reglab/statecodes huggingface dataset:
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 1 - Department Administration › Article 2 - Administration › Section 1007 - Request for Confidentiality

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Director will withhold from public
				  inspection, pursuant to the applicable state and/or federal law, information
				  received in connection with an application (including applications for
				  interpretive opinions) or report, if in the opinion of the Director, the public
				  inspection of such information is not necessary for the purposes of the law
				  under which the information was filed, and the information is reasonably shown
				  to meet either of the following:
(1) The
				  information is proprietary or of a confidential business nature, including but
				  not limited to trade secrets, and has been confidentially maintained by the
				  business entity and the release of which would be damaging or prejudicial to
				  the business concern.
(2) The
				  information is such that the private and/or public interest is served in
				  withholding the information.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 1 - Department Administration › Article 2 - Administration › Section 1008 - Availability of Department Forms, Publications and Notices; Fees

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Department
				  forms required by the Act or regulations, releases, notice of regulatory
				  changes, and other publications are available free of charge on the
				  Department's web page.
(b)
				  Department forms required by the Act or regulations, releases, notice of
				  regulatory changes, and other publications are available at either the
				  Department's Sacramento or Los Angeles office, or via the mail. The Department
				  will charge thirty cents ($0.30) per page for any document picked up at the
				  Department's offices. Documents requested by mail should be directed to the
				  Department of Managed Health Care, 980 9th Street, Suite 500, Sacramento, CA
				  95814-2724. The fee for any document mailed will be thirty cents ($0.30) per
				  page, plus postage. The minimum charge for any single order by mail will be
				  $5.00. No charges will be incurred for providing a single copy of the
				  Department's consumer complaint form.
1. New
					 section filed 8-12-2002; operative 9-11-2002 (Register 2002, No.
					 33).
Note: Authority cited: Sections
						1344
						and
						1346.4,
						Health and Safety Code. Reference: Sections
						1344
						and
						1346,
						Health and Safety Code.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 1 - Department Administration › Article 2 - Administration › Section 1009 - Retention of Department Records

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Department shall maintain records and
				  files necessary to accomplish the Department's regulatory function according to
				  subdivision (b) and the approved Record Retention Schedule by the Department of
				  General Services. Records and files may be maintained by the Department using
				  either paper, electronic or other alternative storage technologies, including
				  but not limited to, photography, microphotography, electronically recorded
				  video images on magnetic surfaces, electronic data processing systems, optical
				  disk storage, or any other trusted medium that does not permit additions,
				  deletions, or changes to the original document. Unless specifically superseded
				  by another legal obligation, Department records and files shall be destroyed
				  pursuant to the schedule in subsection (b).
(b) Department records and files shall be
				  destroyed as follows:
(1) Plan license
				  applications, amendments, and material modifications:
(A) A plan's license, original application
				  and execution pages A through D, as described in section
				  1300.51, shall be retained by the
				  Department until a plan's license is surrendered or revoked. Records and files
				  pertaining to the plan's license will be maintained by the Department for a
				  minimum of two years following the plan's surrender or revocation of the
				  license. Thereafter, the records and files shall be destroyed.
(B) Exhibits to a plan's license application,
				  as described in section
				  1300.51 subsections E through FF,
				  amendments, and material modifications shall be retained by the Department for
				  a minimum of five years from the date of filing. Thereafter, the records and
				  files shall be destroyed.
(C)
				  Records and files regarding a plan's financial status and fiscal arrangements,
				  as described in section
				  1300.51, shall be retained for a
				  minimum of five years from the date of filing. Thereafter, the records and
				  files shall be destroyed.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 1 - Department Administration › Article 2 - Administration › Section 1011 - Assessment for University of California Analysis of Proposed Mandate Legislation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For the fiscal years 2004-05 and 2005-06,
				  the Department shall assess each full service plan its share of the amount
				  necessary to fund the Health Care Benefits Fund for that fiscal year. The
				  amount necessary for each fiscal year will be determined by the Department and
				  the Department of Insurance in consultation with the University of California
				  (University) and will be based on the amount necessary to fund the actual and
				  necessary expenses of the University, not to exceed $2 million, in the analysis
				  of legislative health care benefit mandates for the fiscal year.
(b) The total amount owed by all full-service
				  health plans will be 87.6% of the total amount necessary to fund the Health
				  Care Benefits Fund. That percentage is based on the ratio between persons
				  enrolled in full-service health care service plans and those persons enrolled
				  in health reimbursement plans regulated by the Department of Insurance as
				  reported in the publication "Accident & Health Covered Lives 2002" (Revised
				  December 11, 2003) published by the Department of Insurance in May,
				  2002.
(c) The Department shall
				  annually calculate each full-service health plan's portion of the amount
				  specified in subsection (b) as follows:
(1)
				  The Department shall calculate the per-enrollee cost by dividing the amount of
				  revenues required to be paid by all full-service health care service plans, by
				  the total number of enrollees in this state that are enrolled in all
				  full-service plans as of the March 31 immediately preceding the date of the
				  assessment.
(2) The Department
				  shall calculate each plan's annual fee by multiplying the per-enrollee cost
				  determined pursuant to paragraph (1) of this subsection (c) by the number of
				  enrollees in the plan as of the March 31 immediately preceding the date of the
				  assessment.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 1 - Department Administration › Article 3 - Electronic Filing › Section 1300.41.8 - Electronic Filing

