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| Public Act 098-0524
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| SB1194 Enrolled | LRB098 03986 RPM 37333 b |
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AN ACT concerning insurance.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 1. Short title. This Act may be cited as the |
Navigator Certification Act.
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Section 5. Definitions.
As used in this Act: |
"Certified application counselor" has the same meaning as |
in federal regulations and guidelines. |
"Director" means the Director of Insurance. |
"Exchange" means any health benefit exchange established |
or operating in this State, including any exchange established |
or operated by the United States Department of Health and Human |
Services. |
"Navigator" means a person or entity selected to perform |
the activities and duties identified in 42 U.S.C. 18031(i) in |
this State. "Navigator" includes any person or entity who |
receives grant funds from the United States Department of |
Health and Human Services, the State of Illinois, or an |
exchange or private funds to perform any of the activities and |
duties identified in 42 U.S.C. 18031(i), including, but not |
limited to, in-person assisters as defined by federal |
regulations or guidelines.
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Section 10. Certificate required.
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(a) No individual or entity shall perform, offer to |
perform, or advertise any service as a navigator in this State |
or receive navigator grant funding from the United States |
Department of Health and Human Services, the State of Illinois, |
or an exchange or private funds unless certified as a navigator |
by the Director under this Act. |
(b) A navigator who complies with the requirements of this |
Act
shall do the following: |
(1) conduct public education activities to raise |
awareness of the availability of qualified health plans; |
(2) distribute fair and impartial information |
concerning enrollment in qualified health plans offered |
within the exchange and the availability of the premium tax |
credits under Section 36B of the Internal Revenue Code of |
1986, 26 U.S.C. 36B, and cost-sharing reductions under |
Section 1402 of the federal Patient Protection and |
Affordable Care Act; |
(3) facilitate enrollment in qualified health plans; |
(4) provide referrals to appropriate federal and State |
agencies for any enrollee with a grievance, complaint, or |
question regarding their health plan or coverage or a |
determination under such plan or coverage; |
(5) provide information in a manner that is culturally |
and linguistically appropriate to the needs of the |
population being served by the exchange. |
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(c) A navigator may not: |
(1) sell, solicit, or negotiate, as these terms are |
defined in Section 500-10 of the Illinois Insurance Code, |
any of the classes of insurance enumerated in Section 4 of |
the Illinois Insurance Code; |
(2) offer advice about which health plan is better or |
worse for a particular individual or employer; |
(3) recommend or endorse a particular health plan or |
advise consumers about which health plan to choose; |
(4) provide any information or services related to |
health benefit plans or other insurance products not |
offered in the exchange, except for health care providers |
when furnishing information or services related to a |
patient's existing health benefit plan or other existing |
health insurance coverage; or |
(5) accept any compensation or consideration, directly |
or indirectly, from any issuer of accident and health |
insurance or stop-loss insurance that is dependent, in |
whole or in part, on whether a person enrolls in or |
purchases a particular private health benefit plan. |
(d) Items (1), (2), (3), (4), and (5) of subsection (c) of |
this Section do not apply to navigators when assisting |
individuals with the enrollment process in the State Medicaid |
program or other public programs.
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Section 15. Application for certificate.
