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ACROSS SESSIONS
- Subject Index: Since 1995
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- Summaries: Since 1994
Developed and maintained by the Division of Legislative Automated Systems.
2000 SESSION
Be it enacted by the General Assembly of Virginia:
1. That §§ 38.2-4214, 38.2-4319 as it is currently effective and as it may become effective, 38.2-4509, 38.2-5500 through 38.2-5510, and 38.2-5513 of the Code of Virginia are amended and reenacted and that the Code of Virginia is amended by adding in Chapter 55 of Title 38.2 a section numbered 38.2-5515 as follows:
§ 38.2-4214. Application of certain provisions of law.
No provision of this title except this chapter and, insofar as they are not
inconsistent with this chapter, §§ 38.2-200, 38.2-203, 38.2-210 through
38.2-213, 38.2-218 through 38.2-225, 38.2-230, 38.2-232, 38.2-305, 38.2-316, 38.2-322,
38.2-400, 38.2-402 through 38.2-413, 38.2-500 through 38.2-515, 38.2-600
through 38.2-620, 38.2-700 through 38.2-705, 38.2-900 through 38.2-904,
38.2-1017, 38.2-1018, 38.2-1038, 38.2-1040 through 38.2-1044, Articles 1 (§
38.2-1300 et seq.) and 2 (§ 38.2-1306.2 et seq.) of Chapter 13, §§ 38.2-1312,
38.2-1314, 38.2-1317 through 38.2-1328, 38.2-1334, 38.2-1340, 38.2-1400 through 38.2-1444,
38.2-1800 through 38.2-1836, 38.2-3400, 38.2-3401, 38.2-3404, 38.2-3405, 38.2-3405.1,
38.2-3407.1 through 38.2-3407.6:1, 38.2-3407.9 through 38.2-3407.16, 38.2-3409,
38.2-3411 through 38.2-3419.1, 38.2-3430.1 through 38.2-3437, 38.2-3501,
38.2-3502, 38.2-3514.1, 38.2-3514.2, 38.2-3516 through 38.2-3520 as they apply
to Medicare supplement policies, §§ 38.2-3522.1 through 38.2-3523.4, 38.2-3525,
38.2-3540.1, 38.2-3541, 38.2-3542, 38.2-3543.2, 38.2-3600 through 38.2-3607,
Chapter 53 (§ 38.2-5300 et seq.), Chapter 55 (§ 38.2-5500 et seq.),
Chapter 58 (§ 38.2-5800 et seq.) and Chapter 59 (§ 38.2-5900 et seq.) of
this title shall apply to the operation of a plan.
§ 38.2-4319. (Effective until July 1, 2004) Statutory construction and relationship to other laws.
A. No provisions of this title except this chapter and, insofar as they are not
inconsistent with this chapter, §§ 38.2-100, 38.2-200, 38.2-203, 38.2-210
through 38.2-213, 38.2-218 through 38.2-225, 38.2-229, 38.2-232, 38.2-305, 38.2-316,
38.2-322, 38.2-400, 38.2-402 through 38.2-413, 38.2-500 through 38.2-515, 38.2-600
through 38.2-620, Chapter 9 (§ 38.2-900 et seq.), §§ 38.2-1057, 38.2-1306.2
through 38.2-1309, Articles 4 (§ 38.2-1317 et seq.) and 5 (§ 38.2-1322 et seq.)
of Chapter 13, Articles 1 (§ 38.2-1400 et seq.) and 2 (§ 38.2-1412 et seq.) of
Chapter 14, §§ 38.2-1800 through 38.2-1836, 38.2-3401, 38.2-3405, 38.2-3405.1,
38.2-3407.2 through 38.2-3407.6:1, 38.2-3407.9 through 38.2-3407.16,
38.2-3411.2, 38.2-3412.1:01, 38.2-3414.1, 38.2-3418.1 through 38.2-3418.11,
38.2-3419.1, 38.2-3430.1 through 38.2-3437, 38.2-3500, 38.2-3514.1,
38.2-3514.2, 38.2-3522.1 through 38.2-3523.4, 38.2-3525, 38.2-3542,
38.2-3543.2, Chapter 53 (§ 38.2-5300 et seq.), Chapter 55 (§ 38.2-5500 et
seq.), Chapter 58 (§ 38.2-5800 et seq.) and Chapter 59 (§ 38.2-5900 et seq.) of
this title shall be applicable to any health maintenance organization granted a license under
this chapter. This chapter shall not apply to an insurer or health services
plan licensed and regulated in conformance with the insurance laws or Chapter
42 (§ 38.2-4200 et seq.) of this title except with respect to the activities of
its health maintenance organization.
B. Solicitation of enrollees by a licensed health maintenance organization or by its representatives shall not be construed to violate any provisions of law relating to solicitation or advertising by health professionals.
C. A licensed health maintenance organization shall not be deemed to be engaged in the unlawful practice of medicine. All health care providers associated with a health maintenance organization shall be subject to all provisions of law.
D. Notwithstanding the definition of an eligible employee as set forth in § 38.2-3431, a health maintenance organization providing health care plans pursuant to § 38.2-3431 shall not be required to offer coverage to or accept applications from an employee who does not reside within the health maintenance organization's service area.
