Illinois General Assembly - Full Text of SB1194
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Full Text of SB1194  98th General Assembly




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1    AN ACT concerning insurance.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 1. Short title. This Act may be cited as the
5Navigator Certification Act.
6    Section 5. Definitions. As used in this Act:
7    "Certified application counselor" has the same meaning as
8in federal regulations and guidelines.
9    "Director" means the Director of Insurance.
10    "Exchange" means any health benefit exchange established
11or operating in this State, including any exchange established
12or operated by the United States Department of Health and Human
14    "Navigator" means a person or entity selected to perform
15the activities and duties identified in 42 U.S.C. 18031(i) in
16this State. "Navigator" includes any person or entity who
17receives grant funds from the United States Department of
18Health and Human Services, the State of Illinois, or an
19exchange or private funds to perform any of the activities and
20duties identified in 42 U.S.C. 18031(i), including, but not
21limited to, in-person assisters as defined by federal
22regulations or guidelines.



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1    Section 10. Certificate required.
2    (a) No individual or entity shall perform, offer to
3perform, or advertise any service as a navigator in this State
4or receive navigator grant funding from the United States
5Department of Health and Human Services, the State of Illinois,
6or an exchange or private funds unless certified as a navigator
7by the Director under this Act.
8    (b) A navigator who complies with the requirements of this
9Act 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; or
13        (5) accept any compensation or consideration, directly
14    or indirectly, from any issuer of accident and health
15    insurance or stop-loss insurance that is dependent, in
16    whole or in part, on whether a person enrolls in or
17    purchases a particular private health benefit plan.
18    (d) Items (1), (2), (3), (4), and (5) of subsection (c) of
19this Section do not apply to navigators when assisting
20individuals with the enrollment process in the State Medicaid
21program or other public programs.
22    Section 15. Application for certificate.
23    (a) An entity or individual applying for a navigator
24certificate shall make application to the Director on a form
25developed by the Director and declare under penalty of refusal,



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1suspension, or revocation of the certificate that the
2statements made in the application are true, correct, and
3complete to the best of the individual's or entity's knowledge
4and belief. Before approving the application, the Director
5shall find that the individual:
6        (1) is at least 18 years of age;
7        (2) resides in this State or maintains his or her
8    principal place of business in this State;
9        (3) is not disqualified due to having committed any act
10    that would be grounds for denial, suspension, or revocation
11    of a navigator certification in accordance with Section 30
12    of this Act;
13        (4) has successfully completed the federal and State
14    training provided by the exchange or equivalent State
15    requirements as determined by the Department; and
16        (5) when applicable, has the written consent of the
17    Director pursuant to 18 U.S.C. 1033, or any successor
18    statute regulating crimes by or affecting persons engaged
19    in the business of insurance whose activities affect
20    interstate commerce.
21    (b) An entity that acts as a navigator, supervises the
22activities of individual navigators, or receives funding to
23perform such activities shall obtain a navigator entity
24certificate. An entity applying for a navigator entity
25certificate shall make application on a form containing the
26information prescribed by the Director and shall list the



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1individuals acting as navigators under the entity certificate.
2        (1) The entity shall designate a certified navigator
3    responsible for the navigator entity's compliance with the
4    laws of this State and the exchange.
5        (2) The entity, under penalty of revocation,
6    suspension, or other discipline prescribed by the
7    Director, shall certify that each individual completes the
8    mandatory training required by item (4) of subsection (a)
9    of Section 15 of this Act.
10    (c) The Director may require any documents deemed necessary
11to verify the information contained in an application submitted
12in accordance with subsections (a) and (b) of this Section.
13    (d) Entities certified as navigators shall provide the
14Director with a list of all individual navigators that it
15employs, supervises, or is affiliated with at renewal.
16    (e) The Director may require, in a manner determined by the
17Director, that each entity that acts as a navigator demonstrate
18a level of financial responsibility capable of protecting all
19persons against the wrongful acts, misrepresentations, or
20negligence of the navigator.
21    (f) Prior to any exchange becoming operational in this
22State, the Director, in coordination with the exchange, shall
23prescribe the initial training and continuing education
24requirements for navigators.
25    (g) Certificate holders must inform the Director, in
26writing, of a change of address within 30 days after the



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2    (h) In order to assist in the performance of the Director's
3duties, the Director may contract with the National Association
4of Insurance Commissioners (NAIC), or any affiliates or
5subsidiaries that the NAIC oversees, to perform any ministerial
6functions, including the collection of fees, related to
7certification that the Director and the nongovernmental entity
8may deem appropriate.
9    Section 20. Certificate renewal.
10    (a) An individual navigator entity certificate shall be
11valid for one year.
12    (b) A navigator may file an application for renewal of a
13certificate in a method prescribed by the Director. Any
14navigator who fails to timely file for certificate renewal
15shall be charged a late fee in an amount prescribed by the
17    (c) Prior to the filing date for application for renewal of
18a certificate, an individual navigator shall comply with
19ongoing training and continuing education requirements
20established by the Director. The navigator shall file with the
21Director, by a method prescribed by the Director, satisfactory
22certification of completion of the continuing education
23requirements. Any failure to fulfill the ongoing training and
24continuing education requirements shall result in the
25expiration of the certificate.