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Definitions:
(1) "Electronic" means relating
				  to technology having electrical, digital, magnetic, wireless, optical,
				  electromagnetic, or similar capabilities;
(2) "Electronic signature" means an
				  electronic sound, symbol, or process attached to or logically associated with
				  an electronic record, executed or adopted by a party with the intent to
				  represent a manual signature.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 1 - Exemptions › Section 1300.43 - Small Plans

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A health care service plan or specialized health care
					 service plan which provides health care services or specialized health care
					 services only to the employees of one employer, or only to the employees of
					 employers under common ownership and control, which is administered solely by
					 the employer, and which does not have more than five subscribers (regardless of
					 the number of persons enrolled based upon their relationship to or dependence
					 upon such subscribers) is exempt from all provisions of the Act and the rules
					 thereunder, except Sections
					 1381,
					 1384 and
					 1385. Such plans are exempt from
					 any rules adopted pursuant to such sections unless such rules are made
					 specifically applicable to plans exempted under this section.
1. New
					 Subchapter 5.5, Articles 1-14 (1300.43-1300.99, not consecutive) filed 6-1-76;
					 effective thirtieth day thereafter (Register 76, No.
					 23).
Note: Authority cited: Section
						6, Chapter 941, Statutes 1975, and
						Section
						1344,
						Health and Safety Code. Reference: Knox-Keene Health Care Service Plan Act of
						1975.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 1 - Exemptions › Section 1300.43.1 - New Plans. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Amendment
					 filed 11-30-76 as an emergency; effective upon filing (Register 76, No. 49).
					 For prior history, see Register 76, No. 42.
2. Reinstatement of
					 section as it existed prior to emergency amendment filed 11-30-76, by operation
					 of Section
					 11422.1(b),
					 Government Code (Register 77, No. 24).
3. Repealer filed 6-29-84;
					 effective thirtieth day thereafter (Register 84, No.
					 26).
Note: Authority cited: Section
						1344,
						Health and Safety Code. Reference: Section
						1343,
						Health and Safety Code.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 1 - Exemptions › Section 1300.43.2 - Extension for Enrollers Under Medi-Cal Program. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 8-12-76 as an emergency; effective upon filing (Register 76, No.
					 33).
2. Amendment filed 9-30-76 as an emergency; effective upon
					 filing (Register 76, No. 40).
3. Amendment filed 10-12-76 as an
					 emergency; effective upon filing. Certificate of Compliance included (Register
					 76, No. 42).
4. Repealer filed 1-12-83; effective thirtieth day
					 thereafter (Register 83, No. 3).
Note: Authority cited: Section
						1344,
						Health and Safety Code. Reference: Section
						1343,
						Health and Safety Code.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 1 - Exemptions › Section 1300.43.3 - Ambulance Plans: Conditional Exemption

