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Health Plan Filings and Reporting

This section describes how plans may file required documentation with the DMHC. Licensed health care service plans are required to file certain types of information with the department for various reasons. In some cases, plans are required under statute or regulation to regularly submit reports or documentation to establish initial or ongoing compliance with the law (e.g. timely access reporting, financial reporting). In other cases, plans are required to file documentation or reports to the DMHC when they are planning to make an operational, business, product, or other change that affects the scope or applicability of their license. Those filings often come in the form of an amendment or material modification to the plan’s license and, in some cases, are subject to departmental approval prior to making the requested change to health plan operations.

Most health plan filings are delivered via the DMHC’s efile system and are reviewed by the DMHC staff for adequacy and compliance. By statute, the DMHC is required to make some of the statutorily required health plan reports available to the public via the DMHC website. This section provides information on different required reports prepared by health plans and the DMHC, such as Public Information and Reports and Departmental Reports. It also provides a link for plans to submit Quarterly Grievance Reports, Block Transfer Filings and Timely Access Reporting.