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["California Health Benefit Exchange "]
["Issuer Intent To Apply for Plan Year 2020 Certification"]
[]
["E-mail completed form to QHPCertification@covered.ca.gov no later than 5:00 pm on February 15, 2019. Insert in Subject Line: Qualified Health Plan Intent to Submit Bid."]
[]
["Please provide the following information:"]
["NAIC Company Code"]
["NAIC Group Code"]
["Federal Employer ID"]
["HIOS/Issuer ID"]
["Issuer Name"]
["Address"]
["City"]
["State"]
["ZIP"]
["Contact Name"]
["Contact Title "]
["Contact Phone Number"]
["Contact E-mail"]
[]
["Intent to Apply is non-binding, but must be submitted by the deadline, February 15, 2019 by  5:00 pm in order to receive applicant trainings and login information to access the electronic application submission portal. "]
["Separate Intent to Apply forms must be completed for each application type."]
["Covered California will provide Applicant trainings after the Letter of Intent (LOI) period closes (2/15/19) to Applicants who have successfully submitted an LOI. Applicant training information will be sent to the  \"Contact Name\" listed above and can be shared with additional plan representatives. The trainings will assist with completing application responses, including how to access and use the electronic application submission portal."]

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["California Health Benefit Exchange \nQHP Certification Application for Plan Year 2020\nIndividual Marketplace\nLetter of Intent - Plan Type By Rating Region ",null,null,null,"Selecting a box below means Applicant intends to submit a bid for the selected rating region for all metal tiers and a catastrophic benefit design within that rating region. Applicant must offer a complete array of metal tiers and a catastrophic plan. HDHP Bronze Plans are optional. \nPlease complete the following pages below for each product type you intend to offer.\n"]
[]
[]
[]
["1.Product Type Offered (Please Choose One) -->",null,null,null,"Select"]
["Rating Region","County","Full County \nYes / No","Platinum Plan","Gold Plan","Silver Plan","Bronze Plan","Catastrophic Plan","HDHP Bronze Plan"]
["Region 1","Alpine"]
["Region 1","Del Norte"]
["Region 1","Siskiyou"]
["Region 1","Modoc"]
["Region 1","Lassen"]
["Region 1","Shasta"]
["Region 1","Trinity"]
["Region 1","Humboldt"]
["Region 1","Tehama"]
["Region 1","Plumas"]
["Region 1","Nevada"]
["Region 1","Sierra"]
["Region 1","Mendocino"]
["Region 1","Lake"]
["Region 1","Butte"]
["Region 1","Glenn"]
["Region 1","Sutter"]
["Region 1","Yuba"]
["Region 1","Colusa"]
["Region 1","Amador"]
["Region 1","Calaveras"]
["Region 1","Tuolumne"]
["Region 2","Napa"]
["Region 2","Sonoma"]
["Region 2","Solano"]
["Region 2","Marin"]
["Region 3","Sacramento"]
["Region 3","Placer"]
["Region 3","El Dorado"]
["Region 3","Yolo"]
["Region 4","San Francisco"]
["Region 5","Contra Costa"]
["Region 6","Alameda"]
["Region 7","Santa Clara"]
["Region 8","San Mateo"]
["Region 9","Santa Cruz"]
["Region 9","Monterey"]
["Region 9","San Benito"]
["Region 10","San Joaquin"]
["Region 10","Stanislaus"]
["Region 10","Merced"]
["Region 10","Mariposa"]
["Region 10","Tulare"]
["Region 11","Fresno"]
["Region 11","Kings"]
["Region 11","Madera"]
["Region 12","San Luis Obispo"]
["Region 12","Ventura"]
["Region 12","Santa Barbara"]
["Region 13","Mono"]
["Region 13","Inyo"]
["Region 13","Imperial"]
["Region 14","Kern"]
["Region 15","Los Angeles"]
["Region 16","Los Angeles"]
["Region 17","San Bernardino"]
["Region 17","Riverside"]
["Region 18","Orange"]
["Region 19","San Diego"]
[]
["California Health Benefit Exchange \nQHP Certification Application for Plan Year 2020\nIndividual Marketplace\nLetter of Intent - Plan Type By Rating Region "]
[]
[]
[]
["2. Product Type Offered (Please Choose One) -->",null,null,null,"Select"]
["Rating Region","County","Full County \nYes / No","Platinum Plan","Gold Plan","Silver Plan","Bronze Plan","Catastrophic Plan","HDHP Bronze Plan"]
["Region 1","Alpine"]
["Region 1","Del Norte"]
["Region 1","Siskiyou"]
["Region 1","Modoc"]
["Region 1","Lassen"]
["Region 1","Shasta"]
["Region 1","Trinity"]
["Region 1","Humboldt"]
["Region 1","Tehama"]
["Region 1","Plumas"]
["Region 1","Nevada"]
["Region 1","Sierra"]
["Region 1","Mendocino"]
["Region 1","Lake"]
["Region 1","Butte"]
["Region 1","Glenn"]
["Region 1","Sutter"]
["Region 1","Yuba"]
["Region 1","Colusa"]
["Region 1","Amador"]
["Region 1","Calaveras"]
["Region 1","Tuolumne"]
["Region 2","Napa"]