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Definitions. For the purposes of this
				  section:
(1) "Ground ambulance services"
				  means the emergency, including advanced life support services, and
				  non-emergency transportation of an enrollee by an individual licensed pursuant
				  to Articles 1 and 2 of Chapter 2.5 of Division 2 of the Vehicle Code where
				  health care services are provided to an enrollee for the duration of such
				  transportation.
(2) "Air ambulance
				  services" means the emergency, including advanced life support services, and
				  non-emergency transportation of an enrollee by legally authorized air ambulance
				  where health care services are provided to the enrollee for the duration of
				  such transportation.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 1 - Exemptions › Section 1300.43.4 - Employee Welfare Benefit Plans. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Amendment
					 filed 3-6-78 as an emergency; designated effective 3-6-78 (Register 78, No.
					 10). For prior history, see Register 77, No. 36.
2. Certificate of
					 Compliance filed 4-20-78 (Register 78, No. 16).
3. Amendment filed
					 8-14-78 as an emergency; designated effective 8-15-78 (Register 78, No.
					 33).
4. Certificate of Compliance filed 11-8-78 (Register 78, No.
					 45).
5. Repealer filed 9-27-79; effective thirtieth day thereafter
					 (Register 79, No. 39).
Note: Authority cited: Sections
						1343
						and
						1344,
						Health and Safety Code. Reference: Section
						1343,
						Health and Safety Code.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 1 - Exemptions › Section 1300.43.5 - Exemption for Licensees of Insurance Commissioner. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 12-20-77 as an emergency; effective upon filing (Register 77, No.
					 52).
2. Certificate of Compliance filed 4-4-78 (Register 78, No.
					 14).
3. Repealer filed 1-12-83; effective thirtieth day thereafter
					 (Register 83, No. 3).
Note: Authority cited: Section
						1344,
						Health and Safety Code. Reference: Section
						1343,
						Health and Safety Code.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 1 - Exemptions › Section 1300.43.6 - Moribund Plans

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A health care service plan which is a general acute care
					 hospital whose business as a plan is limited to providing, administering, or
					 otherwise arranging for the provision of health care services to members of one
					 moribund group of not more than 250 members is exempted from the provisions of
					 the Knox-Keene Health Care Service Plan Act of 1975, subject to each of the
					 following conditions:
(a) That such
				  plan is licensed as a health facility pursuant to Chapter 2 (commencing with
				  Section 1250) of the Health and Safety
				  Code, and is not insolvent.
(b)
				  That such plan has not accepted any new members for the last twenty years and
				  does not accept any new members for the duration of this exemption.
(c) That such plan receives prepaid or
				  periodic charges, if any, from members of such group in an amount not exceeding
				  $5 per member per month and has received no substantial payment or transfer of
				  property from or on behalf of such contracting group during the last twenty
				  years.
(d) That such plan derives
				  not more than one-half of one percent of its annual income from prepaid or
				  periodic charges paid by or on behalf of members of such group, and has a
				  minimum net worth of $15,000,000 based upon its most recent certified financial
				  statements (prepared as of a date within the preceding 15 months).
(e) That such plan establish and maintain a
				  grievance procedure substantially complying with Section
				  1300.68.
(f) That such plan deliver to each subscriber
				  and enrollee within 60 days of the adoption of this section, and thereafter to
				  any subscriber or enrollee upon request, the following written notice:
"(Name of plan) IS A HEALTH CARE SERVICE PLAN OPERATING
					 PURSUANT TO AN EXEMPTION FROM THE KNOX-KEENE HEALTH CARE SERVICE PLAN ACT OF
					 1975 PROVIDED BY RULE OF THE DIRECTOR OF THE DEPARTMENT OF MANAGED HEALTH CARE
					 OF THE STATE OF CALIFORNIA."
1. New
					 section filed 6-13-78 as an emergency; effective upon filing (Register 78, No.
					 24).
2. Certificate of Compliance filed 8-18-78 (Register 78, No.
					 33).
3. Editorial correction of subsection (f) (Register 95, No.
					 12).
4. Change without regulatory effect amending subsection (f)
					 filed 7-18-2000 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2000, No. 29).
5. Change without regulatory
					 effect amending subsection (f) filed 11-21-2002 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2002, No. 47).
Note: Authority cited: Sections
						1343
						and
						1344,
						Health and Safety Code. Reference: Section
						1343,
						Health and Safety Code.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 1 - Exemptions › Section 1300.43.7 - Student Emergency Care Arrangements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
There is exempted from the provisions of the Act any
					 nonprofit corporation or association all of whose members are licensed
					 physicians and which is a health care service plan as defined by subdivision
					 (f) of Section
					 1345 only by reason of health care
					 service plan contracts with one or more colleges or universities pursuant to
					 which such nonprofit corporation or association furnishes or arranges only
					 emergency health care services and health care services ancillary thereto to
					 members of the student body of, employees of, and visitors to such colleges or
					 universities, provided that each of the following conditions is met:
(a) At least 95 percent of the cost of health
				  care services furnished pursuant to such contracts is furnished by employees or
				  members of such nonprofit corporation or association or contracting
				  providers.
(b) All services
				  furnished by members pursuant to such contracts are furnished pursuant to
				  provider contracts which comply with Section
				  1379 of the Act.
1. New
					 section filed 8-22-78; effective thirtieth day thereafter (Register 78, No.
					 34).
Note: Authority cited: Section
						1343,
						Health and Safety Code. Reference: Section
						1343,
						Health and Safety Code.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 1 - Exemptions › Section 1300.43.8 - Public Agencies. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 9-27-79; effective thirtieth day thereafter (Register 79, No.
					 39).
2. Repealer filed 1-12-83; effective thirtieth day thereafter
					 (Register 83, No. 3).
Note: Authority cited: Section
						1343,
						Health and Safety Code. Reference: Section
						1343,
						Health and Safety Code.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 1 - Exemptions › Section 1300.43.9 - Unlicensed Solicitors and Solicitor Firms. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 11-9-79 as an emergency; effective upon filing (Register 79, No.
					 45). A Certificate of Compliance must be filed within 120 days or emergency
					 language will be repealed on 3-9-80.
2. Repealed by operation of
					 Section
					 11422.1(c),
					 Government Code (Register 80, No. 24).
Note: Authority cited: Sections
						1343
						and
						1344,
						Health and Safety Code. Reference: Section
						1343,
						Health and Safety Code.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 1 - Exemptions › Section 1300.43.11 - Exemption for Solicitors of Nonprofit Retirees' Plans. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 11-21-79; effective thirtieth day thereafter (Register 79, No.
					 47).
2. Repealer filed 1-12-83; effective thirtieth day thereafter
					 (Register 83, No. 3).
Note: Authority cited: Sections
						1343
						and
						1344,
						Health and Safety Code. Reference: Section
						1343,
						Health and Safety Code.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 1 - Exemptions › Section 1300.43.12 - Medi-Cal Dental Contract

