Health Plan Licensing | Application & Requirements

All licensed health care service plans must maintain compliance with all applicable managed care laws. Below, you’ll find valuable information about how to obtain and maintain a license to operate a health care service plan under the Knox-Keene Act.

Obtain a License

The sections of the law below pertain to health care service plan licensing requirements and should be reviewed by the applicant before a pre-filing conference is scheduled.

After reviewing the relevant laws, please complete the Pre-Filing Request Form by entering information into the applicable fields and checking the applicable boxes. Submit the completed form to Duty.Counsel@dmhc.ca.gov and allow 5 business days to process.

DMHC 10-195 Pre-Filing Request Form

Relevant Laws

• Knox-Keene Act (KKA) - Article 3. Licensing and Fees, sections 1349 to 1356.2
• California Code of Regulations (CCR) - 1300.51 to 1300.52.4
• Section 1345(f)(1). This is the definition of a health care service plan, the legal entity that DMHC is authorized to license and regulate.
• Application for License - 1300.51
• General Licensure Requirements - 1300.49

See Laws and Regulations relating to health care service plans in California.

Resources

• Cal MediConnect Transition to Medicare Medi-Cal Plans Checklist
• New Medicare Medi-Cal Plans Product and Benefit Expansion Filings Checklist
• Medicare Advantage and Medicare Prescription Drug Plans New License Application Checklist (Revised 12/1/2023)
• Medicare Service Area Expansion Checklist (Revised 3/20/2023)
• All Plan Letter 20-038 - General Licensure Regulation 3rd Phase in Period (Issued 12/3/2020)

For more information please contact the DMHC's Office of Plan Licensing at 916-324-9046 or Duty.Counsel@dmhc.ca.gov.

Please be aware that while the Office of Plan Licensing may provide you with information and answer general questions, staff are prohibited from providing you with legal advice. Legal advice is the application of law to a specific set of facts. If your question requires legal advice, you may wish to seek independent legal counsel from a licensed attorney competent to represent you.

Electronic Fund Transfer

The Electronic Fund Transfer (EFT) program is a method that allows health plans to make an Automated Clearing House (ACH) Debit transaction to pay DMHC invoices. This program allows plans to electronically transfer funds from its bank account to the DMHC bank account. The plan will maintain total control to initiate a transaction by specifying the amount and date of its withdrawal.

If your health plan administrator has authorized you to make payments for your health plan, log into the Web Portal to make payments.

If you need assistance, contact the DMHC Accounting Office at (916) 445-2282 between the hours of 8:00 a.m. to 4:30 p.m. (Pacific Standard Time, Monday through Friday, excluding holidays).

Applications and Orders of Exemption

View pending applications and the breakdown of active health plans.

View list of issued Orders by month:

2025

2024

2023

2022

2021

2020

2019