["Region 2","Sonoma"]
["Region 2","Solano"]
["Region 2","Marin"]
["Region 3","Sacramento"]
["Region 3","Placer"]
["Region 3","El Dorado"]
["Region 3","Yolo"]
["Region 4","San Francisco"]
["Region 5","Contra Costa"]
["Region 6","Alameda"]
["Region 7","Santa Clara"]
["Region 8","San Mateo"]
["Region 9","Santa Cruz"]
["Region 9","Monterey"]
["Region 9","San Benito"]
["Region 10","San Joaquin"]
["Region 10","Stanislaus"]
["Region 10","Merced"]
["Region 10","Mariposa"]
["Region 10","Tulare"]
["Region 11","Fresno"]
["Region 11","Kings"]
["Region 11","Madera"]
["Region 12","San Luis Obispo"]
["Region 12","Ventura"]
["Region 12","Santa Barbara"]
["Region 13","Mono"]
["Region 13","Inyo"]
["Region 13","Imperial"]
["Region 14","Kern"]
["Region 15","Los Angeles"]
["Region 16","Los Angeles"]
["Region 17","San Bernardino"]
["Region 17","Riverside"]
["Region 18","Orange"]
["Region 19","San Diego"]
[]
["California Health Benefit Exchange \nQHP Certification Application for Plan Year 2020\nIndividual Marketplace\nLetter of Intent - Plan Type By Rating Region "]
[]
[]
[]
["3. Product Type Offered (Please Choose One) -->",null,null,null,"Select"]
["Rating Region","County","Full County \nYes / No","Platinum Plan","Gold Plan","Silver Plan","Bronze Plan","Catastrophic Plan","HDHP Bronze Plan"]
["Region 1","Alpine"]
["Region 1","Del Norte"]
["Region 1","Siskiyou"]
["Region 1","Modoc"]
["Region 1","Lassen"]
["Region 1","Shasta"]
["Region 1","Trinity"]
["Region 1","Humboldt"]
["Region 1","Tehama"]
["Region 1","Plumas"]
["Region 1","Nevada"]
["Region 1","Sierra"]
["Region 1","Mendocino"]
["Region 1","Lake"]
["Region 1","Butte"]
["Region 1","Glenn"]
["Region 1","Sutter"]
["Region 1","Yuba"]
["Region 1","Colusa"]
["Region 1","Amador"]
["Region 1","Calaveras"]
["Region 1","Tuolumne"]
["Region 2","Napa"]
["Region 2","Sonoma"]
["Region 2","Solano"]
["Region 2","Marin"]
["Region 3","Sacramento"]
["Region 3","Placer"]
["Region 3","El Dorado"]
["Region 3","Yolo"]
["Region 4","San Francisco"]
["Region 5","Contra Costa"]
["Region 6","Alameda"]
["Region 7","Santa Clara"]
["Region 8","San Mateo"]
["Region 9","Santa Cruz"]
["Region 9","Monterey"]
["Region 9","San Benito"]
["Region 10","San Joaquin"]
["Region 10","Stanislaus"]
["Region 10","Merced"]
["Region 10","Mariposa"]
["Region 10","Tulare"]
["Region 11","Fresno"]
["Region 11","Kings"]
["Region 11","Madera"]
["Region 12","San Luis Obispo"]
["Region 12","Ventura"]
["Region 12","Santa Barbara"]
["Region 13","Mono"]
["Region 13","Inyo"]
["Region 13","Imperial"]
["Region 14","Kern"]
["Region 15","Los Angeles"]
["Region 16","Los Angeles"]
["Region 17","San Bernardino"]
["Region 17","Riverside"]
["Region 18","Orange"]
["Region 19","San Diego"]
[]
["California Health Benefit Exchange \nQHP Certification Application for Plan Year 2020\nIndividual Marketplace\nLetter of Intent - Plan Type By Rating Region "]
[]
[]
[]
["4. Product Type Offered (Please Choose One) -->",null,null,null,"Select"]
["Rating Region","County","Full County \nYes / No","Platinum Plan","Gold Plan","Silver Plan","Bronze Plan","Catastrophic Plan","HDHP Bronze Plan"]
["Region 1","Alpine"]
["Region 1","Del Norte"]
["Region 1","Siskiyou"]
["Region 1","Modoc"]
["Region 1","Lassen"]
["Region 1","Shasta"]
["Region 1","Trinity"]
["Region 1","Humboldt"]
["Region 1","Tehama"]
["Region 1","Plumas"]
["Region 1","Nevada"]
["Region 1","Sierra"]
["Region 1","Mendocino"]
["Region 1","Lake"]
["Region 1","Butte"]
["Region 1","Glenn"]
["Region 1","Sutter"]
["Region 1","Yuba"]
["Region 1","Colusa"]
["Region 1","Amador"]
["Region 1","Calaveras"]
["Region 1","Tuolumne"]
["Region 2","Napa"]
["Region 2","Sonoma"]
["Region 2","Solano"]
["Region 2","Marin"]
["Region 3","Sacramento"]
["Region 3","Placer"]
["Region 3","El Dorado"]
["Region 3","Yolo"]
["Region 4","San Francisco"]
["Region 5","Contra Costa"]
["Region 6","Alameda"]
["Region 7","Santa Clara"]
["Region 8","San Mateo"]
["Region 9","Santa Cruz"]
["Region 9","Monterey"]
["Region 9","San Benito"]
["Region 10","San Joaquin"]
["Region 10","Stanislaus"]
["Region 10","Merced"]
["Region 10","Mariposa"]
["Region 10","Tulare"]
["Region 11","Fresno"]
["Region 11","Kings"]
["Region 11","Madera"]
["Region 12","San Luis Obispo"]
["Region 12","Ventura"]
["Region 12","Santa Barbara"]
["Region 13","Mono"]
["Region 13","Inyo"]
["Region 13","Imperial"]
["Region 14","Kern"]
["Region 15","Los Angeles"]
["Region 16","Los Angeles"]
["Region 17","San Bernardino"]
["Region 17","Riverside"]
["Region 18","Orange"]
["Region 19","San Diego"]