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The contract of the Department of Health Services which is
					 entered as the result of successful bidding in response to said Department's
					 request for proposal and which requires the contractor to provide only dental
					 benefits for the state's Medi-Cal beneficiaries pursuant to Section
					 14104.3
					 of the Welfare and Institutions Code and incorporates the terms and provisions
					 set forth in the request for proposal, is exempt from the provisions of the
					 Act, if the successful bidder ("entity") is not already licensed under the Act,
					 for the period indicated below, subject to each of the following:
(a) The entity engages in no activities as a
				  plan other than those pursuant to the Medi-Cal dental contract described above
				  or pursuant to a separate exemption in the Act or these rules.
(b) The entity properly files an application
				  for licensure under the Act, as required by Sections
				  1351 and
				  1356 of the Act, prior to
				  executing the contract referred to above, except that the information contained
				  in the application submitted at the time of filing need not include information
				  not required to be provided to the Department of Health Services pursuant to
				  its request for proposal, so long as the additional information required by
				  Section 1351 of the Act or by the
				  application form provided by the Director is filed as an amendment to the
				  license application within six weeks of the date of execution of the contract
				  referred to above, or any longer period as the Director by order may allow
				  under the Director's waiver authority set forth in Section
				  1344(a) of the
				  Act.
(c) The entity reasonably
				  pursues the completion of its application and compliance with the provisions of
				  the Act and applicable rules thereunder.
(d) The entity, for the duration of the
				  exemption provided by this section, shall be subject to the provisions of
				  Sections 1351.1,
				  1381,
				  1384, and
				  1385 of the Act, and may be
				  examined by the Director in the manner and subject to the arrangements provided
				  in Section
				  1382 of the Act.
(e) The exemption provided by this section
				  shall be effective only until the earlier of
(1) final action by the Director on the
				  application, or
(2) the expiration
				  of nine months after execution of the contract referred to above, except that
				  said nine month period may be waived by order of the Director for any
				  additional one month periods under the Director's waiver authority set forth in
				  Section 1344(a) of the
				  Act.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 1 - Exemptions › Section 1300.43.15 - Foreign Plans

