(a) "Adjusted RBC report" means an RBC report which has been adjusted by the commissioner in accordance with K.S.A. 40-2d04 and amendments thereto.
(b) "Corrective order" means an order issued by the commissioner specifying corrective actions which the commissioner has determined are required.
(c) "Domestic health organization" means any health organization which is licensed and organized in this state.
(d) "Foreign health organization" means any health organization not domiciled in this state which is licensed to do business in this state pursuant to articles 19a, 19c or 32 of chapter 40 of the Kansas Statutes Annotated, and amendments thereto.
(e) "NAIC" means the national association of insurance commissioners.
(f) "Health organization" means a health maintenance organization, limited health service organization, dental or vision plan, hospital, medical and dental indemnity or service corporation or other managed care organization licensed under articles 19a, 19c or 32 of chapter 40 of the Kansas Statutes Annotated, and amendments thereto. This definition shall not include an organization that is licensed as either a life and health insurer or a property and casualty insurer under articles 4, 5, 9, 10, 11, 12, 12a, 15 or 16 of chapter 40 of the Kansas Statutes Annotated, and amendments thereto, and that is otherwise subject to either the life or property and casualty RBC requirements in K.S.A. 40-2c01 et seq., and amendments thereto.
(g) "RBC" means risk-based capital.
(h) "RBC instructions" means the risk-based capital instructions for managed care organizations promulgated by the NAIC which are in effect on December 31, 1999, or any later version as adopted by the commissioner in rules and regulations.
(i) "RBC level" means a health organization'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 health organization, 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; and
(4) "mandatory control level RBC" means the product of .70 and the authorized control level RBC.
(j) "RBC plan" means a comprehensive financial plan containing the elements specified in K.S.A. 40-2d05, and amendments thereto. If the commissioner rejects the RBC plan, and it is revised by the health organization, with or without the commissioner's recommendation, the plan shall be called the "revised RBC plan."
(k) "RBC report" means the report required by K.S.A. 40-2d02, 40-2d03 and 40-2d04 and amendments thereto.
(l) "Total adjusted capital" means the sum of:
(1) A health organization's capital and surplus as determined in accordance with the annual financial statements required to be filed under articles 19a, 19c or 32 of chapter 40 of the Kansas Statutes Annotated and amendments thereto; and
(2) such other items, if any, as the RBC instructions may provide.
(m) "Commissioner" means the commissioner of insurance.
History: L. 2000, ch. 147, § 2; July 1.
(1) With the NAIC in accordance with the RBC instructions; and
(2) with the insurance commissioner in any state in which the health organization is authorized to do business, if such insurance commissioner has notified the health organization of its request in writing, in which case, the health organization shall file its RBC report not later than the later of:
(A) 15 days from the receipt of notice to file its RBC report with that state; or
(B) the filing date otherwise specified in this subsection.
(b) The risk-based capital requirements of this section shall not apply to any health organization contracting with the Kansas department of social and rehabilitation services to provide services provided under title XIX and title XXI of the social security act or any other public benefits, provided the public benefit contracts represent at least 90% of the premium volume of the health organization.
History: L. 2000, ch. 147, § 3; July 1.
(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; determined in each case by applying the factors in the manner set forth in the RBC instructions.
(b) An excess of capital over the amount produced by the risk-based capital requirements contained in this act and the formulas, schedules and instructions referenced in this act is desirable in the business of insurance. Accordingly, each health organization 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 a health organization 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.
History: L. 2000, ch. 147, § 4; July 1.
History: L. 2000, ch. 147, § 5; July 1.
(a) The filing of an RBC report by a health organization which indicates that a 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.
(b) The notification by the commissioner to the health organization of an adjusted RBC report that indicates the event described in subsection (a) if:
(1) The health organization does not challenge the adjusted RBC report pursuant to K.S.A. 40-2d19, and amendments thereto; or
(2) the commissioner has rejected such challenge after a hearing.
History: L. 2000, ch. 147, § 6; July 1.
(a) Identify the conditions in the health organization's operation which contribute to the company action level event;
(b) contain proposals of corrective actions which the health organization intends to take that would be expected to result in the elimination of the company action level event;
(c) 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 the 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 may include separate projections for each major line of business and separately identify each significant income, expense and benefit component;
(d) identify the key assumptions impacting the health organization's projections and the sensitivity of the projections to the assumptions; and
(e) identify the quality of, and problems associated with, the 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.
History: L. 2000, ch. 147, § 7; July 1.
(a) Within 45 days of the company action level event; or
(b) within 45 days after notification to the health organization that the commissioner has rejected the health organization's challenge to an adjusted RBC report pursuant to K.S.A. 40-2d19 and amendments thereto.
History: L. 2000, ch. 147, § 8; July 1.
(a) Within 45 days after the notification from the commissioner; or
(b) within 45 days after a notification to the health organization that the commissioner has, pursuant to K.S.A. 40-2d19, and amendments thereto, rejected the health organization's challenge to the commissioner's original findings as authorized by this section.
History: L. 2000, ch. 147, § 9; July 1.