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1    Section 25. Navigator referrals. On contact with a person
2who acknowledges having existing health insurance coverage
3obtained through an insurance producer, a navigator shall refer
4the person back to that insurance producer for information,
5assistance, and any other services unless:
6        (1) the individual is eligible for but has not obtained
7    a federal premium subsidy and cost-sharing assistance
8    available only through an exchange;
9        (2) the insurance producer is not authorized to sell
10    health plans in an individual exchange; or
11        (3) the individual would prefer not to seek further
12    assistance from the individual's insurance producer.
13    Section 30. Certificate denial, nonrenewal, or revocation.
14    (a) The Director may place on probation, suspend, revoke,
15or refuse to issue or renew a navigator's certificate or may
16levy a civil penalty as established by rule.
17    (b) If an action by the Director is to nonrenew, suspend,
18or revoke a certificate or to deny an application for a
19certificate, then the Director shall notify the applicant or
20certificate holder and advise, in writing, the applicant or
21certificate holder of the reason for the suspension,
22revocation, or denial or nonrenewal of the applicant's or
23certificate holder's certificate. The applicant or certificate
24holder may make written demand upon the Director within 30 days



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1after the date of mailing for a hearing before the Director to
2determine the reasonableness of the Director's action. The
3hearing must be held within not fewer than 20 days nor more
4than 30 days after the mailing of the notice of hearing and
5shall be held pursuant to Part 2402 of Title 50 of the Illinois
6Administrative Code.
7    (c) A navigator entity certificate may be suspended,
8revoked, or refused or information turned over to the U.S.
9Department of Health and Human Services and applicable state
10agencies if the Director finds, after hearing, that a certified
11individual's violation was known or should have been known by
12one or more of the partners, officers, or managers acting on
13behalf of the navigator entity.
14    (d) In addition to or instead of any applicable denial,
15suspension, or revocation of a certificate, a person may, after
16hearing, be subject to a civil penalty in accordance with
17emergency rules issued by the Director.
18    (e) The Director has the authority to enforce the
19provisions of and impose any penalty or remedy authorized by
20this Act against any person who is under investigation of or
21charged with a violation of this Act or rules, even if the
22person's certificate has been surrendered or has lapsed by
23operation of law.
24    (f) Upon the suspension, denial, or revocation of a
25certificate, the certificate holder or other person having
26possession or custody of the certificate shall promptly deliver



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1it to the Director in person or by mail. The Director shall
2publish all suspensions, denials, or revocations after the
3suspensions, denials, or revocations become final in a manner
4designed to notify the public.
5    (g) A person whose certificate is revoked or whose
6application is denied pursuant to this Section is ineligible to
7apply for any certificate for 3 years after the revocation or
8denial. A person whose certificate as a navigator has been
9revoked, suspended, or denied may not be employed, contracted,
10or engaged in an exchange-related capacity during the time the
11revocation, suspension, or denial is in effect.
12    Section 35. Reporting to the Director.
13    (a) Each navigator shall report to the Director within 30
14calendar days after the final disposition of a matter that
15violates the provisions set forth in this Act that results in
16any administrative action taken against him in another
17jurisdiction or by another governmental agency in this State.
18The report shall include a copy of the order, consent to order,
19or other relevant legal documents.
20    (b) Within 30 days after the initial pretrial hearing date,
21a navigator shall report to the Director any criminal
22prosecution of the navigator of a matter that violates the
23provisions set forth in this Act taken in any jurisdiction. The
24report shall include a copy of the initial complaint filed, the
25order resulting from the hearing, and any other relevant legal



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2    (c) An entity that acts as a navigator that terminates the
3employment, engagement, affiliation, or other relationship
4with an individual navigator shall notify the Director within
530 days following the effective date of the termination, using
6a format prescribed by the Director, if the reason for
7termination is one of the reasons set forth in this Act or the
8entity has knowledge the navigator was found by a court or
9government body to have engaged in any of the activities
10prohibited by this Act. Upon the written request of the
11Director, the entity shall provide additional information,
12documents, records, or other data pertaining to the termination
13or activity of the individual.
14    Section 40. Certified application counselor.
15    (a) A certified application counselor may not:
16        (1) sell, solicit, or negotiate, as these terms are
17    defined in Section 500-10 of the Illinois Insurance Code,
18    any of the classes of insurance enumerated in Section 4 of
19    the Illinois Insurance Code;
20        (2) offer advice about which health plan is better or
21    worse for a particular individual or employer;
22        (3) recommend or endorse a particular health plan or
23    advise consumers about which plan to choose;
24        (4) provide any information or services related to
25    health benefit plans or other insurance products not



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1    offered in the exchange; or
2        (5) accept any compensation or consideration, directly
3    or indirectly, from any issuer of accident and health
4    insurance or stop-loss insurance that is dependent, in
5    whole or in part, on whether a person enrolls in or
6    purchases a particular health benefit plan.
7    (b) Items (1), (2), (3), (4) and (5) of subsection (a) of
8this Section do not apply to certified application counselors
9when assisting individuals with the enrollment process in the
10State Medicaid program or other public programs.
11    (c) The Director shall develop education and certification
12requirements for certified application counselors by rule.
13    Section 45. Other laws; rulemaking authority.
14    (a) The requirements of this Act shall not apply to any
15individual or entity licensed as an insurance producer in this
17    (b) Pursuant to the authority granted by this Act, the
18Director may adopt rules as may be necessary or appropriate for
19the administration and enforcement of this Act.
20    Section 97. Severability. The provisions of this Act are
21severable under Section 1.31 of the Statute on Statutes.
22    Section 99. Effective date. This Act takes effect upon
23becoming law.