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  There is exempted from the provisions of the Act (other than Sections
				  1360,
				  1360.1,
				  1381 and
				  1395) any plan whose activity in
				  this state is limited to the offer and sale of plan contracts for enrollees who
				  are residents of or domiciled in a foreign country, provided:
(1) the provision of health care services by
				  the plan, and the receipt of consideration from persons located in this State,
				  does not violate any law of the foreign country in which the enrollee resides
				  or any law of the United States,
(2) the annual premium per enrollee does not
				  exceed $200 (US),
(3) the
				  solicitors or solicitor firms authorized to solicit on behalf of the plan are
				  physically present in this state, and
(4) the plan has filed a notice with the
				  Director as provided in subsection (b) within the preceding 24
				  months.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 2 - Administration › Section 1300.44 - Interpretive Opinions. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Repealer
					 filed 6-29-84; effective thirtieth day thereafter (Register 84, No.
					 26).
Note: Authority cited: Section
						1344,
						Health and Safety Code.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 2 - Administration › Section 1300.44.1 - Application for Exemption from Rule. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Amendment
					 of subsection (b) filed 1-12-83; effective thirtieth day thereafter (Register
					 83, No. 3).
2. Repealer filed 6-29-84; effective thirtieth day
					 thereafter (Register 84, No. 26).
Note: Authority cited: Section
						1344,
						Health and Safety Code. Reference: Sections
						1344,
						1351
						and
						1352,
						Health and Safety Code.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 2 - Administration › Section 1300.45 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
In addition to the definitions contained in Section
					 1345 of the Act, the following
					 definitions apply to the interpretation of these rules and the Act:
(a) "Act" means the Knox-Keene Health Care
				  Service Plan Act of 1975.
(b)
				  "Advertisement" includes the disclosure form required pursuant to Section
				  1363 of the Act.
(c)
(1) An
				  "affiliate" of a person is a person controlled by, under common control with,
				  or controlling such person.
(2) A
				  person's relationship with another person is that of an "affiliated person" if
				  such person is, as to such other person, a director, trustee or a member of its
				  executive committee or other governing board or committee, or that of an
				  officer or general partner, or holds any other position involving
				  responsibility and authority similar to that of a principal officer or general
				  partner; or who is the holder of 5% or more of its outstanding equity
				  securities; or who has any such relationship with an affiliate of such person.
				  An affiliate is also an affiliated person.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 2 - Administration › Section 1300.46 - Prohibition of Bonuses or Gratuities in Solicitations

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
No person subject to the provisions of the Act shall offer
					 or otherwise distribute any bonus or gratuity to potential subscribers for the
					 purpose of inducing enrollment or to existing subscribers for the purpose of
					 inducing the continuation of enrollment.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 2 - Administration › Section 1300.47 - Advisory Committee on Managed Health Care