§ 38.2-4319. (Effective July 1, 2004) Statutory construction and relationship to other laws.
A. No provisions of this title except this chapter and, insofar as they are not
inconsistent with this chapter, §§ 38.2-100, 38.2-200, 38.2-203, 38.2-210
through 38.2-213, 38.2-218 through 38.2-225, 38.2-229, 38.2-232, 38.2-305, 38.2-316,
38.2-322, 38.2-400, 38.2-402 through 38.2-413, 38.2-500 through 38.2-515, 38.2-600
through 38.2-620, Chapter 9 (§ 38.2-900 et seq.), §§ 38.2-1057, 38.2-1306.2
through 38.2-1309, Articles 4 (§ 38.2-1317 et seq.) and 5 (§ 38.2-1322 et seq.)
of Chapter 13, Articles 1 (§ 38.2-1400 et seq.) and 2 (§ 38.2-1412 et seq.) of
Chapter 14, §§ 38.2-1800 through 38.2-1836, 38.2-3401, 38.2-3405, 38.2-3405.1,
38.2-3407.2 through 38.2-3407.6:1, 38.2-3407.9 through 38.2-3407.16,
38.2-3411.2, 38.2-3414.1, 38.2-3418.1 through 38.2-3418.11, 38.2-3419.1,
38.2-3430.1 through 38.2-3437, 38.2-3500, 38.2-3514.1, 38.2-3514.2, 38.2-3522.1
through 38.2-3523.4, 38.2-3525, 38.2-3542, 38.2-3543.2, Chapter 53 (§ 38.2-5300
et seq.), Chapter 55 (§ 38.2-5500 et seq.), Chapter 58 (§ 38.2-5800 et seq.)
and Chapter 59 (§ 38.2-5900 et seq.) of this title shall be applicable to any
health maintenance organization granted a license under this chapter. This
chapter shall not apply to an insurer or health services plan licensed and
regulated in conformance with the insurance laws or Chapter 42 (§ 38.2-4200 et
seq.) of this title except with respect to the activities of its health maintenance
organization.
B. Solicitation of enrollees by a licensed health maintenance organization or by its representatives shall not be construed to violate any provisions of law relating to solicitation or advertising by health professionals.
C. A licensed health maintenance organization shall not be deemed to be engaged in the unlawful practice of medicine. All health care providers associated with a health maintenance organization shall be subject to all provisions of law.
D. Notwithstanding the definition of an eligible employee as set forth in § 38.2-3431, a health maintenance organization providing health care plans pursuant to § 38.2-3431 shall not be required to offer coverage to or accept applications from an employee who does not reside within the health maintenance organization's service area.
§ 38.2-4509. Application of certain laws.
A. No provision of this title except this chapter and, insofar as they are not inconsistent with this chapter, §§ 38.2-200, 38.2-203, 38.2-210 through 38.2-213, 38.2-218 through 38.2-225, 38.2-229, 38.2-316, 38.2-400, 38.2-402 through 38.2-413, 38.2-500 through 38.2-515, 38.2-600 through 38.2-620, 38.2-900 through 38.2-904, 38.2-1038, 38.2-1040 through 38.2-1044, Articles 1 (§ 38.2-1300 et seq.) and 2 (§ 38.2-1306.2 et seq.) of Chapter 13, §§ 38.2-1312, 38.2-1314, Article 4 (§ 38.2-1317 et seq.) of Chapter 13, §§ 38.2-1400 through 38.2-1444, 38.2-1800 through 38.2-1836, 38.2-3401, 38.2-3404, 38.2-3405, 38.2-3407.10, 38.2-3407.13, 38.2-3407.14, 38.2-3407.15, 38.2-3415, 38.2-3541, 38.2-3600 through 38.2-3603, Chapter 55 (§ 38.2-5500 et seq.), Chapter 58 (§ 38.2-5800 et seq.) and Chapter 59 (§ 38.2-5900 et seq.) of this title shall apply to the operation of a plan.
B. The provisions of subsection A of § 38.2-322 shall apply to an optometric services plan. The provisions of subsection C of § 38.2-322 shall apply to a dental services plan.
C. The provisions of Article 1.2 (§ 32.1-137.7 et seq.) of Chapter 5 of Title 32.1 shall not apply to either an optometric or dental services plan.
§ 38.2-5500. Applicability.
The provisions of this chapter shall be known as The Risk-Based Capital Act for
Insurers and may be referred to herein as "the Act." The Act shall apply to all
insurers persons licensed in this Commonwealth to transact the business of an
insurance business pursuant to provisions in Chapter 10 (§ 38.2-1000 et seq.),
11 (§ 38.2-1100 et seq.), 12 (§ 38.2-1200 et seq.) or, 25 (§ 38.2-2500 et
seq.), 42 (§ 38.2-4200 et seq.), 43 (§ 38.2-4300 et seq.) or 45 (§
38.2-4500 et seq.).
§ 38.2-5501. Definitions.
As used in this chapter, the following terms shall have the following meanings:
"Adjusted RBC Report" means an RBC report which has been adjusted by the Commission in accordance with subsection E of § 38.2-5502.
