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Filing and Reporting Process

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.

Required Periodic Reports

If you are a licensed plan, you must submit periodic reports to the DMHC. For your convenience, below you’ll find charts that include information on the reports you need to submit, including description, frequency, and due date of the report.

The lists below are believed to be complete as of the date of compilation. However, licensed health care service plans may not rely on the lists and should consult the Knox-Keene Health Care Service Plan Act of 1975 and associated regulations for filing requirements.

How to File

Health care service plans electronically submit Knox-Keene Act compliance documents and reports to the DMHC via the eFiling webportal pursuant to Rule 1300.41.8. There are three different categories of individuals who may access eFiling:

1. eFiling User – To become an eFiling user and have access to the eFiling webportal you must obtain an individual login and password from your plan’s eFiling administrator.

2. eFiling Administrator – An eFiling administrator is a person designated by the plan who has the ability to provide eFiling access to other eFiling users by creating new accounts, adding new staff, editing accounts, modifying and deleting existing accounts, and resetting accounts or monitoring user activity.

3. eFiling Signatory – An eFiling signatory is a fully authorized officer of the plan who certifies, under penalty of perjury, as knowing the contents of the Electronic Signature Verification Form and certifies that all electronic documents submitted to the DMHC are true and correct. The eFiling signatory authorizes eFiling users to submit filings on behalf of the plan. An original hardcopy of the Electronic Signature Verification Form is due to the DMHC within 30 days of becoming an eFiling signatory. If the plan has not sent the form in, the DMHC will email the plan requesting the form and will calendar 30 days to follow up. The signatory is not required to be an eFiling user.

Note: The plan may designate as many administrators, users and signatories as it deems necessary, but the plan must designate at least one individual for all three eFiling access categories. The same individual may serve in all three categories.

Resources

For any further inquiries, please contact LicensingeFiling@dmhc.ca.gov

Financial Examination Reports

Financial examinations are conducted of all licensed health plans, including full-service and all specialty health plans. The purpose of the financial examinations is to evaluate and report on regulatory compliance with the Knox Keene Act.

View Financial Examination Reports

Resources available to assist health plans with understanding the examination process: