Department of Managed Health Care

State of California

Official Website: https://www.dmhc.ca.gov

The California Department of Managed Health Care protects consumers’ health care rights and ensures a stable health care delivery system

Forms & Documents

Browse all Department of Managed Health Care government forms

All 14 forms

Form Title Topics
APL 18-013 (HC) Independent Medical Review (IMR)/Complaint Form (DMHC 20-224)
APPLICATION FORM FOR PHARMACY BENEFIT MANAGER REGISTRATION
Authorized Assistant Form ENGLISH
California Annual Aggregate Rate Data Report Form
California Department of Managed Health Care/Department of Insurance SB 17 - Large Group Prescription Drug Cost Reporting Form For policies subject to CHSC 1385.045 or CIC 10181.45
California Large Group Annual Aggregate Rate Data Report Form
California Rate Filing Form For Individual and Small Group Health Insurance Rate Filings for Existing Products
California Rate Filing Form For Individual and Small Group Health Insurance Rate Filings for Existing Products 6/25/2019
DMHC New Product Rate Filing Form 6/25/2019
Exhibit E-1 Form II.A. Health Plan
Exhibit E-1 Health Plan
New Independent Medical Review Application/Complaint Form 12.10.2015
Pre-Filing Request Form
Request for Confidentiality 6.14.19

Contact Information & Office Locations

1 contact point

Headquarters

Address:
980 9th Street
Suite 500
Sacramento, CA 95814-2725

Phone numbers:
  • (888) 466-2219
  • (877) 688-9891 (TDD)
Fax numbers:
  • (916) 255-5241

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