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(a) STATUTORY FINANCIAL STATEMENTS Increasingly, HMOs and provider-sponsored networks are coming under regulation by state departments of insurance Generally speaking, regulated insurers are required by their state of domicile to submit annually a set of audited nancial statements that are prepared using that state s prescribed regulatory accounting principles ( statutory nancial statements ) In 1999, the National Association of Insurance Commissioners completed a process to codify statutory accounting practices (SAP) for managed care organizations, resulting in a revised Accounting Practices and Procedures Manual Nine of the Statements of Statutory Accounting Principles (SSAPs) included in the Manual have been speci cally modi ed or written to address issues related to managed care These include SSAP No 25, Accounting for and Disclosures about Transactions with Af liates and Other Related Parties, No 35, Guaranty Fund and Other Assessments, No 47, Uninsured Plans, No 50, Classi cations and De nitions of Insurance or Managed Care Contracts in Force, No 54, Individual and Group Accident and Health Contracts, No 55, Unpaid Claims, Losses and Loss Adjustment Expenses, No 66, Retrospectively Rated Insurance Contracts, No 73, Health Care Delivery Assets Supplies, Pharmaceuticals and Surgical Supplies, Durable Medical Equipment, Furniture, Medical Equipment and Fixtures, and Leasehold Improvements in Health Care Facilities, and No 84, Health Care Receivables All other SSAPs should be considered that are applicable to the particular managed care entity The Manual is updated annually to re ect revisions or additions to SAP It is expected that most states will require insurers to comply with most, if not all, provisions of the Manual States may adopt the Manual in whole, or in part, as an element of prescribed SAP in those states If, however, the requirements of state laws, regulations, and administrative rules differ from guidance provided in the Manual, those state laws, regulations, and administrative rules preempt the guidance in the Manual (b) RISK ASED CAPITAL FOR MANAGED CARE ORGANIZATIONS State laws generally require insurers to maintain minimum levels of capital or surplus The NAIC has implemented a risk-based capital (RBC) formula for managed care organizations under which affected managed care organizations must calculate and report to regulators its capital requirement and total adjusted capital There are ve principal elements to the RBC formula: af liated investment risk, asset risk,.

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