"Capital and surplus" or "capital," except when used in the term “risk-based capital” or “adjusted capital,” means net worth of a health maintenance organization and, for all other licensees, means surplus to policyholders.
"Corrective Order" means an order issued by the Commission specifying corrective actions which the Commission has determined are required.
"Delinquency proceeding" means any proceeding commenced against an insurer a
licensee for the purpose of liquidating, rehabilitating, reorganizing or
conserving an insurer a licensee pursuant to the provisions of Chapter 15 (§
38.2-1500 et seq.).
"Domestic health organization" means a health organization domiciled in this Commonwealth.
"Domestic insurer" means any domestic company which has obtained a license to engage in insurance transactions in this Commonwealth in accordance with the applicable provisions of Chapter 10 (§ 38.2-1000 et seq.).
"Domestic licensee" means and includes a domestic insurer and a domestic health organization.
"Foreign health organization" means a health organization not domiciled in this Commonwealth which is licensed to do business in this Commonwealth.
"Foreign insurer" means any company not domiciled in this Commonwealth which has obtained a license to engage in insurance transactions in this Commonwealth in accordance with the applicable provisions in Chapter 10 (§ 38.2-1000 et seq.).
"Foreign licensee" means and includes a foreign insurer and a foreign health organization.
"Health organization" means an insurer which is required by the Commission to use the NAIC’s Health Annual Statement blank when filing the annual statement prescribed by § 38.2-1300, or a corporation licensed pursuant to Chapter 42 (§ 38.2-4200 et seq.) of this title operating a health or hospital services plan in this Commonwealth, or a health maintenance organization or limited health maintenance organization licensed pursuant to Chapter 43 (§ 38.2-4300 et seq.) of this title, or a corporation licensed pursuant to Chapter 45 (§ 38.2-4500 et seq.) of this title and operating a dental or optometric services plan in this Commonwealth.
"Licensee" means and includes a life and health insurer, a property and casualty insurer, and a health organization.
"Life and health insurer" and "life or health insurer" mean means any domestic
insurer or foreign insurer, whether known as a life insurer or a property and casualty insurer or a reciprocal,
which is authorized to write any class of life insurance, annuities, or
accident and sickness insurance, and is not writing a class of insurance set
forth in §§ 38.2-110 through 38.2-132, provided that "life and health insurer"
shall not include any insurer which is required by the Commission to use the
NAIC’s Health Annual Statement blank when filing the annual statement
prescribed by § 38.2-1300.
"NAIC" means the National Association of Insurance Commissioners.
"Negative Trend," with respect to a life insurer, health insurer or life and
health insurer, means a negative trend over a period of time, as determined in accordance
with the "Trend Test Calculation" included in the RBC Instructions.
"Property and casualty insurer" means any domestic insurer or foreign insurer
which is authorized under any chapter of this title to write any class of
insurance except a class of life insurance or annuities, provided that
"property and casualty insurer" shall not include monoline mortgage guaranty
insurers, financial guaranty insurers and title insurers, nor shall it include
any insurer which is authorized to write a class of insurance set forth in §§
38.2-110 through 38.2-132 but is writing only accident and sickness insurance
required by the Commission to use the NAIC’s Health Annual Statement blank when
filing the annual statement prescribed by § 38.2-1300.
"RBC" means risk-based capital.
"RBC Instructions" means the RBC Report including risk-based capital instructions adopted by the NAIC, as such RBC Instructions may be amended by the NAIC from time to time in accordance with the procedures adopted by the NAIC.
"RBC Level" means an insurer's a licensee's Company Action Level RBC,
Regulatory Action Level RBC, Authorized Control Level RBC, or Mandatory Control Level RBC where:
1. "Company Action Level RBC" means, with respect to any insurer licensee, the
product of 2.0 and its Authorized Control Level RBC;
2. "Regulatory Action Level RBC" means the product of 1.5 and its Authorized Control Level RBC;
3. "Authorized Control Level RBC" means the number determined under the risk-based capital formula in accordance with the RBC Instructions;
4. "Mandatory Control Level RBC" means the product of 0.70 and the Authorized Control Level RBC.
"RBC Plan" means a comprehensive financial plan containing the elements
specified in subsection B of § 38.2-5503. If the Commission rejects the RBC
Plan, and it is revised by the insurer licensee, with or without the
Commission's recommendation, the plan shall be called the "Revised RBC Plan."
"RBC Report" means the report required in § 38.2-5502.
"Total Adjusted Capital" means the sum of:
1. An insurer's A licensee's statutory capital and surplus as determined in
accordance with statutory accounting applicable to the annual financial statements required to be
filed under § 38.2-1300; and
2. Such other items, if any, as the RBC Instructions may provide.
§ 38.2-5502. RBC Reports.
A. Every domestic insurer licensee shall, on or prior to each March 1, the
"filing date," prepare and submit to the Commission 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, every domestic insurer licensee
shall file its RBC Report:
1. With the NAIC in accordance with the RBC Instructions; and
2. With the insurance commissioner in any state in which the insurer licensee
is authorized to do business, if the insurance commissioner has notified the
insurer licensee of its request in writing, in which case, the insurer
licensee shall file its RBC Report not later than the later of:
a. Fifteen days from the receipt of notice to file its RBC Report with that state; or
b. The filing date.
