['Employee Benefits']
['Patient Protection and Affordable Care Act']
12/05/2023
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(a) If a State’s insurance commissioner, superintendent, or other responsible official determines that the payment of rebates by a domestic issuer in that State will cause the issuer’s risk based capital (RBC) level to fall below the Company Action Level RBC, as defined in the NAIC’s Risk Based Capital (RBC) for Insurers Model Act, the commissioner, superintendent, or other responsible official must notify the Secretary. In such a circumstance, the commissioner, superintendent, or other responsible official may request that the Secretary defer all or a portion of the rebate payments owed by the issuer.
(b) In the event an insurance commissioner, superintendent, or other responsible official makes the request set forth in paragraph (a) of this section, the following should be provided to the Secretary along with the notification:
(b)(1) The domestic issuer’s RBC reports for the current calendar year and the 2 preceding calendar years; and
(b)(2) A calculation of the amount of rebates that would be owed by the domestic issuer pursuant to this Part.
(c) Upon receipt of the notification under paragraph (a), the Secretary will examine the information provided by the insurance commissioner, superintendent, or other responsible official along with any other information the Secretary may request from the issuer, and determine whether the payment of rebates by the issuer will cause its RBC level to fall below the Company Action Level RBC.
(d) When the Secretary determines that the payment of rebates by an issuer will cause its RBC level to fall below the Company Action Level RBC, the Secretary may permit a deferral of all or a portion of the rebates owed, but only for a period determined by the Secretary in consultation with the State. The Secretary will require that the issuer must pay these rebates with interest in a future year in which payment of the rebates would not cause the issuer’s RBC level to fall below the Company Action Level RBC.
[75 FR 74930 Dec. 1, 2010]
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