DEPARTMENT OF MANAGED HEALTH
CARE STATE OF CALIFORNIA
NOTICE OF FOREIGN PLAN EXEMPTION
RULE 1300.43.15, KNOX-KEENE HEALTH CARE
SERVICE PLAN ACT
() Original Notice | () Amendment to Notice Dated___________________________ |
The person/entity named in Item 1 below files this notice/amended notice claiming the exemption pursuant to Rule 1300.43.15 under the Knox-Keene Health Care Service Plan Act:
Date of Notice | ___________________________ | |
(Name of Person/Entity Filing Notice) | ||
___________________________ | ___________________________ | |
(Signature of Authorized Officer) | ||
___________________________ | ||
(Printed Name and Title of Signatory) |
Verification:
I certify (or declare) under penalty of perjury under the laws of the State of California that I have read this Notice and its attachments thereto and know the contents thereof and that the statements therein are true and correct.
Executed at ____________________ (City and State) __________ (Date).
___________________________ | |
(Signature) |
Cal. Code Regs. Tit. 28, § 1300.43.15
2. Change without regulatory effect amending subsections (a)(4) and (b) filed 7-18-2000 pursuant to section 100, title 1, California Code of Regulations (Register 2000, No. 29).
3. Change without regulatory effect amending subsection (b)--form 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.
2. Change without regulatory effect amending subsections (a)(4) and (b) filed 7-18-2000 pursuant to section 100, title 1, California Code of Regulations (Register 2000, No. 29).
3. Change without regulatory effect amending subsection (b) -form filed 11-21-2002 pursuant to section 100, title 1, California Code of Regulations (Register 2002, No. 47).