History: L. 2000, ch. 147, § 10; July 1.
(a) Such state has an RBC provision substantially similar to K.S.A. 40-2d20, and amendments thereto; and
(b) the insurance commissioner of that state has notified the health organization of such insurance commissioner's request for the filing in writing, in which case the health organization shall file a copy of the RBC plan or revised RBC plan in that state no later than the later of:
(1) 15 days after the receipt of notice to file a copy of its RBC plan or revised RBC plan with the state; or
(2) the date on which the final RBC plan or revised RBC plan is filed under K.S.A. 40-2d07 or 40-2d08, and amendments thereto.
History: L. 2000, ch. 147, § 11; July 1.
(a) The filing of an RBC report by the health organization which indicates that the health organization's total adjusted capital is greater than or equal to its authorized control level RBC but less than its regulatory action level RBC;
(b) the notification by the commissioner to the health organization of an adjusted RBC report that indicates the event described in subsection (a) if:
(1) The health organization does not challenge the adjusted RBC report pursuant to K.S.A. 40-2d19, and amendments thereto; or
(2) the commissioner has rejected such challenge after a hearing; and
(c) the failure of the health organization to file an RBC report by the filing date, unless the health organization has provided an explanation for such failure which is satisfactory to the commissioner and has cured the failure within 10 days after the filing date;
(d) the failure of the health organization to submit an RBC plan to the commissioner within the time period set forth in K.S.A. 40-2d07, and amendments thereto;
(e) notification by the commissioner to the health organization that:
(1) The RBC plan or revised RBC plan submitted by the health organization is, in the judgment of the commissioner, unsatisfactory; and
(2) (A) the health organization has not challenged the determination pursuant to K.S.A. 40-2d19, and amendments thereto; or
(B) the commissioner has rejected such challenge.
(f) Notification by the commissioner to the health organization that the health organization 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 health organization to eliminate the company action level event in accordance with its RBC plan or revised RBC plan and the commissioner has so stated in the notification, if:
(1) The health organization has not challenged such determination pursuant to K.S.A. 40-2d19, and amendments thereto; or
(2) the commissioner has rejected such challenge after a hearing.
History: L. 2000, ch. 147, § 12; July 1.
(a) Require the health organization to prepare and submit an RBC plan or, if applicable, a revised RBC plan;
(b) perform such examination or analysis as the commissioner deems necessary of the assets, liabilities and operations of the health organization including a review of its RBC plan or revised RBC plan; and
(c) subsequent to the examination or analysis, issue a corrective order specifying such actions as the commissioner determines are required.
History: L. 2000, ch. 147, § 13; July 1.
(a) Within 45 days after the occurrence of the regulatory action level event;
(b) within 45 days after the notification to the health organization that the commissioner has rejected the health organization's challenge to an adjusted RBC report pursuant to K.S.A. 40-2d19, and amendments thereto; or
(c) within 45 days after notification to the health organization that the commissioner has rejected the health organization's challenge to a revised RBC plan pursuant to K.S.A. 40-2d19, and amendments thereto.
History: L. 2000, ch. 147, § 14; July 1.
History: L. 2000, ch. 147, § 15; July 1.
(a) The filing of an RBC report by the health organization which indicates that the health organization's total adjusted capital is greater than or equal to its mandatory control level RBC but less than its authorized control level RBC;
(b) the notification by the commissioner to the health organization of an adjusted RBC report that indicates the event described in subsection (a) if:
(1) The health organization does not challenge the adjusted RBC report pursuant to K.S.A. 40-2d19, and amendments thereto; or
(2) the commissioner has rejected such challenge after a hearing;
(c) the failure of the health organization to respond, in a manner satisfactory to the commissioner, to a corrective order if the health organization has not challenged the corrective order under K.S.A. 40-2d19, and amendments thereto; or
(d) if the commissioner has rejected the challenge to the corrective order or modified the corrective order pursuant to K.S.A. 40-2d19, and amendments thereto, the failure of the health organization to respond, in a manner satisfactory to the commissioner, to the corrective order subsequent to rejection or modification by the commissioner.
History: L. 2000, ch. 147, § 16; July 1.
(a) Shall take such actions as are required under K.S.A. 40-2d11 through 40-2d14, and amendments thereto, regarding a health organization with respect to which a regulatory action level event has occurred; or
(b) if the commissioner deems it to be in the best interests of the policyholders and creditors of the health organization and of the public, shall take such actions as are necessary to cause the health organization to be placed under regulatory control pursuant to K.S.A. 40-3605 et seq., and amendments thereto. In the event the commissioner takes such actions, the authorized control level event shall be deemed sufficient grounds for the commissioner to take action under K.S.A. 40-3605 et seq., and amendments thereto, and the commissioner shall have the rights, powers and duties with respect to the health organization as are set forth in K.S.A. 40-3605 et seq., and amendments thereto. In the event the commissioner takes actions under this subsection pursuant to an adjusted RBC report, the health organization shall be entitled to such protections as are afforded to health organizations under the provisions of K.S.A. 77-501 et seq., and amendments thereto, pertaining to summary proceedings.