B. A life and health insurer's RBC shall be determined in accordance with the formula set forth in the RBC Instructions. The formula shall take into account, and may adjust for the covariance between, the following risks:
1. The risk with respect to the insurer's assets;
2. The risk of adverse insurance experience with respect to the insurer's liabilities and obligations;
3. The interest rate risk with respect to the insurer's business; and
4. All other business risks and such other relevant risks as are set forth in the RBC Instructions.
Each risk shall be determined in each case by applying the factors in the manner set forth in the RBC Instructions.
C. A property and casualty insurer's RBC shall be determined in accordance with the formula set forth in the RBC Instructions. The formula shall take into account, and may adjust for the covariance between, the following risks:
1. Asset risk;
2. Credit risk;
3. Underwriting risk; and
4. All other business risks and such other relevant risks as are set forth in the RBC Instructions.
Each risk shall be determined in each case by applying the factors in the manner set forth in the RBC Instructions.
D. A health organization’s RBC shall be determined in accordance with the formula set forth in the RBC Instructions. The formula shall take into account, and may adjust for the covariance between, the following risks:
1. Asset risk;
2. Credit risk;
3. Underwriting risk; and
4. All other business risks and such other relevant risks as are set forth in the RBC Instructions.
Each risk shall be determined in each case by applying the factors in the manner set forth in the RBC Instructions.
D. E. An excess of capital over the amount produced by the risk-based capital
requirements contained in this Act and the formulas, schedules and instructions referred to in this
Act is desirable in the business of insurance. Accordingly, insurers licensees
should seek to maintain capital above the RBC levels required by this Act. Additional capital is used
and useful in the insurance business and helps to secure an insurer a licensee
against various risks inherent in, or affecting, the business of insurance and not accounted for or
only partially measured by the risk-based capital requirements contained in this Act.
E. F. If a domestic insurer licensee files an RBC Report which in the judgment
of the Commission is inaccurate, then the Commission shall adjust the RBC
Report to correct the inaccuracy and shall notify the insurer licensee 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."
§ 38.2-5503. Company Action Level Event.
A. "Company Action Level Event" means any of the following events:
1. The filing of an RBC Report by an insurer a licensee which indicates that:
a. The insurer's licensee'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 2.5 and has a negative trend;
2. The notification by the Commission to the insurer licensee of an Adjusted
RBC Report that indicates the event in subdivision A 1 a or A 1 b, provided the
insurer licensee does not challenge the Adjusted RBC Report under §
38.2-5507; or
3. If, pursuant to § 38.2-5507, the insurer licensee challenges an Adjusted RBC
Report that indicates the event in subdivision A 1 a or A 1 b, the notification by
the Commission to the insurer licensee that the Commission has, after a
hearing, rejected the insurer's licensee's challenge.
B. In the event of a Company Action Level Event, the insurer licensee shall
prepare and submit to the Commission an RBC Plan which shall:
1. Identify the conditions in the insurer licensee which contribute to the
Company Action Level Event;
2. Contain proposals of corrective actions which the insurer licensee intends
to take and would be expected to result in the elimination of the Company Action Level Event;
3. Provide projections of the insurer's licensee's financial results in the
current year and for at least the four succeeding years if the licensee is a
life and health insurer or a property and casualty insurer, or at least two succeeding years if
the licensee is a health organization, 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. If appropriate, the projections
for both new and renewal business shall 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 licensee's projections
and the sensitivity of the projections to the assumptions; and
5. Identify the quality of, and problems associated with, the insurer's
licensee'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, if any, in each case.
C. The RBC Plan shall be submitted:
1. Within forty-five days of the Company Action Level Event; or
2. If the insurer licensee challenges an Adjusted RBC Report pursuant to §
38.2-5507, within forty-five days after notification to the insurer licensee
that the Commission has, after a hearing, rejected the insurer's licensee's
challenge.
D. Within sixty days after the submission by an insurer a licensee of an RBC
Plan to the Commission, the Commission shall notify the insurer licensee
whether the RBC Plan shall be implemented or is, in the judgment of the Commission, unsatisfactory.
If the Commission determines the RBC Plan is unsatisfactory, the notification to the
insurer licensee 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 Commission. Upon notification from the Commission, the insurer licensee
shall prepare a Revised RBC Plan, which may incorporate by reference any revisions proposed by the
Commission, and shall submit the Revised RBC Plan to the Commission:
1. Within forty-five days after the notification from the Commission; or
2. If the insurer licensee challenges the notification from the Commission
under § 38.2-5507, within forty-five days after a notification to the insurer
licensee that the Commission has, after a hearing, rejected the insurer's
licensee's challenge.
E. In the event of a notification by the Commission to an insurer a licensee
that the insurer's licensee's RBC Plan or Revised RBC Plan is unsatisfactory,
the Commission may at the Commission's discretion, subject to the insurer's
licensee's right to a hearing under § 38.2-5507, specify in the
notification that the notification constitutes a Regulatory Action Level Event.
