Submit Financial Filings and Reports

As required under the law, and in furtherance of its mission to protect consumers, the DMHC reviews the health plans’ financial and compliance information on an ongoing basis to ensure a financially stable health care delivery system.

The DMHC provides the tools health plans need to submit all of the appropriate financial and compliance filings and reports.

Submit Financial Reporting Forms

All health plans are required to report their periodic financial information using the DMHC Financial Reporting Forms. Please login to the DMHC’s web portal for the DMHC Financial Reporting Form templates and reporting instructions. Please submit the completed DMHC Financial Reporting Form through the DMHC’s web’s portal.

Health Plan Web Portal

If you need access to the DMHC’s web portal, please see your Administrator Account user. If you do not know who the Administrator Account user is, please contact the Office of Plan Licensing at 916-324-9046.

If you have any further questions please contact healthplanreporting@dmhc.ca.gov or call 916-255-2443 or 916-255-2447.

Annual Dental Medical Loss Ratio (MLR)

Use the Dental MLR Reporting Form below for annual dental MLR reporting.

If you need access to the DMHC’s web portal, please see your Administrator Account user. If you do not know who the Administrator Account user is, please contact the Office of Plan Licensing at 916-324-9046. 

Please provide comments and feedback at healthplanreporting@dmhc.ca.gov  regarding the reporting forms.

 

Resources

Financial Solvency Reports

Health plans are required to provide the DMHC with certain information relating to the risk assigned to their provider network on a quarterly and annual basis.

Claims Settlement Practices and Dispute Resolution

The Quarterly and Annual Claims Settlement Practices Reports are required to be submitted for each licensed health plan. Health plans report claim information if the plan or any of its capitated providers have failed to timely reimburse at least 95% of complete claims with correct payment including interest and penalties due, that became payable during the reporting period.

Click the link below to view the summary of the Quarterly Claims Settlement Practices Report:

Rate Filing (Premium Rate Review and Aggregate Rate Data)

The DMHC issued the following letters to provide guidance to health plans regarding premium rate filings:

Director’s Letter (Letter 3-K) was issued on December 2, 2010 to provide additional guidance to health plans regarding electronic rate filings.

Director’s Letter (Letter 8-K) was issued on September 2, 2016 and amends May 24, 2011 and February 2, 2012 versions. This letter provides additional guidance to health plans regarding individual and small group premium rate filings and aggregate data submissions. This letter also provides guidance for large group aggregate rate information submissions discussed below.

Director’s Letter (Letter 11-K) was issued on July 2, 2012, to provide additional guidance to health plans regarding premium rate filings for individual policies sold through associations.

Rate Review for Individual and Small Group Markets

Beginning January 1, 2011, health plans are required to submit rate filings to the DMHC pursuant to Senate Bill 1163 (Chapter 661, Statutes of 2010). All rate filing documents are to be submitted through the National Association of Insurance Commissioners’ System for Electronic Rate and Form Filing (SERFF).

For individual and small group products, health plans are required to submit, through SERFF, separate documentation for each of the categories listed below.

  • The information identified in California Health and Safety Code section 1385.03(b) including a detailed actuarial certification can be found here.
  • The information requested in California Health and Safety Code section 1385.07(d) that is required to be displayed on the DMHC’s website as well as the submitting health plan’s website can be found here.

The DMHC has released the following forms for submissions via the SERFF system:

Further guidance regarding rate filing and rate filing contents may be released later.

Rate and Prescription Drug Cost Data for Large Group Market

Beginning October 1, 2016, health plans are required to submit aggregate rate information to the DMHC pursuant to Senate Bill 546 (Chapter 801, Statutes of 2015). In addition, beginning October 1, 2018, health plans are required to submit specific prescription drug cost information to the DMHC pursuant to Senate Bill 17 (Chapter 603, Statutes of 2017). All rate filing documents are to be submitted through the National Association of Insurance Commissioners’ System for Electronic Rate and Form Filing (SERFF). The large group aggregate rate information submitted by health plans is posted under Premium Rate Review.

Additionally, the DMHC is required to hold a public meeting to discuss the large group aggregate rate information submitted to the DMHC annually and to provide an opportunity for public discussion of the reasons for the changes in the rates, benefits, and cost sharing in the large group market.

For large group products, health plans are required to submit, through SERFF, separate documentation for each of the categories listed below.

  • The information requested in California Health and Safety Code section 1385.07(d) that is required to be displayed on the DMHC’s website as well as the submitting health plan’s website.

DMHC has released the following forms for submissions via the SERFF system:

SB 546 Reporting Documents

SB 17 Reporting Form to be included in the SB 546 Rate Data Filing 

Prescription Drug Cost Data for Commercial Plans

Beginning October 1, 2018, health plans are required to submit prescription drug cost information to the DMHC pursuant to Senate Bill 17 (Chapter 603, Statutes of 2017). All cost filing documents for commercial plans are to be submitted via the DMHC e-filing portal.

Additionally, the DMHC is required to aggregate the data that it receives from health plans and compile a report for the public and legislators that demonstrates the overall impact of prescription drug costs on health care premiums. Information specific to individual health plans is considered confidential and will be withheld from public disclosure.

The DMHC has released the following forms for submissions via the DMHC's e-filing portal:

For large group health care service plan contracts, SB 17 requires specific cost information regarding covered prescription drugs be filed through SERFF. The DMHC has created reporting forms and instructions for this submission that can be found in the above section, Rate and Prescription Drug Cost Data for Large Group Market.   

Further guidance regarding rate filing and rate filing contents may be released later.