Full Text of SB1194 98th General Assembly
SB1194enr 98TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning insurance.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 1. Short title. This Act may be cited as the | 5 | | Navigator Certification Act. | 6 | | Section 5. Definitions.
As used in this Act: | 7 | | "Certified application counselor" has the same meaning as | 8 | | in federal regulations and guidelines. | 9 | | "Director" means the Director of Insurance. | 10 | | "Exchange" means any health benefit exchange established | 11 | | or operating in this State, including any exchange established | 12 | | or operated by the United States Department of Health and Human | 13 | | Services. | 14 | | "Navigator" means a person or entity selected to perform | 15 | | the activities and duties identified in 42 U.S.C. 18031(i) in | 16 | | this State. "Navigator" includes any person or entity who | 17 | | receives grant funds from the United States Department of | 18 | | Health and Human Services, the State of Illinois, or an | 19 | | exchange or private funds to perform any of the activities and | 20 | | duties identified in 42 U.S.C. 18031(i), including, but not | 21 | | limited to, in-person assisters as defined by federal | 22 | | regulations or guidelines.
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| 1 | | Section 10. Certificate required.
| 2 | | (a) No individual or entity shall perform, offer to | 3 | | perform, or advertise any service as a navigator in this State | 4 | | or receive navigator grant funding from the United States | 5 | | Department of Health and Human Services, the State of Illinois, | 6 | | or an exchange or private funds unless certified as a navigator | 7 | | by the Director under this Act. | 8 | | (b) A navigator who complies with the requirements of this | 9 | | Act
shall do the following: | 10 | | (1) conduct public education activities to raise | 11 | | awareness of the availability of qualified health plans; | 12 | | (2) distribute fair and impartial information | 13 | | concerning enrollment in qualified health plans offered | 14 | | within the exchange and the availability of the premium tax | 15 | | credits under Section 36B of the Internal Revenue Code of | 16 | | 1986, 26 U.S.C. 36B, and cost-sharing reductions under | 17 | | Section 1402 of the federal Patient Protection and | 18 | | Affordable Care Act; | 19 | | (3) facilitate enrollment in qualified health plans; | 20 | | (4) provide referrals to appropriate federal and State | 21 | | agencies for any enrollee with a grievance, complaint, or | 22 | | question regarding their health plan or coverage or a | 23 | | determination under such plan or coverage; | 24 | | (5) provide information in a manner that is culturally | 25 | | and linguistically appropriate to the needs of the | 26 | | population being served by the exchange. |
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| 1 | | (c) A navigator may not: | 2 | | (1) sell, solicit, or negotiate, as these terms are | 3 | | defined in Section 500-10 of the Illinois Insurance Code, | 4 | | any of the classes of insurance enumerated in Section 4 of | 5 | | the Illinois Insurance Code; | 6 | | (2) offer advice about which health plan is better or | 7 | | worse for a particular individual or employer; | 8 | | (3) recommend or endorse a particular health plan or | 9 | | advise consumers about which health plan to choose; | 10 | | (4) provide any information or services related to | 11 | | health benefit plans or other insurance products not | 12 | | offered in the exchange, except for health care providers | 13 | | when furnishing information or services related to a | 14 | | patient's existing health benefit plan or other existing | 15 | | health insurance coverage; or | 16 | | (5) accept any compensation or consideration, directly | 17 | | or indirectly, from any issuer of accident and health | 18 | | insurance or stop-loss insurance that is dependent, in | 19 | | whole or in part, on whether a person enrolls in or | 20 | | purchases a particular private health benefit plan. | 21 | | (d) Items (1), (2), (3), (4), and (5) of subsection (c) of | 22 | | this Section do not apply to navigators when assisting | 23 | | individuals with the enrollment process in the State Medicaid | 24 | | program or other public programs. | 25 | | Section 15. Application for certificate.