F. Every domestic insurer licensee that files an RBC Plan or Revised RBC Plan
with the Commission shall file a copy of the RBC Plan or Revised RBC Plan with the insurance
commissioner in any state in which the insurer licensee is authorized to do
business if:
1. Such state has an RBC provision substantially similar to subsection A of § 38.2-5508; and
2. The insurance commissioner of that state has notified the insurer licensee
of its request for the filing in writing, in which case the insurer licensee
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 C of § 38.2-5504.
§ 38.2-5504. Regulatory Action Level Event.
A. "Regulatory Action Level Event" means, with respect to any insurer licensee,
any of the following events:
1. The filing of an RBC Report by the insurer licensee which indicates that the
insurer's licensee's Total Adjusted Capital is greater than or equal to its
Authorized Control Level RBC but less than its Regulatory Action Level RBC;
2. The notification by the Commission to an insurer a licensee of an Adjusted
RBC Report that indicates the event in subdivision A 1, provided the insurer
licensee does not challenge the Adjusted RBC Report under § 38.2-5507;
3. If, pursuant to § 38.2-5507, the insurer licensee challenges an Adjusted RBC
Report that indicates the event in subdivision A 1, the notification by the
Commission to the insurer licensee that the Commission has, after a
hearing, rejected the insurer's licensee's challenge;
4. The failure of the insurer licensee to file an RBC Report by the filing
date, unless the insurer licensee has provided an explanation for such failure
which is satisfactory to the Commission and has cured the failure within ten days after the filing
date;
5. The failure of the insurer licensee to submit an RBC Plan to the Commission
within the time period set forth in subsection C of § 38.2-5503;
6. Notification by the Commission to the insurer licensee that:
a. The RBC Plan or Revised RBC Plan submitted by the insurer licensee is, in
the judgment of the Commission, unsatisfactory; and
b. Such notification constitutes a Regulatory Action Level Event with respect
to the insurer licensee, provided the insurer licensee has not challenged the
determination under § 38.2-5507;
7. If, pursuant to § 38.2-5507, the insurer licensee challenges a determination
by the Commission under subdivision A 6, the notification by the Commission to the
insurer licensee that the Commission has, after a hearing, rejected such
challenge;
8. Notification by the Commission to the insurer licensee that the insurer
licensee has failed to adhere to its RBC Plan or Revised RBC Plan, but
only if such failure has a substantial adverse effect on the ability of the
insurer licensee to eliminate the Company Action Level Event in accordance
with its RBC Plan or Revised RBC Plan and the Commission has so stated in the notification,
provided the insurer licensee has not challenged the determination under §
38.2-5507; or
9. If, pursuant to § 38.2-5507, the insurer licensee challenges a determination
by the Commission under subdivision A 8, the notification by the Commission to the
insurer licensee that the Commission has, after a hearing, rejected the
challenge.
B. In the event of a Regulatory Action Level Event, the Commission shall:
1. Require the insurer licensee to prepare and submit an RBC Plan or, if
applicable, a Revised RBC Plan;
2. Perform such examination or analysis as the Commission deems necessary of
the assets, liabilities and operations of the insurer licensee including a
review of its RBC Plan or Revised RBC Plan; and
3. Subsequent to the examination or analysis, issue a corrective order
specifying such corrective actions as the Commission shall determine are
required. In determining corrective actions, the Commission may take into
account such factors as are deemed relevant with respect to the insurer
licensee based upon the Commission's examination or analysis of the
assets, liabilities and operations of the insurer licensee, including, but not
limited to, the results of any sensitivity tests undertaken pursuant to the RBC Instructions.
C. The RBC Plan or Revised RBC Plan shall be submitted:
1. Within forty-five days after the occurrence of the Regulatory Action Level Event;
2. If the insurer licensee challenges an Adjusted RBC Report pursuant to §
38.2-5507 and the challenge is not frivolous in the judgment of the Commission, within forty-five days
after the notification to the insurer licensee that the Commission has, after a
hearing, rejected the insurer's licensee's challenge; or
3. If the insurer licensee challenges a Revised RBC Plan under § 38.2-5507 and
the challenge is not frivolous in the judgment of the Commission, within forty-five days after
notification to the insurer licensee that the Commission has, after a hearing,
rejected the insurer's licensee's challenge.
D. The Commission may retain actuaries and investment experts and other
consultants as may be necessary in the judgment of the Commission to review the
insurer's licensee's RBC Plan or Revised RBC Plan, examine or analyze the
assets, liabilities and operations, including contractual relationships, of the
insurer licensee and formulate the corrective order with respect to the insurer
licensee. The fees, costs and expenses relating to consultants shall be borne
by the affected insurer licensee or such other party as directed by the
Commission.
§ 38.2-5505. Authorized Control Level Event.