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(a) An entity or individual applying for a navigator |
certificate shall make application to the Director on a form |
developed by the Director and declare under penalty of refusal, |
suspension, or revocation of the certificate that the |
statements made in the application are true, correct, and |
complete to the best of the individual's or entity's knowledge |
and belief. Before approving the application, the Director |
shall find that the individual: |
(1) is at least 18 years of age; |
(2) resides in this State or maintains his or her |
principal place of business in this State; |
(3) is not disqualified due to having committed any act |
that would be grounds for denial, suspension, or revocation |
of a navigator certification in accordance with Section 30 |
of this Act; |
(4) has successfully completed the federal and State |
training provided by the exchange or equivalent State |
requirements as determined by the Department; and |
(5) when applicable, has the written consent of the |
Director pursuant to 18 U.S.C. 1033, or any successor |
statute regulating crimes by or affecting persons engaged |
in the business of insurance whose activities affect |
interstate commerce. |
(b) An entity that acts as a navigator, supervises the |
activities of individual navigators, or receives funding to |
perform such activities shall obtain a navigator entity |
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certificate. An entity applying for a navigator entity |
certificate shall make application on a form containing the |
information prescribed by the Director and shall list the |
individuals acting as navigators under the entity certificate. |
(1) The entity shall designate a certified navigator |
responsible for the navigator entity's compliance with the |
laws of this State and the exchange. |
(2) The entity, under penalty of revocation, |
suspension, or other discipline prescribed by the |
Director, shall certify that each individual completes the |
mandatory training required by item (4) of subsection (a) |
of Section 15 of this Act. |
(c) The Director may require any documents deemed necessary |
to verify the information contained in an application submitted |
in accordance with subsections (a) and (b) of this Section. |
(d) Entities certified as navigators shall provide the |
Director with a list of all individual navigators that it |
employs, supervises, or is affiliated with at renewal. |
(e) The Director may require, in a manner determined by the |
Director, that each entity that acts as a navigator demonstrate |
a level of financial responsibility capable of protecting all |
persons against the wrongful acts, misrepresentations, or |
negligence of the navigator. |
(f) Prior to any exchange becoming operational in this |
State, the Director, in coordination with the exchange, shall |
prescribe the initial training and continuing education |
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requirements for navigators.
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(g) Certificate holders must inform the Director, in |
writing, of a change of address within 30 days after the |
change. |
(h) In order to assist in the performance of the Director's |
duties, the Director may contract with the National Association |
of Insurance Commissioners (NAIC), or any affiliates or |
subsidiaries that the NAIC oversees, to perform any ministerial |
functions, including the collection of fees, related to |
certification that the Director and the nongovernmental entity |
may deem appropriate.
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Section 20. Certificate renewal.
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(a) An individual navigator entity certificate shall be |
valid for one year. |
(b) A navigator may file an application for renewal of a |
certificate in a method prescribed by the Director. Any |
navigator who fails to timely file for certificate renewal |
shall be charged a late fee in an amount prescribed by the |
Director. |
(c) Prior to the filing date for application for renewal of |
a certificate, an individual navigator shall comply with |
ongoing training and continuing education requirements |
established by the Director. The navigator shall file with the |
Director, by a method prescribed by the Director, satisfactory |
certification of completion of the continuing education |
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requirements. Any failure to fulfill the ongoing training and |
continuing education requirements shall result in the |
expiration of the certificate.
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Section 25. Navigator referrals.
On contact with a person |
who acknowledges having existing health insurance coverage |
obtained through an insurance producer, a navigator shall refer |
the person back to that insurance producer for information, |
assistance, and any other services unless: |
(1) the individual is eligible for but has not obtained |
a federal premium subsidy and cost-sharing assistance |
available only through an exchange; |
(2) the insurance producer is not authorized to sell |
health plans in an individual exchange; or |
(3) the individual would prefer not to seek further |
assistance from the individual's insurance producer.
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Section 30. Certificate denial, nonrenewal, or revocation.