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Each member of the Advisory Committee on Managed Health
					 Care shall file with the Director a statement setting forth the
					 following:
(a) The firm with which
				  such member is employed or affiliated and the capacity in which employed or
				  affiliated.
(b) Whether such firm
				  is a health care service plan or solicitor firm under the Act or is a provider,
				  or a fiscal intermediary for a plan, or furnishing services, goods or
				  facilities to any plan, solicitor firm or provider.
(c) Whether such member has any financial
				  interest in any firm specified in (b) or receives compensation from such
				  firm.
(d) The name of each plan in
				  which the member is enrolled, or has been enrolled during the preceding 10
				  years.
1. Amendment
					 filed 1-12-83; effective thirtieth day thereafter (Register 83, No.
					 3).
2. Change without regulatory effect amending section heading and
					 first paragraph filed 7-18-2000 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2000, No. 29).
3. Change without regulatory
					 effect amending section heading and first paragraph filed 11-21-2002 pursuant
					 to section
					 100, title 1, California Code of
					 Regulations (Register 2002, No. 47).
Note: Authority cited: Section
						1344,
						Health and Safety Code. Reference: Section
						1347,
						Health and Safety Code.
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 1300.49 - General Licensure Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Definitions
As used in this section:
(1) "Global risk" means the acceptance of a
				  prepaid or periodic charge from or on behalf of enrollees in return for the
				  assumption of both professional and institutional risk.
(2) "Institutional risk" means the assumption
				  of the cost for the provision of hospital inpatient, hospital outpatient, or
				  hospital ancillary services to subscribers or enrollees undertaken by a person,
				  other than services performed pursuant to the person's own license under
				  section
				  1253
				  of the Health and Safety Code, in return for a prepaid or periodic charge paid
				  by or on behalf of the subscriber or enrollee.
(3) "Limited health care service plan" means
				  a person with a health care service plan license with waivers issued by the
				  Department or its predecessor prior to January 1, 2000 for the provision of, or
				  the arranging, payment, or reimbursement for the provision of, health care
				  services to subscribers or enrollees of another health care service plan under
				  a contract or other arrangement whereby the person assumes both professional
				  and institutional risk.
(4)
				  "Prepaid or periodic charge" for the purposes of this section means any amount
				  of compensation, either at the start or end of a predetermined period, for
				  assuming the risk, or arranging for others to assume the risk, of delivering or
				  arranging for the delivery of the contracted-for health care services for
				  subscribers or enrollees that may be fixed either in amount or percentage of
				  savings or losses in which the entity shares.
(5) "Professional risk" means the assumption
				  of the cost for the provision of physician, ancillary, or pharmacy services
				  undertaken by physicians or other licensed or certified providers to
				  subscribers or enrollees in return for a prepaid or periodic charge paid by or
				  on behalf of the subscriber or enrollee.
(6) "Restricted health care service plan"
				  means a person with a health care service plan license issued by the Department
				  for the provision of, or the arranging, payment, or reimbursement for the
				  provision of, health care services to subscribers or enrollees of another full
				  service or specialized health care service plan under a contract or other
				  arrangement whereby the person assumes both professional and institutional risk
				  but does not directly market, solicit, or sell health care service plan
				  contracts.
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 1300.50 - Notice of Intention to Apply for Plan License. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Repealer
					 filed 6-29-84; effective thirtieth day thereafter (Register 84, No.
					 26).
Note: Authority cited: Section
						1344,
						Health and Safety Code.
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 1300.51 - Application for License as a Health Care Service Plan or Specialized Health Care Service Plan

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An
				  application for license as a health care service plan or specialized health
				  care service plan shall be filed in the form specified in subsection (c) and
				  contain the information specified in this section and prepared as required by
				  Rule 1300.51.3.
(b) Applications
				  filed prior to the effective date of subsection (c) (revised plan application
				  form) and which remain pending on that date will be processed; however,
				  amendments to such applications filed prior to licensure shall be filed upon
				  the form specified in subsection (c) in accordance with the instructions
				  specified in Rule 1300.51.3, and in accordance with the correlation table for
				  the old and new applications provided in Form HP 1300.51-COR. Such amendments
				  will be required only to update the information contained in the application
				  and to remedy deficiencies in the information provided therein.
(c) Revised Health Care Service Plan
				  Application Form.
OFFICIAL USE ONLY
DEPARTMENT OF MANAGED
FEE PAID $__________
HEALTH CARE
RECEIPT NO.__________
LICENSE
							 NO._______________
Date of Filing
FILING FEE:__________
(To be completed by Applicant.) Not
							 refundable except pursuant to Section
							 250.15, Title 10, California Code
							 of Regulations.
PLAN LICENSE APPLICATION
KNOX-KEENE HEALTH CARE SERVICE PLAN ACT
(EXECUTION PAGE)
A. Identification of Plan
1. Name of Applicant.
a. Legal
				  Name___________________________
b.
				  Please list all fictitious names you intend to use:
___________________________
___________________________
___________________________
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 1300.51.3 - Preparation and Amendment of Application for License as a Health Care Service Plan Under Section 1300.51

