit to the director an RBC plan which shall:

(1) Identify the conditions in the insurer or health organization which contribute to the company action level event;

(2) Contain proposals of corrective actions which the insurer or health organization intends to take and would be expected to result in the elimination of the company action level event;

(3) (a) Provide projections of the insurer's financial results in the current year and at least the four succeeding years, both in the absence of proposed corrective actions and giving effect to the proposed corrective actions, including projections of statutory operating income, net income, capital or surplus. The projections for both new and renewal business might include separate projections for each major line of business and separately identify each significant income, expense and benefit component;

(b) Provide projections of the health organization's financial results in the current year and at least the two succeeding years, both in the absence of proposed corrective actions and giving effect to the proposed corrective actions, including projections of statutory balance sheets, operating income, net income, capital and surplus, and RBC levels. The projections for both new and renewal business might include separate projections for each major line of business and separately identify each significant income, expense, and benefit component;

(4) Identify the key assumptions impacting the insurer's or health organization's projections and the sensitivity of the projections to the assumptions; and

(5) Identify the quality of, and problems associated with, the insurer's or health organization's business, including but not limited to its assets, anticipated business growth and associated surplus strain, extraordinary exposure to risk, mix of business and use of reinsurance in each case, if any.

3. The RBC plan shall be submitted:

(1) Within forty-five days of the company action level event; or

(2) If the insurer or health organization challenges an adjusted RBC report pursuant to section 375.1265 within forty-five days after notification to the insurer or health organization that the director has, after a hearing, rejected the insurer's or health organization's challenge.

4. Within sixty days after the submission by an insurer or health organization of an RBC plan to the director, the director shall notify the insurer or health organization whether the RBC plan shall be implemented or is, in the judgment of the director, unsatisfactory. If the director determines the RBC plan is unsatisfactory, the notification to the insurer or health organization shall set forth the reasons for the determination, and may set forth proposed revisions which will render the RBC plan satisfactory, in the judgment of the director. Upon notification from the director, the insurer or health organization shall prepare a revised RBC plan, which may incorporate by reference any revisions proposed by the director, and shall submit the revised RBC plan to the director:

(1) Within forty-five days after the notification from the director; or

(2) If the insurer or health organization challenges the notification from the director pursuant to section 375.1265, within forty-five days after a notification to the insurer or health organization that the director has, after a hearing, rejected the insurer's or health organization's challenge.

5. In the event of a notification by the director to an insurer's or health organization that the insurer or health organization's RBC plan or revised RBC plan is unsatisfactory, the director may at the director's discretion, subject to the insurer's or health organization's right to a hearing under section 375.1265, specify in the notification that the notification constitutes a regulatory action level event.

6. Every domestic insurer or domestic health organization that files an RBC plan or revised RBC plan with the director shall file a copy of the RBC plan or revised RBC plan with the chief insurance regulatory official in any state in which the insurer is authorized to do business if:

(1) Such state has an RBC provision, substantially similar to subsection 1 of section 375.1267; and

(2) The chief insurance regulatory official of that state has notified the insurer or health organization of its request for the filing in writing, in which case the insurer or organization shall file a copy of the RBC plan or revised RBC plan in that state no later than the later of:

(a) Fifteen days after the receipt of notice to file a copy of its RBC plan or revised RBC plan with the state; or

(b) The date on which the RBC plan or revised RBC plan is filed under subsection 3 or 4 of this section.

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(L. 1993 H.B. 709 § 3, A.L. 1996 S.B. 759, A.L. 2010 S.B. 583, A.L. 2014 H.B. 1968)