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(a) The Director may place on probation, suspend, revoke, |
or refuse to issue or renew a navigator's certificate or may |
levy a civil penalty as established by rule. |
(b) If an action by the Director is to nonrenew, suspend, |
or revoke a certificate or to deny an application for a |
certificate, then the Director shall notify the applicant or |
certificate holder and advise, in writing, the applicant or |
certificate holder of the reason for the suspension, |
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revocation, or denial or nonrenewal of the applicant's or |
certificate holder's certificate. The applicant or certificate |
holder may make written demand upon the Director within 30 days |
after the date of mailing for a hearing before the Director to |
determine the reasonableness of the Director's action. The |
hearing must be held within not fewer than 20 days nor more |
than 30 days after the mailing of the notice of hearing and |
shall be held pursuant to Part 2402 of Title 50 of the Illinois |
Administrative Code. |
(c) A navigator entity certificate may be suspended, |
revoked, or refused or information turned over to the U.S. |
Department of Health and Human Services and applicable state |
agencies if the Director finds, after hearing, that a certified |
individual's violation was known or should have been known by |
one or more of the partners, officers, or managers acting on |
behalf of the navigator entity. |
(d) In addition to or instead of any applicable denial, |
suspension, or revocation of a certificate, a person may, after |
hearing, be subject to a civil penalty in accordance with |
emergency rules issued by the Director. |
(e) The Director has the authority to enforce the |
provisions of and impose any penalty or remedy authorized by |
this Act against any person who is under investigation of or |
charged with a violation of this Act or rules, even if the |
person's certificate has been surrendered or has lapsed by |
operation of law. |
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(f) Upon the suspension, denial, or revocation of a |
certificate, the certificate holder or other person having |
possession or custody of the certificate shall promptly deliver |
it to the Director in person or by mail. The Director shall |
publish all suspensions, denials, or revocations after the |
suspensions, denials, or revocations become final in a manner |
designed to notify the public. |
(g) A person whose certificate is revoked or whose |
application is denied pursuant to this Section is ineligible to |
apply for any certificate for 3 years after the revocation or |
denial. A person whose certificate as a navigator has been |
revoked, suspended, or denied may not be employed, contracted, |
or engaged in an exchange-related capacity during the time the |
revocation, suspension, or denial is in effect.
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Section 35. Reporting to the Director.
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(a) Each navigator shall report to the Director within 30 |
calendar days after the final disposition of a matter that |
violates the provisions set forth in this Act that results in |
any administrative action taken against him in another |
jurisdiction or by another governmental agency in this State. |
The report shall include a copy of the order, consent to order, |
or other relevant legal documents. |
(b) Within 30 days after the initial pretrial hearing date, |
a navigator shall report to the Director any criminal |
prosecution of the navigator of a matter that violates the |
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provisions set forth in this Act taken in any jurisdiction. The |
report shall include a copy of the initial complaint filed, the |
order resulting from the hearing, and any other relevant legal |
documents. |
(c) An entity that acts as a navigator that terminates the |
employment, engagement, affiliation, or other relationship |
with an individual navigator shall notify the Director within |
30 days following the effective date of the termination, using |
a format prescribed by the Director, if the reason for |
termination is one of the reasons set forth in this Act or the |
entity has knowledge the navigator was found by a court or |
government body to have engaged in any of the activities |
prohibited by this Act. Upon the written request of the |
Director, the entity shall provide additional information, |
documents, records, or other data pertaining to the termination |
or activity of the individual.
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Section 40. Certified application counselor. |
(a) A certified application counselor may not: |
(1) sell, solicit, or negotiate, as these terms are |
defined in Section 500-10 of the Illinois Insurance Code, |
any of the classes of insurance enumerated in Section 4 of |
the Illinois Insurance Code; |
(2) offer advice about which health plan is better or |
worse for a particular individual or employer; |
(3) recommend or endorse a particular health plan or |
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advise consumers about which plan to choose; |
(4) provide any information or services related to |
health benefit plans or other insurance products not |
offered in the exchange, except for health care providers |
when furnishing information or services related to a |
patient's existing health benefit plan or other existing |
health insurance coverage; or |
(5) accept any compensation or consideration, directly |
or indirectly, from any issuer of accident and health |
insurance or stop-loss insurance that is dependent, in |
whole or in part, on whether a person enrolls in or |
purchases a particular health benefit plan. |
(b) Items (1), (2), (3), (4) and (5) of subsection (a) of |
this Section do not apply to certified application counselors |
when assisting individuals with the enrollment process in the |
State Medicaid program or other public programs. |
(c) The Director shall develop education and certification |
requirements for certified application counselors by rule.
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Section 45. Other laws; rulemaking authority.
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(a) The requirements of this Act shall not apply to any |
individual or entity licensed as an insurance producer in this |
State. |
(b) Pursuant to the authority granted by this Act, the |
Director may adopt rules as may be necessary or appropriate for |
the administration and enforcement of this Act.
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