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| 1 | | (a) An entity or individual applying for a navigator | 2 | | certificate shall make application to the Director on a form | 3 | | developed by the Director and declare under penalty of refusal, | 4 | | suspension, or revocation of the certificate that the | 5 | | statements made in the application are true, correct, and | 6 | | complete to the best of the individual's or entity's knowledge | 7 | | and belief. Before approving the application, the Director | 8 | | shall find that the individual: | 9 | | (1) is at least 18 years of age; | 10 | | (2) resides in this State or maintains his or her | 11 | | principal place of business in this State; | 12 | | (3) is not disqualified due to having committed any act | 13 | | that would be grounds for denial, suspension, or revocation | 14 | | of a navigator certification in accordance with Section 30 | 15 | | of this Act; | 16 | | (4) has successfully completed the federal and State | 17 | | training provided by the exchange or equivalent State | 18 | | requirements as determined by the Department; and | 19 | | (5) when applicable, has the written consent of the | 20 | | Director pursuant to 18 U.S.C. 1033, or any successor | 21 | | statute regulating crimes by or affecting persons engaged | 22 | | in the business of insurance whose activities affect | 23 | | interstate commerce. | 24 | | (b) An entity that acts as a navigator, supervises the | 25 | | activities of individual navigators, or receives funding to | 26 | | perform such activities shall obtain a navigator entity |
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| 1 | | certificate. An entity applying for a navigator entity | 2 | | certificate shall make application on a form containing the | 3 | | information prescribed by the Director and shall list the | 4 | | individuals acting as navigators under the entity certificate. | 5 | | (1) The entity shall designate a certified navigator | 6 | | responsible for the navigator entity's compliance with the | 7 | | laws of this State and the exchange. | 8 | | (2) The entity, under penalty of revocation, | 9 | | suspension, or other discipline prescribed by the | 10 | | Director, shall certify that each individual completes the | 11 | | mandatory training required by item (4) of subsection (a) | 12 | | of Section 15 of this Act. | 13 | | (c) The Director may require any documents deemed necessary | 14 | | to verify the information contained in an application submitted | 15 | | in accordance with subsections (a) and (b) of this Section. | 16 | | (d) Entities certified as navigators shall provide the | 17 | | Director with a list of all individual navigators that it | 18 | | employs, supervises, or is affiliated with at renewal. | 19 | | (e) The Director may require, in a manner determined by the | 20 | | Director, that each entity that acts as a navigator demonstrate | 21 | | a level of financial responsibility capable of protecting all | 22 | | persons against the wrongful acts, misrepresentations, or | 23 | | negligence of the navigator. | 24 | | (f) Prior to any exchange becoming operational in this | 25 | | State, the Director, in coordination with the exchange, shall | 26 | | prescribe the initial training and continuing education |
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| 1 | | requirements for navigators.
| 2 | | (g) Certificate holders must inform the Director, in | 3 | | writing, of a change of address within 30 days after the | 4 | | change. | 5 | | (h) In order to assist in the performance of the Director's | 6 | | duties, the Director may contract with the National Association | 7 | | of Insurance Commissioners (NAIC), or any affiliates or | 8 | | subsidiaries that the NAIC oversees, to perform any ministerial | 9 | | functions, including the collection of fees, related to | 10 | | certification that the Director and the nongovernmental entity | 11 | | may deem appropriate. | 12 | | Section 20. Certificate renewal.
| 13 | | (a) An individual navigator entity certificate shall be | 14 | | valid for one year. | 15 | | (b) A navigator may file an application for renewal of a | 16 | | certificate in a method prescribed by the Director. Any | 17 | | navigator who fails to timely file for certificate renewal | 18 | | shall be charged a late fee in an amount prescribed by the | 19 | | Director. | 20 | | (c) Prior to the filing date for application for renewal of | 21 | | a certificate, an individual navigator shall comply with | 22 | | ongoing training and continuing education requirements | 23 | | established by the Director. The navigator shall file with the | 24 | | Director, by a method prescribed by the Director, satisfactory | 25 | | certification of completion of the continuing education |
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| 1 | | requirements. Any failure to fulfill the ongoing training and | 2 | | continuing education requirements shall result in the | 3 | | expiration of the certificate.
| 4 | | Section 25. Navigator referrals.
On contact with a person | 5 | | who acknowledges having existing health insurance coverage | 6 | | obtained through an insurance producer, a navigator shall refer | 7 | | the person back to that insurance producer for information, | 8 | | assistance, and any other services unless: | 9 | | (1) the individual is eligible for but has not obtained | 10 | | a federal premium subsidy and cost-sharing assistance | 11 | | available only through an exchange; | 12 | | (2) the insurance producer is not authorized to sell | 13 | | health plans in an individual exchange; or | 14 | | (3) the individual would prefer not to seek further | 15 | | assistance from the individual's insurance producer. | 16 | | Section 30. Certificate denial, nonrenewal, or revocation.