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) General Instructions.
(1) Type the information requested in the
				  English language using black ribbon.
(2) Complete each item on the application,
				  and type "N/A" in the right hand margin for those items which are not
				  applicable.
(3) Number each exhibit
				  as specified in the item to which the exhibit responds. If several exhibits are
				  required under the same letter/number designation, add a sequential letter or
				  roman numeral as indicated in the following example. Example: If Item Q-1 calls
				  for copies of the specified documents, an applicant employing three different
				  documents would label them as follows: Exhibit Q-1-a; Exhibit Q-1-b; Exhibit
				  Q-1-c.
(4) Arrange all exhibits in
				  sequential order. Attach a "tab" to the right margin of the first page of each
				  major exhibit or series of exhibits to facilitate ready reference.
(5) Submit originals only when requested.
				  Otherwise, submit clearly legible mechanical reproductions.
(6) Submit requested information as an
				  exhibit if the space provided in the application form itself is insufficient.
				  Use the procedure detailed in Item (3), above, to indicate the exhibit
				  number.
(7) Submit three complete
				  copies of the original license application and each amendment submitted prior
				  to licensure to the Department's Sacramento Office to the attention of the
				  Health Plan Division Filing Clerk.
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 - Amendments to Plan Application

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
An amendment to a plan application pursuant to subdivision
					 (a) of Section
					 1352 of the Act shall be filed in
					 the Department's Sacramento Office to the attention of the Health Plan Division
					 Filing Clerk, upon the form contained in Section
					 1300.51 and shall include an
					 original and two complete copies and comply with the following:
(a) The following portions of the application
				  specified in Rule 1300.51 need not be amended after the issuance of a license:
Item E Summary of Information in Application
Item H-2 Map of Service Area.
Item H-3 Index to Map.
Item V Advertising.
Item CC Group Contract Enrollment Projections.
Item DD Individual Contract Enrollment Projections.
Item EE Summary of Enrollment Projections.
Item GG Current Financial Visibility Including Tangible Net
					 Equity.
Item HH Projected Financial Viability.
(b) The amendment must be accompanied by a
				  copy of the Execution Page of the application, and all portions of those pages
				  must be completed.
(c) Attach to
				  the Execution Page only those pages of the application and/or those exhibits
				  which are changed by the amendment.
(d) If a page of the application is amended,
				  complete all items on that page and "redline" or otherwise clearly designate
				  the changed item.
(e) If an
				  exhibit, other than a list required by Item 13A, 13C or 24D of the old
				  application form or Item I-1, I-2 or I-3 of the new application is being
				  amended.
(1) Furnish the complete exhibit as
				  amended, bearing the same number as the original exhibit, with the changed
				  portions of the exhibit "redlined" or otherwise clearly designated,
				  or
(2) Furnish the pages of the
				  exhibit which are amended, each page to be marked with the exhibit number and
				  the page number of the exhibit, and with the changed portions "redlined" or
				  otherwise clearly designated. If this method of amendment is employed, the
				  applicant shall refile the entire exhibit as amended whenever more than 10% of
				  its pages have been amended or promptly upon the request of the
				  Director.
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 1300.52.2 - Change in Plan Personnel

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Pursuant to subdivision (c) of Section
					 1352 of the Act, a plan shall file
					 an amendment to its applications in the form required by Section
					 1300.52, when there are any of the
					 following changes in personnel of the plan, of any management company of the
					 plan, or of any parent company of such plan or management company:
(a) There is an addition or deletion of a
				  director, trustee, principal officer, general partner, general manager or
				  principal management persons, or persons occupying similar positions or
				  performing similar functions, or a substantial and material change in the
				  duties of any such person.
(b)
				  There is the addition or deletion of a limited partner, shareholder or owner of
				  an equity interest in the plan, whose interest exceeds 5 percent of the total
				  partnership interests, shares or equity interests, or there is a change in the
				  interest of any partner, shareholder or owner of an equity interest exceeding 5
				  percent of the total partnership interests, shares or equity
				  interests.
(c) There is the
				  addition or deletion of a principal creditor, as defined in Section
				  1300.45, a material change in the
				  terms of the obligation to a principal creditor, a material increase or
				  decrease in the amount due a principal creditor other than (except in the case
				  of a demand obligation) by the normal terms of the obligation, or a default in
				  the obligation to a principal creditor.
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 1300.52.3 - Filings and Actions Relating to Charitable or Public Activities

