Current through Register 2024 Notice Reg. No. 12, March 22, 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.
(b) Amendment of an Application.
(1) An amendment to application either before
or after issuance of a license must comply with Rule 1300.52. However, Rules
1300.52.1 and 1300.52.2 apply only after an applicant has been
licensed.
(c) Updating
Application Prior to Licensure. In addition to complying with Rule 1300.52, an
amendment to a pending application shall comply with the following:
(1) Material changes (see Rule 1300.45(1)) to
information previously submitted in connection with an application (as amended
to date) shall be submitted as an amendment to the license application
immediately, except as provided in subsection (f) of Rule 1300.52.
(2) Nonmaterial changes to the information
previously submitted in connection with an application (as amended to date) may
be accumulated and shall be submitted as an amendment to the license
application monthly or within 30 days (or other period requested by the
Director) of each such change.
(3)
Financial statements and calculations of tangible net equity previously
submitted in connection with an application (as amended to date) shall be
updated to an amendment to the license application which shall consist of
quarterly financial statements (see Rule 1300.84.2a(1), (2), and (3)) and a
calculation of applicant's tangible net equity as of the closing date of such
quarter, and shall be filed within 30 days after the close of each quarter of
applicant's fiscal year.
1. New
section filed 12-17-85; effective thirtieth day thereafter (Register 85, No.
51).
2. Change without regulatory effect amending subsection (a)(7)
filed 8-24-92; operative 9-23-92 (Register 92, No. 35).
3. Change
without regulatory effect amending subsection (a)(7) filed 4-4-2000 pursuant to
section 100, title 1, California Code of
Regulations (Register 2000, No. 14).
4. Change without regulatory
effect amending subsection (c)(2) 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: Sections
1351
and
1352,
Health and Safety Code.
