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["California Health Benefit Exchange "]
["Issuer Intent To Apply for Plan Year 2018 Certification"]
[]
["E-mail completed form to QHP@covered.ca.gov no later than 5:00 pm on February 15, 2017. 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, 2017 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."]
["Applicant trainings will be provided prior to March 2, 2017 to provide applicants with information to assist in completing application responses, including how to access and use the electronic application submission portal. \nOnce your LOI is received, webinar registration information will be sent to the contact person listed above for registration information. Registration information can be shared with additional plan representatives.\nPlease note the following training dates and times:"]
[]
[]
["Wednesday, February 22, 2017 10 am -12 pm PT"]
["Thursday, February 23, 2017 1 pm - 3 pm PT"]
["Friday, February 24, 2017 10 am -11:30 pm PT"]

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["California Health Benefit Exchange \nQDP Certification Application for Plan Year 2018\nCovered California for Small Business (CCSB)\nLetter of Intent - Plan Type By Rating Region ",null,null,"Selecting a box below means Issuer intends to submit a bid for the selected rating region to offer Qualified Dental Plans within that region.  \n\nPlease complete the following pages below for each product type you are intending to offer.\n"]
[]
[]
[]
["1.Product Type Offered (Please Choose one)",null,null,null,"Select"]
["Rating Region","County","Full County \nYes / No","Family Dental Plan","Children's Dental Plan","Employer-Sponsored Dental 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 \nQDP Certification Application for Plan Year 2018\nCovered California for Small Business (CCSB)\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","Family Dental Plan","Children's Dental Plan","Employer-Sponsored Dental 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 \nQDP Certification Application for Plan Year 2018\nCovered California for Small Business (CCSB)\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","Family Dental Plan","Children's Dental Plan","Employer-Sponsored Dental 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 \nQDP Certification Application for Plan Year 2018\nCovered California for Small Business (CCSB)\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","Family Dental Plan","Children's Dental Plan","Employer-Sponsored Dental 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"]