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Amendments to a
				  plan application or notices of material modifications filed pursuant to Section
				  1352 or any other reports or
				  filings under the Act shall not be deemed to be notices or requests for
				  approval or ruling pursuant to Article 2, Part 11, Division 2, Title 1 of the
				  Corporations Code or special reports pursuant to Section
				  1300.84.7, nor shall any such
				  notices or requests for approval or ruling or special reports be deemed to be
				  amendments to a plan application or notices of material modifications of a plan
				  or its operations pursuant to Section
				  1352 or other reports or filings
				  under the Act. However, this section shall not prevent a plan from filing
				  notices or requests pursuant to Article 2 (commencing with Section
				  10820), Part 11, Division 2, Title
				  1 of the Corporations Code and/or special reports pursuant to Section
				  1300.84.7 concurrently with
				  materials being filed under Section
				  1352 and utilizing common
				  exhibits, subject to the provisions of Section
				  1300.824(c).
(b) Orders and other actions of the Director
				  pursuant to Section
				  1352 or other provision of the
				  Act, and the effects thereof, are limited to the effects contemplated under the
				  Act and are of no effect or consequence in connection with any other law
				  administered by the Director. Similarly, actions of the Director under any
				  other law are of no effect or consequence in relation to Section
				  1352 or other provision of the
				  Act.
1. New
					 section filed 4-16-82; effective thirtieth day thereafter (Register 82, No.
					 16).
2. Change without regulatory effect amending subsection (b)
					 filed 7-18-2000 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2000, No. 29).
Note: Authority cited: Section
						1344,
						Health and Safety Code. Reference: Section
						1352,
						Health and Safety Code.
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 1300.52.4 - Standards for Amendments and Notices of Material Modification

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Notwithstanding anything to the contrary in Sections
					 1300.52,
					 1300.52.1,
					 1300.52.2, and
					 1300.52.3, the following standards
					 shall apply to amendments and notices of material modification to a plan
					 license application once a health care service plan has been issued its
					 license. These standards shall apply to full-service health care service plans
					 and specialized health care service plans.
(a) General Statement of Requirements.
(i) If a plan makes a change that (A)
				  constitutes an amendment to its plan license application and (B) is not listed
				  in subsection (d) of this Section
				  1300.52.4, then the plan shall
				  file an amendment with the Department. If the plan makes a change that is
				  listed in subsection (d) of this Section
				  1300.52.4, then the plan shall
				  file a notice of material modification with the Department.
(ii) The plan shall include in any amendment
				  or notice of material modification any document or other information
				  specifically required by one of the items set forth in Section
				  1300.51, which is pertinent to the
				  amendment or material modification. Other information may be required if it is
				  determined by the Department to be necessary in order to make a finding under
				  the Act that the amendment or material modification is in the public interest
				  and consistent with the intent and purpose of the Act.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 4 - Solicitors › Section 1300.57 - Solicitor Application. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Amendment
					 filed 6-2-78; effective thirtieth day thereafter (Register 78, No.
					 22).
2. Repealer filed 1-12-83; effective thirtieth day thereafter
					 (Register 83, No. 3).
Note: Authority cited: Section
						1344,
						Health and Safety Code. Reference: Sections
						1357
						and
						1358,
						Health and Safety Code.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 4 - Solicitors › Section 1300.57.1 - Solicitor Firm Application by Person Not Licensed by Insurance Commissioner. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Amendment
					 filed4-27-79; effective thirtieth day thereafter (Register 79, No.
					 17).
2. Repealer filed 1-12-83; effective thirtieth day thereafter
					 (Register 83, No. 3).
Note: Authority cited: Section
						1344,
						Health and Safety Code. Reference: Section
						1357,
						Health and Safety Code.
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 4 - Solicitors › Section 1300.57.2 - Amendment to Solicitor Firm Application. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Repealer
					 filed 1-12-83; effective thirtieth day thereafter (Register 83, No.
					 3).
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 4 - Solicitors › Section 1300.57.3 - Fees Payable by Licensed Insurance Agents and Brokers. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Repealer
					 filed 1-12-83; effective thirtieth day thereafter (Register 83, No.
					 3).
California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 4 - Solicitors › Section 1300.57.4 - Solicitor Financial Records Authorization. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 11-9-77 as an emergency; effective upon filing (Register 77, No.
					 46).
2. Certificate of Compliance filed 2-6-78 (Register 78, No.
					 6).
3. Repealer filed 1-12-83; effective thirtieth day thereafter
					 (Register 83, No. 3).
Note: Authority cited: Sections
						1343
						and
						1344,
						Health and Safety Code. Reference: Section
						1357,
						Health and Safety Code.