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Submit Health Plan Filings and Reporting

As required under the law, and in furtherance of its mission to protect consumers, the DMHC reviews a variety of health plan operations on an ongoing basis for compliance with the law.

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

Qualified Dental and Health Plans

The DMHC offers the following information to assist Individual and Covered California for Small Business Qualified Health and Dental Plan filings for the Plan Year 2018, for compliance with the Knox-Keene Act at California Health and Safety Code Sections 1340 et seq. (Act) and regulations promulgated by the DMHC at California Code of Regulations, title 28 (Rules).  For Health and Dental plans licensed pursuant to the Act, the DMHC has primary responsibility for regulatory review and preliminary recommendations with respect to certain selection criteria identified by the California Health Benefit Exchange (Exchange) in evaluation of whether an applicant is in “good standing.” All licensure, regulatory and product requirements of the Act and Rules apply to QHPs and QDPs offered through the Exchange.

Attachment to Dental Checklist

QHP Attachment RX Attestation

Qualified Health Plans (Revised May 26, 2017)

QHP Attachment Subcontractor Worksheet

QHP Attachment Filing Worksheet

Qualified Dental Plans

 

Quarterly Grievance Report

In accordance with Rule 1300.68 (f), all health plans shall submit a quarterly report to the Department describing grievances that were or are pending and unresolved for 30 days or more. The report shall be prepared for the quarters ending March 31st, June 30th, September 30th and December 31st of each calendar year and is due to the department within 30 days of the end of the reporting quarter.

View & Submit Quarterly Grievance Report

Block Transfer Filings

Please use the following link to submit Block Transfer Filings for provider group and hospital contract terminations where there is a block transfer of enrollees. Please reference Section 1373.65 and Rule 1300.67.1.3.

View and Submit Block Transfer Filing via the Block Transfer Webportal

Provider Group Block Transfer Filings

If a health care service plan has an upcoming contract termination with a provider group, at least 75-days prior to the contract termination, a block transfer filing must be made with the DMHC. California Code of Regulations, Title 28, Rule 1300.67.1.3 (b). A "Provider Group" is defined by Rule 1300.67.1.3(a)(6).

If fewer than 2,000 enrollees are assigned to the provider group, a block transfer filing does not need to be made with the Department. Pursuant to Rule 1300.67.13(c)(1), an enrollee transfer notice would need to be sent to affected enrollees at least 60-days prior to the contract termination. The notice must be approved by the DMHC.

Hospital Block Transfer Filings

Plans must complete the Hospital Block Transfer Filing Form after logging into the block transfer webportal. The form must be completed in its entirety, with all necessary attachments provided.

 

Arbitration Decisions

Each health plan, which uses arbitration to settle disputes with its members must file with the Department a copy of any written arbitration decision. The filed copy must include the amount of the award, the reasons for the award and the names of the arbitrators. By law, the names of the plan, member, witnesses, attorneys, provider, plan employees and plan facilities are deleted from the copy filed with the Department. These redacted copies of the decisions are filed each quarter and every effort will be made to post them on this site within the following quarter and make available to the public.

View Arbitration Decisions