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Public Information & Reports

Reporting to the public is an important part of the consumer protection provided by the DMHC. Below is a listing of the various documents available to the public, including reports to officials and other entities, including the Governor, legislature and others.

Legislative Reports

• Legislative Reports - reports that have approved by the Legislative Office.

Premium Rate Review Reports

• Quarterly Reports - SB 1163 requires the DMHC to report quarterly to the legislature on any unreasonable premium rate health plan filings.
• Rate Review Grant Quarterly Reports - As recipients of the federal Rate Review Grant funds, the DMHC is required to report quarterly on the progress of the grant rate review activities.

Decisions on Rulemaking Petitions

• Petition by Kaiser Foundation Health Plan, Inc. Requesting Initiation of Formal Rulemaking and Promulgation of Regulations Related to Senate Bill 946.
• DMHC’s Decision on the Petition by Kaiser Foundation Health Plan, Inc., Requesting Initiation of Formal Rulemaking and Promulgation of Regulations Related to Senate Bill 946.

Consumer Information

• Ten Year Report on Health Care Consumer Protections - The year 2010 marks a major milestone for consumers and the managed care industry in California -- the ten-year anniversary of the establishment of the DMHC. This report details the significant consumer protection laws and policies established by the DMHC over the past ten years.
• Annual Reports / Complaint and IMR Data Summaries - The Department publishes an annual report that details the number and types of complaints or grievances received during the calendar year, including Independent Medical Review (IMR) data.
• California Public Records Act Request - The California Public Records Act (CPRA) allows the public to access any and all existing, disclosable documents maintained by the Department. The Department encourages, but does not require, requests for records to be made in writing. Written requests help the Department correctly identify the records requested. Written requests for records can be submitted through the Department’s Request for General Information Form.
• Language Assistance Report to the Legislature - SB 853 requires the DMHC to report every two years to the legislature on health plan compliance with Language Assistance standards.
• MRMIP - The Major Risk Medical Insurance Program (MRMIP) is California's insurance program for people with health problems who are not able to buy individual health insurance.
• 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.
• Member Services Contact Information for Health Plans - Many, but not all health plans doing business in California that are regulated by the Department. This list provides the plan's licensed name, its business name (if different from the licensed name, and the health plan type.
• Director's Letters & Opinions -
These interpretive opinions are submitted by third parties to provide a written answer to resolve unsettled questions of law within the scope of responsibility of DMHC.

About Health Plans

• Plan Filing and Reporting - View reports required to be submitted by health plans regarding the plan’s finances and financial solvency. Licensed plans can submit licensing documents by eFile, Quarterly Grievance Reports, and Block Transfer Filing Forms.
• HMO Financial Reporting - Search and view health plans’financial statements, and the results of our financial examinations in report form style. Licensed plans can access and download the Examiner’s and Claims Technical Assistance Guides.
• List of Licensed Plans - This contact information is specific to a health plan's maintaining its license in California. This list should not be used to contact a plan for questions regarding the plan's services or benefits.
• List of Pending Health Plan Applications - Applications for a health plan license submitted to the Department and under Knox-Keene Act review.
• Medical Survey Reports - California managed care law (Knox-Keene Health Care Service Plan Act) requires the Department to conduct a routine medical survey of each licensed full service and specialty health plan at least once every three years.
• 6 Month Survey Schedule - The Division of Plan Surveys posts a rotating 6 Month Survey Schedule of all routine medical surveys of health plans.
• Search Enforcement Actions - Search for enforcement actions which have been adjudicated since July 1, 2000, in the Enforcement Action Database.
• Required Periodic Reports (Non-Medicare plans) - A list of periodic reports that licensed health plans are required to submit to the Department.
• Results of the Department of Managed Health Care settlement agreements related to recissions - In 2008, the Department of Managed Health Care (DMHC) entered into settlement agreements with the five largest health plans in California.
• Required Periodic Reports (Medicare Advantage and Part D plans) - A list of periodic reports that licensed health plans are required to submit to the Department.
• Addendum to Required Periodic Reports to DMHC - A list of Knox-Keene Health Care Service Plan Act sections that require a periodic report from licensed health plans.

About Providers

• Quarterly Claims Settlement Practices Report Summary - A summary of self reported information that is required to be submitted by each licensed health plan regarding the timely payment of claims for health care services.
• Risk Bearing Organizations' Financial Reporting Results - These charts, divided by calendar quarter, list Risk Bearing Organizations (RBO) (by provider identification number, name, region, county and reporting period), whether the RBO has submitted a financial survey or compliance report, and the results of those surveys or reports. Comparative aggregated data can be summarized statewide or regionally.
• Provider Complaint / Dispute Issues Statistics - The Department's Provider Complaint Unit tracks complaints divided by calendar quarter, submitted by providers. The complaints are also sorted by provider type, health plan and issue in dispute.
• Plan Dispute Resolution Program - This annual report includes both a summary and statistics of the number and types of providers using the health plan dispute resolution process, the types of disputes resolved, and the disposition of those disputes with full service and specialized health plans.

See a Complete List of Archived Documents

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