A. "Authorized Control Level Event" means any of the following events:
1. The filing of an RBC Report by the insurer licensee which indicates that the
insurer's licensee's Total Adjusted Capital is greater than or equal to its
Mandatory Control Level RBC but less than its Authorized Control Level RBC;
2. The notification by the Commission to the insurer licensee of an Adjusted
RBC Report that indicates the event in subdivision A 1, provided the insurer
licensee does not challenge the Adjusted RBC Report under § 38.2-5507;
3. If, pursuant to § 38.2-5507, the insurer licensee challenges an Adjusted RBC
Report that indicates the event in subdivision A 1, the notification by the
Commission to the insurer licensee that the Commission has, after a
hearing, rejected the insurer's licensee's challenge;
4. The failure of the insurer licensee to respond, in a manner satisfactory to
the Commission, to a corrective order, provided the insurer licensee has not
challenged the corrective order under § 38.2-5507; or
5. If the insurer licensee has challenged a corrective order under § 38.2-5507
and the Commission has, after a hearing, rejected the challenge or modified the corrective order, the
failure of the insurer licensee to respond, in a manner satisfactory to the
Commission, to the corrective order subsequent to rejection or modification by the Commission.
B. In the event of an Authorized Control Level Event with respect to an insurer
a licensee, the Commission shall:
1. Take such actions as are required under § 38.2-5504 regarding an insurer a
licensee with respect to which a Regulatory Action Level Event has occurred; or
2. If the Commission deems it to be in the best interests of the policyholders
and creditors of the insurer licensee and of the public, take such actions as
are necessary to cause the insurer licensee to be placed under regulatory
control under the provisions of Chapter 15 (§ 38.2-1500 et seq.). In the event
the Commission takes such actions, the Authorized Control Level Event shall be
deemed an indication of a hazardous financial condition which serves as sufficient
grounds for the Commission to commence delinquency proceedings, and the
receiver appointed in conjunction with such proceedings shall have the rights,
powers and duties with respect to the insurer licensee as are set forth in
Chapter 15 or any order of liquidation, rehabilitation or conservation entered pursuant thereto. In
the event the Commission takes actions under this subdivision pursuant to an Adjusted RBC Report, the
insurer licensee shall be entitled to such protections as are afforded to
insurers licensees under the appropriate provisions of this title
pertaining to summary proceedings.
§ 38.2-5506. Mandatory Control Level Event.
A. "Mandatory Control Level Event" means any of the following events:
1. The filing of an RBC Report which indicates that the insurer's licensee's
Total Adjusted Capital is less than its Mandatory Control Level RBC;
2. The notification by the Commission to the insurer licensee of an Adjusted
RBC Report that indicates the event in subdivision A 1, provided the insurer
licensee does not challenge the Adjusted RBC Report under § 38.2-5507; or
3. If, pursuant to § 38.2-5507, the insurer licensee challenges an Adjusted RBC
Report that indicates the event in subdivision A 1, notification by the Commission
to the insurer licensee that the Commission has, after a hearing, rejected
the insurer's licensee's challenge.
B. In the event of a Mandatory Control Level Event:
1. With respect to a life or and health insurer, the Commission shall take
actions as are necessary to place the insurer under regulatory control pursuant to the provisions of
Chapter 15 (§ 38.2-1500 et seq.). In that event, the Mandatory Control Level
Event shall be deemed an indication of a hazardous financial condition which serves
as sufficient grounds for the Commission to commence delinquency proceedings, and
the receiver appointed in conjunction with such proceedings, shall have the
rights, powers and duties with respect to the insurer as are set forth in
Chapter 15 or any order of liquidation, rehabilitation or conservation entered
thereunder. If the Commission takes actions pursuant to an Adjusted RBC Report,
the insurer shall be entitled to such protections as are afforded to insurers
under the appropriate provisions of this title pertaining to summary
proceedings. Notwithstanding any of the foregoing, the Commission may forego
action for up to ninety days after the Mandatory Control Level Event if the
Commission finds there is a reasonable expectation that the Mandatory Control
Level Event may be eliminated within the ninety-day period.
2. With respect to a property and casualty insurer, the Commission shall take actions as are necessary to place the insurer under regulatory control pursuant to the provisions of Chapter 15, or, in the case of an insurer which is writing no business and which is running-off its existing business, may allow the insurer to continue to run-off under the supervision of the Commission. In either event, the Mandatory Control Level Event shall be deemed an indication of a hazardous financial condition which serves as sufficient grounds for the Commission to commence delinquency proceedings, and the receiver appointed in conjunction with such proceedings, shall have the rights, powers and duties with respect to the insurer as are set forth in Chapter 15 or any order of liquidation, rehabilitation, or conservation entered thereunder. If the Commission takes actions pursuant to an Adjusted RBC Report, the insurer shall be entitled to such protections as are afforded to insurers under the appropriate provisions of this title pertaining to summary proceedings. Notwithstanding any of the foregoing, the Commission may forego action for up to ninety days after the Mandatory Control Level Event if the Commission finds there is a reasonable expectation that the Mandatory Control Level Event may be eliminated within the ninety-day period.