| 17 | | (a) The Director may place on probation, suspend, revoke, | 18 | | or refuse to issue or renew a navigator's certificate or may | 19 | | levy a civil penalty as established by rule. | 20 | | (b) If an action by the Director is to nonrenew, suspend, | 21 | | or revoke a certificate or to deny an application for a | 22 | | certificate, then the Director shall notify the applicant or | 23 | | certificate holder and advise, in writing, the applicant or | 24 | | certificate holder of the reason for the suspension, |
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| 1 | | revocation, or denial or nonrenewal of the applicant's or | 2 | | certificate holder's certificate. The applicant or certificate | 3 | | holder may make written demand upon the Director within 30 days | 4 | | after the date of mailing for a hearing before the Director to | 5 | | determine the reasonableness of the Director's action. The | 6 | | hearing must be held within not fewer than 20 days nor more | 7 | | than 30 days after the mailing of the notice of hearing and | 8 | | shall be held pursuant to Part 2402 of Title 50 of the Illinois | 9 | | Administrative Code. | 10 | | (c) A navigator entity certificate may be suspended, | 11 | | revoked, or refused or information turned over to the U.S. | 12 | | Department of Health and Human Services and applicable state | 13 | | agencies if the Director finds, after hearing, that a certified | 14 | | individual's violation was known or should have been known by | 15 | | one or more of the partners, officers, or managers acting on | 16 | | behalf of the navigator entity. | 17 | | (d) In addition to or instead of any applicable denial, | 18 | | suspension, or revocation of a certificate, a person may, after | 19 | | hearing, be subject to a civil penalty in accordance with | 20 | | emergency rules issued by the Director. | 21 | | (e) The Director has the authority to enforce the | 22 | | provisions of and impose any penalty or remedy authorized by | 23 | | this Act against any person who is under investigation of or | 24 | | charged with a violation of this Act or rules, even if the | 25 | | person's certificate has been surrendered or has lapsed by | 26 | | operation of law. |
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| 1 | | (f) Upon the suspension, denial, or revocation of a | 2 | | certificate, the certificate holder or other person having | 3 | | possession or custody of the certificate shall promptly deliver | 4 | | it to the Director in person or by mail. The Director shall | 5 | | publish all suspensions, denials, or revocations after the | 6 | | suspensions, denials, or revocations become final in a manner | 7 | | designed to notify the public. | 8 | | (g) A person whose certificate is revoked or whose | 9 | | application is denied pursuant to this Section is ineligible to | 10 | | apply for any certificate for 3 years after the revocation or | 11 | | denial. A person whose certificate as a navigator has been | 12 | | revoked, suspended, or denied may not be employed, contracted, | 13 | | or engaged in an exchange-related capacity during the time the | 14 | | revocation, suspension, or denial is in effect. | 15 | | Section 35. Reporting to the Director.
| 16 | | (a) Each navigator shall report to the Director within 30 | 17 | | calendar days after the final disposition of a matter that | 18 | | violates the provisions set forth in this Act that results in | 19 | | any administrative action taken against him in another | 20 | | jurisdiction or by another governmental agency in this State. | 21 | | The report shall include a copy of the order, consent to order, | 22 | | or other relevant legal documents. | 23 | | (b) Within 30 days after the initial pretrial hearing date, | 24 | | a navigator shall report to the Director any criminal | 25 | | prosecution of the navigator of a matter that violates the |
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| 1 | | provisions set forth in this Act taken in any jurisdiction. The | 2 | | report shall include a copy of the initial complaint filed, the | 3 | | order resulting from the hearing, and any other relevant legal | 4 | | documents. | 5 | | (c) An entity that acts as a navigator that terminates the | 6 | | employment, engagement, affiliation, or other relationship | 7 | | with an individual navigator shall notify the Director within | 8 | | 30 days following the effective date of the termination, using | 9 | | a format prescribed by the Director, if the reason for | 10 | | termination is one of the reasons set forth in this Act or the | 11 | | entity has knowledge the navigator was found by a court or | 12 | | government body to have engaged in any of the activities | 13 | | prohibited by this Act. Upon the written request of the | 14 | | Director, the entity shall provide additional information, | 15 | | documents, records, or other data pertaining to the termination | 16 | | or activity of the individual.
| 17 | | Section 40. Certified application counselor. | 18 | | (a) A certified application counselor may not: | 19 | | (1) sell, solicit, or negotiate, as these terms are | 20 | | defined in Section 500-10 of the Illinois Insurance Code, | 21 | | any of the classes of insurance enumerated in Section 4 of | 22 | | the Illinois Insurance Code; | 23 | | (2) offer advice about which health plan is better or | 24 | | worse for a particular individual or employer; | 25 | | (3) recommend or endorse a particular health plan or |
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| 1 | | advise consumers about which plan to choose; | 2 | | (4) provide any information or services related to | 3 | | health benefit plans or other insurance products not | 4 | | offered in the exchange, except for health care providers | 5 | | when furnishing information or services related to a | 6 | | patient's existing health benefit plan or other existing | 7 | | health insurance coverage; or | 8 | | (5) accept any compensation or consideration, directly | 9 | | or indirectly, from any issuer of accident and health | 10 | | insurance or stop-loss insurance that is dependent, in | 11 | | whole or in part, on whether a person enrolls in or | 12 | | purchases a particular health benefit plan. | 13 | | (b) Items (1), (2), (3), (4) and (5) of subsection (a) of | 14 | | this Section do not apply to certified application counselors | 15 | | when assisting individuals with the enrollment process in the | 16 | | State Medicaid program or other public programs. | 17 | | (c) The Director shall develop education and certification | 18 | | requirements for certified application counselors by rule. | 19 | | Section 45. Other laws; rulemaking authority.
| 20 | | (a) The requirements of this Act shall not apply to any | 21 | | individual or entity licensed as an insurance producer in this | 22 | | State. | 23 | | (b) Pursuant to the authority granted by this Act, the | 24 | | Director may adopt rules as may be necessary or appropriate for | 25 | | the administration and enforcement of this Act.
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| 1 | | Section 97. Severability. The provisions of this Act are | 2 | | severable under Section 1.31 of the Statute on Statutes.
| 3 | | Section 99. Effective date. This Act takes effect upon | 4 | | becoming law. |
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