California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 3 - Plan Applications and Amendments › Section 1300.52.1 - Notice of Material Modification

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A notice of material modification of its operations or of
					 any plan contract pursuant to subdivision (b) of Section
					 1352 of the Act shall be filed as
					 an amendment to the application as provided in Section
					 1300.52, and there shall be
					 attached to such amendment, preceding the Execution Page, the following
					 form:
DEPARTMENT OF MANAGED HEALTH CARE
STATE OF CALIFORNIA
NOTICE OF MATERIAL MODIFICATION
Pursuant to Health and Safety Code Sec.
					 1352(b)
1. Name of applicant:
				  ___________________________
2.
				  Department of Managed Health Care File Number:
				  _______________________________
3.
				  The fee for filing this application will be forwarded upon receipt of the
				  billing therefore from the Director of the Department of Managed Health Care,
				  pursuant to Health and Safety Code Section
				  1352(d)
				  or pursuant to Section
				  1399.73 if this application
				  involves a conversion or restructuring.
4. Pursuant to Subdivision (b) of Section
				  1352
				  of the Health and Safety Code, applicant requests approval of the material
				  modification of its plan and/or operations, within the time specified below:
(Check appropriate box)
( ) Within the 20 business-day period provided in Section
					 1352(b).
( ) Applicant extends the time for action upon this notice
					 by the Director until - .___________________________
( ) Applicant requests accelerated approval by the Director
					 for the following reasons:
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
5. Conversion or Restructuring. If this
				  application involves a conversion or restructuring, the applicant shall fully
				  disclose information which describes the proposed transaction and demonstrates
				  how the charitable trust requirements of Section
				  1399.72(c) of the
				  Act will be satisfied. In addition, the applicant shall submit a copy of all of
				  its original and amended articles of incorporation and bylaws, and a report as
				  described in Section
				  1399.70(a) of the
				  Act. If this application involves a restructuring, the applicant shall also
				  submit a public benefit program as described in Section
				  1399.71(b) of the
				  Act.
6. Exempt Restructuring
				  Transaction. If this application involves a transaction or transactions
				  described in Section
				  1399.71(e) of the
				  Act, the applicant shall fully disclose information which describes the
				  transaction or transactions and demonstrates how the applicable conditions of
				  exemption of Section
				  1399.71(e) of the
				  Act will be satisfied.
7. Nonprofit
				  Mutual Benefit Health Care Service Plans.
a.
				  Assets subject to a charitable trust obligation. If this application involves a
				  conversion or restructuring of a nonprofit mutual benefit health care service
				  plan with any or all of its assets subject to a charitable trust obligation,
				  the applicant shall submit information pursuant to Item 5 or Item 6 above and,
				  if applicant believes that partial assets are subject to a charitable trust
				  obligation, the applicant shall fully disclose information which:
(i) describes why less than all of its assets
				  are not subject to any charitable trust obligation,
(ii) explains whether any charitable trust
				  obligation terminated for any assets previously held subject to a charitable
				  trust obligation, and
(iii)
				  demonstrates how every noncharitable trust obligation will be
				  satisfied.