Bill Text: IL SB3161 | 2019-2020 | 101st General Assembly | Introduced

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Bill Title: Amends the Navigator Certification Act. Provides that certified application counselors are subject to the same certification requirements as navigators. Provides that navigators or certified application counselors may not engage in any unfair method of competition or any fraudulent, deceptive, or dishonest act or practice related to the health insurance marketplace or to that individual's or entity's absence of a conflict of interest in connection with the enrollment of any individuals or employees in a particular private health benefit plan. Provides that a navigator or certified application counselor who fails to timely file for certificate renewal shall be charged a late fee in an amount prescribed by the Director of Insurance. Replaces provisions concerning criteria and requirements for entities or individuals applying for a navigator certificate with language allowing the Director of Insurance to establish certification terms and requirements for completed applications and exemptions from certification by rule for navigator or certified application counselor certificates. Revises the meaning of the terms "certified application counselor" and "navigator". Makes other changes. Effective immediately.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2021-01-13 - Session Sine Die [SB3161 Detail]

Download: Illinois-2019-SB3161-Introduced.html

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101ST GENERAL ASSEMBLY State of Illinois 2019 and 2020 SB3161 Introduced 2/7/2020, by Sen. Ann Gillespie SYNOPSIS AS INTRODUCED:
215 ILCS 121/5
215 ILCS 121/10
215 ILCS 121/15
215 ILCS 121/30
215 ILCS 121/35
215 ILCS 121/45
215 ILCS 121/20 rep.
215 ILCS 121/25 rep.
215 ILCS 121/40 rep.
Amends the Navigator Certification Act. Provides that certified application counselors are subject to the same certification requirements as navigators. Provides that navigators or certified application counselors may not engage in any unfair method of competition or any fraudulent, deceptive, or dishonest act or practice related to the health insurance marketplace or to that individual's or entity's absence of a conflict of interest in connection with the enrollment of any individuals or employees in a particular private health benefit plan. Provides that a navigator or certified application counselor who fails to timely file for certificate renewal shall be charged a late fee in an amount prescribed by the Director of Insurance. Replaces provisions concerning criteria and requirements for entities or individuals applying for a navigator certificate with language allowing the Director of Insurance to establish certification terms and requirements for completed applications and exemptions from certification by rule for navigator or certified application counselor certificates. Revises the meaning of the terms "certified application counselor" and "navigator". Makes other changes. Effective immediately.
LRB101 16275 BMS 66182 b
FISCAL NOTE ACT MAY APPLY
A BILL FOR
SB3161 LRB101 16275 BMS 66182 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Navigator Certification Act is amended by
changing Sections 5, 10, 15, 30, 35, and 45 as follows:
(215 ILCS 121/5)
Sec. 5. Definitions. As used in this Act:
"Certified application counselor" has the same meaning as
in federal regulations and guidelines, including 45 CFR
155.225.
"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

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regulations or guidelines.
(Source: P.A. 98-524, eff. 8-23-13.)
(215 ILCS 121/10)
Sec. 10. Certificate required.
(a) No individual or entity shall perform, offer to
perform, or advertise any service as a navigator or certified
application counselor 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 or certified application
counselor by the Director under this Act.
(b) The Director may establish exemptions from
certification by rule. 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

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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.
(c) A navigator or 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
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; or .

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(6) engage in an unfair method of competition or a
fraudulent, deceptive, or dishonest act or practice with
respect to the health insurance marketplace or with respect
to that individual's or entity's absence of a conflict of
interest in connection with the enrollment of an individual
or employee in 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 or certified
application counselors when assisting individuals with the
enrollment process in the State Medicaid program or other
public programs.
(Source: P.A. 98-524, eff. 8-23-13.)
(215 ILCS 121/15)
Sec. 15. Application for certificate.
(a) An entity or individual applying for an initial or
renewal a navigator or certified application counselor
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

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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) The Director shall establish certification terms and
requirements for completed applications, including educational
requirements, by rule. 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 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.

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(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) Any navigator or certified application counselor who
fails to timely file for certificate renewal shall be charged a
late fee in an amount prescribed by the Director 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 or
certified application counselor demonstrate a level of
financial responsibility capable of protecting all persons
against the wrongful acts, misrepresentations, or negligence
of the navigator or certified application counselor.
(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
requirements for navigators and certified application
counselors.
(g) Certificate holders must inform the Director, in

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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.
(Source: P.A. 98-524, eff. 8-23-13.)
(215 ILCS 121/30)
Sec. 30. Certificate denial, nonrenewal, or revocation.
(a) The Director may place on probation, suspend, revoke,
or refuse to issue or renew a navigator or certified
application counselor 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,
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

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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 or certified application counselor 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.
(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

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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 or certified
application counselor 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.
(Source: P.A. 98-524, eff. 8-23-13.)
(215 ILCS 121/35)
Sec. 35. Reporting to the Director.
(a) Each navigator or certified application counselor
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 the navigator or certified application counselor
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 or certified application counselor shall report to

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the Director any criminal prosecution of the navigator or
certified application counselor of a matter that violates the
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 is certified acts as a navigator or
certified application counselor that terminates the
employment, engagement, affiliation, or other relationship
with an individual navigator or certified application
counselor 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
related to the requirements or standards one of the reasons set
forth in this Act or the rules adopted by the Director pursuant
to this Act, or the entity has knowledge the navigator or
certified application counselor was found by a court or
government body to have engaged in any of the activities
prohibited by this Act or the rules adopted by the Director
pursuant to 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.
(Source: P.A. 98-524, eff. 8-23-13.)
(215 ILCS 121/45)

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Sec. 45. Other laws; rulemaking authority.
(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. Such rules may
not conflict with or prevent the application of the provisions
of Title I of the Patient Protection and Affordable Care Act or
the federal regulations promulgated under such provisions.
(Source: P.A. 98-524, eff. 8-23-13.)
(215 ILCS 121/20 rep.)
(215 ILCS 121/25 rep.)
(215 ILCS 121/40 rep.)
Section 10. The Navigator Certification Act is amended by
repealing Sections 20, 25, and 40.
Section 99. Effective date. This Act takes effect upon
becoming law.