3. With respect to a health organization, the Commission shall take actions as are necessary to place the health organization under regulatory control pursuant to and in accordance with applicable provisions in Chapter 15 (§ 38.2-1500 et seq.) and §§ 38.2-4214.1, 38.2-4317, or § 38.2-4509.1 of this title. In that event, the Mandatory Control Level Event shall be deemed an indication of a hazardous financial condition which serves as sufficient grounds for the Commission to commence delinquency proceedings, and the receiver appointed in conjunction with such proceedings shall have the rights, powers and duties with respect to the licensee as are set forth in Chapter 15, or any order of liquidation, rehabilitation or conservation entered thereunder. If the Commission takes actions pursuant to an adjusted RBC Report, the health organization shall be entitled to such protections as are afforded to the licensee under the appropriate provisions of this title pertaining to summary proceedings. Notwithstanding any of the foregoing, the Commission may forego action for up to ninety days after the Mandatory Control Level Event if the Commission finds there is a reasonable expectation that the Mandatory Control Level Event may be eliminated within the ninety-day period.
§ 38.2-5507. Hearings.
A. An insurer A licensee shall have the right to a confidential hearing, on a
record before the Commission, at which the insurer licensee may challenge any
determination or action by the Commission, upon:
1. Notification to an insurer a licensee by the Commission of an Adjusted RBC
Report;
2. Notification to an insurer a licensee by the Commission that (i) the
insurer's licensee's RBC Plan or Revised RBC Plan is unsatisfactory and
(ii) such notification constitutes a Regulatory Action Level Event with respect
to such insurer licensee;
3. Notification to an insurer a licensee by the Commission that the insurer
licensee has failed to adhere to its RBC Plan or Revised RBC Plan and that
such failure has a substantial adverse effect on the ability of the insurer
licensee to eliminate the Company Action Level Event with respect to the
insurer licensee in accordance with its RBC Plan or Revised RBC Plan; or
4. Notification to an insurer a licensee by the Commission of a Corrective
Order with respect to the insurer licensee.
B. The insurer licensee shall notify the Commission of its request for a
hearing within five days after the notification by the Commission under subdivision 1, 2, 3 or 4 of
subsection A. Upon receipt of the insurer's licensee's request for a hearing,
the Commission shall set a date for the hearing, which date shall be no less than ten nor more than
thirty days after the date of the insurer's licensee's request.
§ 38.2-5508. Confidentiality; prohibition on announcements; prohibition on use in ratemaking.
A. All RBC Plans and RBC Reports, to the extent the information therein is not
required to be set forth in a publicly available annual statement schedule,
which are filed with the Commission with respect to any domestic insurer
licensee or foreign insurer licensee, constitute information that might be
damaging to the insurer licensee if made available to its competitors, and
therefore shall be kept confidential by the Commission. This information shall
not be made public nor shall it be subject to subpoena, other than by the
Commission and then only for the purpose of enforcement actions taken by the
Commission pursuant to this Act or any other provision of the insurance laws of
this Commonwealth. As used in this subsection, RBC Reports and RBC Plans shall
include the results or report of any examination or analysis of an insurer a
licensee performed by the Commission pursuant to the provisions of this Act or
by the insurance regulatory officials of another state pursuant to the provisions of
a substantially similar risk-based capital statute.
B. The comparison of an insurer's a licensee's Total Adjusted Capital to any of
its RBC Levels is a regulatory tool which may indicate the need for possible corrective action with
respect to the insurer licensee, and is not intended as a means to rank
insurers licensees generally. Therefore, except as otherwise required
under the provisions of this Act, the making, publishing, disseminating, circulating or placing
before the public, or causing, directly or indirectly to be made, published,
disseminated, circulated or placed before the public, in a newspaper, magazine
or other publication, or in the form of a notice, circular, pamphlet, letter or
poster, or over any radio or television station, or in any other way, an
advertisement, announcement or statement containing an assertion,
representation or statement ranking any insurer licensee relative to other
insurers licensees solely on the basis of comparisons between Total
Adjusted Capital and RBC Levels or any component derived in the calculation of RBC Levels, by
any insurer licensee, agent, broker or other person engaged in any manner in
the insurance business would be misleading and is therefore prohibited. If any materially false
statement comparing an insurer's a licensee's Total Adjusted Capital to its RBC
Levels, or any of them, or a misleading comparison of any other amount to the
insurer's licensee's RBC Levels is published in any written publication
and the insurer licensee is able to demonstrate to the Commission with
substantial proof the falsity or misleading nature of such statement, as the case
may be, then the insurer licensee may publish an announcement in a written
publication if the sole purpose of the announcement is to rebut the materially false or
misleading statement.
C. RBC Instructions, RBC Reports, Adjusted RBC Reports, RBC Plans and Revised
RBC Plans are intended solely for use by the Commission in monitoring the
solvency of insurers licensees and the need for possible corrective action with
respect to insurers licensees and shall not be used by the Commission for
ratemaking nor considered or introduced as evidence in any rate proceeding nor used by the Commission
to calculate or derive any elements of an appropriate premium level or rate of
return for any line of insurance which an insurer a licensee or any affiliate
is authorized to write.
§ 38.2-5509. Supplemental provisions; rules; exemption.