History: L. 2000, ch. 147, § 17; July 1.
(a) The filing of an RBC report by the health organization which indicates that the health organization's total adjusted capital is less than its mandatory control level RBC;
(b) the notification by the commissioner to the health organization of an adjusted RBC report that indicates the event described in subsection (a) if:
(1) The health organization does not challenge the adjusted RBC report pursuant to K.S.A. 40-2d19 and amendments thereto; or
(2) the commissioner has rejected such challenge.
History: L. 2000, ch. 147, § 18; July 1.
History: L. 2000, ch. 147, § 19; July 1.
(b) upon notification to an health organization by the commissioner that:
(1) The health organization's RBC plan or revised RBC plan is unsatisfactory; and
(2) such notification constitutes a regulatory action level event with respect to such health organization; or
(c) upon notification to any health organization by the commissioner that the health organization 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 health organization to eliminate the company action level event with respect to the health organization in accordance with its RBC plan or revised RBC plan; or
(d) upon notification to an health organization by the commissioner of a corrective order with respect to the health organization, the health organization shall have the right to a hearing under the Kansas administrative procedure act, at which the health organization may challenge any determination or action by the commissioner. The health organization shall notify the commissioner of its request for a hearing within five days after the notification by the commissioner under subsections (a), (b), (c) or (d). Upon receipt of the health organization's request for a hearing, the commissioner shall set a date for the hearing, which date shall be no less than 10 nor more than 30 days after receipt of the health organization's request. Such hearing shall be governed by K.S.A. 77-513 through 77-532 and amendments thereto.
History: L. 2000, ch. 147, § 20; July 1.
(b) RBC instructions, RBC reports, adjusted RBC reports, RBC plans and revised RBC plans are intended solely for use by the commissioner in monitoring the solvency of health organizations and the need for possible corrective action with respect to health organizations and shall not be used by the commissioner for ratemaking nor considered or introduced as evidence in any rate proceeding nor used by the commissioner to calculate or derive any elements of an appropriate premium level or rate of return for any line of insurance which an health organization or any affiliate is authorized to write.
(c) (1) The commissioner may share or exchange any documents, materials or other information, including confidential and privileged documents referred to in subsection (a), received in the performance of the commissioner's duties under this act, with:
(A) The NAIC;
(B) other state, federal or international regulatory agencies; and
(C) other state, federal or international law enforcement authorities.
(2) (A) The sharing or exchanging of documents, materials or other information under this subsection shall be conditioned upon the recipient's authority and agreement to maintain the confidential and privileged status, if any, of the documents, materials or other information being shared or exchanged.
(B) No waiver of an existing privilege or claim of confidentiality in the documents, materials or information shall occur as a result of disclosure to the commissioner under this section or as a result of sharing as authorized by paragraph (1) of subsection (c).
(3) The commissioner of insurance is hereby authorized to adopt such rules and regulations establishing protocols governing the exchange of information as may be necessary to implement and carry out the provisions of this act.
History: L. 2000, ch. 147, § 21; July 1.
History: L. 2000, ch. 147, § 22; July 1.
History: L. 2000, ch. 147, § 23; July 1.
(a) The date an RBC report would be required to be filed by a domestic health organization under this act; or
(b) Fifteen days after the request is received by the foreign health organization.
Any foreign health organization, at the written request of the commissioner, shall submit promptly to the commissioner a copy of any RBC plan that is filed with the insurance commissioner of any other state.
History: L. 2000, ch. 147, § 24; July 1.
History: L. 2000, ch. 147, § 25; July 1.
History: L. 2000, ch. 147, § 26; July 1.
History: L. 2000, ch. 147, § 27; July 1.
History: L. 2000, ch. 147, § 28; July 1.
(1) In the event of a company action level event with respect to any health organization, the commissioner shall take no regulatory action under this act with respect to such health organization.
(2) In the event of a regulatory action level event with respect to any health organization under either subsection (a) or (b) of K.S.A. 40-2d11, and amendments thereto, the commissioner shall take such action with respect to such health organization under K.S.A. 40-2d05 through 40-2d10, inclusive, and amendments thereto, as the commissioner deems necessary.
(3) In the event of a regulatory action level event with respect to any health organization under any of subsections (c), (d), (e) or (f) of K.S.A. 40-2d11, and amendments thereto, or an authorized control level event, the commissioner shall take such action with respect to such health organization under K.S.A. 40-2d11 through 40-2d14, inclusive, and amendments thereto, as the commissioner deems necessary.
(4) In the event of a mandatory control level event with respect to any health organization, the commissioner shall take action with respect to such health organization as required under K.S.A. 40-2d15 and 40-2d16, and amendments thereto.
(b) The provisions of subsection (a) shall not limit the right of the commissioner to proceed as authorized by any other provision of chapter 40 of the Kansas Statutes Annotated, and amendments thereto or any rule and regulation adopted thereunder.
History: L. 2000, ch. 147, § 29; July 1.
History: L. 2000, ch. 147, § 30; July 1.
History: L. 2000, ch. 147, § 31; July 1.