A. The provisions of this Act are supplemental to any other provisions of the laws of this Commonwealth, and shall not preclude or limit any other powers or duties of the Commission, the Commissioner of Insurance, or any of the Commission's employees or agents under such laws, including, but not limited to, the provisions of §§ 38.2-1038 and 38.2-1040, or §§ 38.2-4316 A 7 and 38.2-4317, and Chapter 15 (§ 38.2-1500 et seq.) and any regulations issued thereunder.
B. The Commission may adopt reasonable rules necessary for the implementation of this Act.
C. The Commission may exempt from the application of this Act any domestic property and casualty insurer which:
1. Writes direct business only in this Commonwealth;
2. Writes direct annual premiums of $2 million or less; and
3. Assumes no reinsurance in excess of five percent of direct premium written.
D. The Commission may exempt from the application of this Act an insurer organized and operating under the laws of this Commonwealth and licensed pursuant to the provisions of Chapter 25 (§ 38.2-2500 et seq.) of this title.
E. The Commission may exempt from the application of this Act a domestic health organization that writes direct business only in this Commonwealth and assumes no reinsurance in excess of five percent of direct premium written, and either (i) writes direct annual premiums of two million dollars or less for comprehensive medical coverages or (ii) is licensed pursuant to Chapter 45 and covers less than 2,000 lives. As used in this subsection, “comprehensive medical coverages” means contracts providing basic health care services and Medicare and Medicaid risk coverages or policies providing hospital, surgical, major medical, Medicare risk and Medicaid risk coverages. Medicare supplement need not be included and premiums for administrative services shall not be included.
§ 38.2-5510. Foreign licensees.
A. Any foreign insurer licensee shall, upon the written request of the
Commission, submit to the Commission an RBC Report as of the end of the calendar year just ended not
later than the later of:
1. The date an RBC Report would be required to be filed by a domestic insurer
licensee under this Act; or
2. Fifteen days after the request is received by the foreign insurer licensee.
Any foreign insurer licensee shall, at the written request of the Commission,
promptly submit to the Commission a copy of any RBC Plan that is filed with the insurance
commissioner of any other state.
B. In the event of a Company Action Level Event, Regulatory Action Level Event
or Authorized Control Level Event with respect to any foreign insurer licensee
as determined under the RBC statute applicable in the state of domicile of the
insurer licensee, or, if no RBC provision is in force in that state, under
the provisions of this Act, if the insurance commissioner of the state of domicile of the
foreign insurer licensee fails to require the foreign insurer licensee to file
an RBC Plan in the manner specified under the RBC statute, or, if no RBC
provision is in force in the state, under § 38.2-5503 hereof, the Commission
may require the foreign insurer licensee to file an RBC Plan with the
Commission. In such event, the failure of the foreign insurer licensee to file
an RBC Plan with the Commission shall be grounds to order the insurer licensee
to cease writing new insurance business in this Commonwealth or to suspend, revoke or refuse to issue
a license pursuant to § 38.2-1040.
C. In the event of a Mandatory Control Level Event with respect to any foreign
insurer licensee, if no domiciliary receiver has been appointed with
respect to the foreign insurer licensee under the rehabilitation and
liquidation statute applicable in the state of domicile of the foreign insurer
licensee, the Commission may deem such insurer licensee in a condition
where any further transaction of business will be hazardous to its policyholders, creditors, members,
subscribers, stockholders, or to the public, and an action may be instituted and conducted pursuant to the
provisions of Chapter 15 (§ 38.2-1500 et seq.) and, if applicable, §
38.2-4214.1, §§ 38.2-4317, or 38.2-4509.1, and the occurrence of the Mandatory
Control Level Event shall be considered adequate grounds for the application for such action.
§ 38.2-5513. Notices.
All notices by the Commission to an insurer a licensee which may result in
regulatory action hereunder shall be effective upon dispatch if transmitted by
registered or certified mail, or in the case of any other transmission shall be
effective upon the insurer's licensee's receipt of such notice.
§ 38.2-5515. Phase-in provisions for health maintenance organizations.
Effective July 1, 2000, the term "insurer" as used in this chapter shall be deemed to mean and include also a health maintenance organization licensed pursuant to Chapter 43 of this title and, for RBC reports required to be filed by such health maintenance organizations with respect to 1999 or 2000, the following requirements apply in lieu of the provisions of §§ 38.2-5503, 38.2-5504, 38.2-5505, and 38.2-5506:
1. In the event of a Company Action Level Event with respect to a domestic health maintenance organization, the Commission shall take no regulatory action under this Act.
2. In the event of a Regulatory Action Level Event under subdivision 1, 2 or 3 of subsection A of § 38.2-5504, the Commission shall take the actions required under § 38.2-5503.
3. In the event of a Regulatory Action Level Event under subdivisions 4 through 9 of subsection A of § 38.2-5504 or an Authorized Control Level Event, the Commission shall take the actions required under § 38.2-5504 with respect to the health maintenance organization.
4. In the event of a Mandatory Control Level Event with respect to a health maintenance organization, the Commission shall take the actions required under § 38.2-5505 with respect to the health maintenance organization.
2. That the provisions of § 38.2-5515 of the Code of Virginia shall expire on January 1, 2001.
3. That the provisions of this act, except § 38.2-5515 of the Code of Virginia, shall become effective on January 1, 2001.