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


Sen. William R. Haine

Filed: 4/15/2013





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2    AMENDMENT NO. ______. Amend Senate Bill 1194 by replacing
3everything after the enacting clause with the following:
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    "Director" means the Director of Insurance.
8    "Exchange" means any health benefit exchange established
9or operating in this State, including any exchange established
10or operated by the United States Department of Health and Human
12    "Navigator" means a person or entity selected to perform
13the activities and duties identified in 42 U.S.C. 18031(i) in
14this State. "Navigator" includes any person or entity who
15receives grant funds from the United States Department of
16Health and Human Services, the State of Illinois, or an



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1exchange or private funds to perform any of the activities and
2duties identified in 42 U.S.C. 18031(i), including, but not
3limited to, in-person assisters and application counselors.
4    Section 10. Certificate required.
5    (a) No individual or entity shall perform, offer to
6perform, or advertise any service as a navigator in this State
7or receive navigator grant funding from the United States
8Department of Health and Human Services, the State of Illinois,
9or an exchange or private funds unless certified as a navigator
10by the Director under this Act.
11    (b) A navigator who complies with the requirements of this
12Act may do any of the following:
13        (1) conduct public education activities to raise
14    awareness of the availability of qualified health plans;
15        (2) distribute fair and impartial information
16    concerning enrollment in all qualified health plans
17    offered within the exchange and the availability of the
18    premium tax credits under Section 36B of the Internal
19    Revenue Code of 1986, 26 U.S.C. 36B, and cost-sharing
20    reductions under Section 1402 of the federal Patient
21    Protection and Affordable Care Act;
22        (3) facilitate enrollment in qualified health plans,
23    without suggesting that an individual select a particular
24    plan;
25        (4) provide referrals to appropriate federal and State



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1    agencies for any enrollee with a grievance, complaint, or
2    question regarding their health plan or coverage or a
3    determination under such plan or coverage;
4        (5) provide information in a manner that is culturally
5    and linguistically appropriate to the needs of the
6    population being served by the exchange.
7    (c) A navigator may not:
8        (1) engage in any activities that would require an
9    insurance producer license;
10        (2) provide advice concerning the substantive
11    benefits, terms, and conditions of a particular health plan
12    or offer advice about which health plan is better or worse
13    for a particular individual or employer;
14        (3) recommend or endorse a particular health plan or
15    advise consumers about which health plan to choose;
16        (4) provide any information or services related to
17    health benefit plans or other products not offered in the
18    exchange; or
19        (5) accept any compensation or consideration that is
20    dependent, in whole or in part, on whether a person enrolls
21    in or purchases a private health benefit plan.
22    (d) Items (2), (3), and (4) of subsection (c) of this
23Section do not apply to navigators who enroll individuals in
24the State Medicaid program or other public programs.
25    (e) Only a person licensed as an insurance producer in this
26State may:



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1        (1) sell, solicit, or negotiate health insurance;
2        (2) provide advice concerning the substantive
3    benefits, terms, and conditions of a particular health plan
4    or offer advice about which health plan is better or worse
5    for a particular individual or employer; or
6        (3) recommend a particular health plan or advise
7    consumers about which health plan to choose.
8    Section 15. Application for certificate.
9    (a) An entity or individual applying for a navigator
10certificate shall make application to the Director on a form
11developed by the Director and declare under penalty of refusal,
12suspension, or revocation of the certificate that the
13statements made in the application are true, correct, and
14complete to the best of the individual's knowledge and belief.
15Before approving the application, the Director shall find that
16the individual:
17        (1) is at least 18 years of age;
18        (2) resides in this State or maintains his or her
19    principal place of business in this State;
20        (3) is not disqualified due to having committed any act
21    that would be grounds for denial, suspension, or revocation
22    of a navigator certification in accordance with Section 30
23    of this Act;
24        (4) has successfully completed the federal and State
25    training provided by the Exchange or equivalent State



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1    requirements as determined by the Department; and
2        (5) when applicable, has the written consent of the
3    Director pursuant to 18 U.S.C. 1033, or any successor
4    statute regulating crimes by or affecting persons engaged
5    in the business of insurance whose activities affect
6    interstate commerce.
7    (b) An entity that acts as a navigator, supervises the
8activities of individual navigators, or receives funding to
9perform such activities shall obtain a navigator entity
10certificate. An entity applying for a navigator entity
11certificate shall make application on a form containing the
12information prescribed by the Director and shall list the
13individuals acting as navigators under the entity certificate.
14        (1) The entity shall designate a certified navigator
15    responsible for the business entity's compliance with the
16    laws of this State and the Exchange.
17        (2) The entity, under penalty of revocation,
18    suspension, or other discipline prescribed by the
19    Director, shall certify that each individual completes the
20    mandatory training required by item (4) of subsection (a)
21    of Section 15 of this Act.
22    (c) The Director may require any documents deemed necessary
23to verify the information contained in an application submitted
24in accordance with subsections (a) and (b) of this Section.
25    (d) Entities certified as navigators shall provide the
26Director with a list of all individual navigators that it



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1employs, supervises, or is affiliated with at renewal.
2    (e) The Director may require, in a manner determined by the
3Director, that each entity that acts as a navigator demonstrate
4a level of financial responsibility capable of protecting all
5persons against the wrongful acts, misrepresentations, or
6negligence of the navigator.
7    (f) Prior to any exchange becoming operational in this
8State, the Director, in coordination with the exchange, shall
9prescribe the initial training and continuing education
10requirements for navigators.
11    (g) Certificate holders must inform the Director, in
12writing, of a change of address within 340 days after the
14    (h) In order to assist in the performance of the Director's
15duties, the Director may contract with the National Association
16of Insurance Commissioners (NAIC), or any affiliates or
17subsidiaries that the NAIC oversees, to perform any ministerial
18functions, including the collection of fees, related to
19certification that the Director and the nongovernmental entity
20may deem appropriate.
21    Section 20. Certificate renewal.
22    (a) An individual navigator and entity certificate shall be
23valid for one year.
24    (b) A navigator may file an application for renewal of a
25certificate in a method prescribed by the Director. Any



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1navigator who fails to timely file for certificate renewal
2shall be charged a late fee in an amount prescribed by the
4    (c) Prior to the filing date for application for renewal of
5a certificate, an individual navigator shall comply with
6ongoing training and continuing education requirements
7established by the Director. The navigator shall file with the
8Director, by a method prescribed by the Director, satisfactory
9certification of completion of the continuing education
10requirements. Any failure to fulfill the ongoing training and
11continuing education requirements shall result in the
12expiration of the certificate.
13    Section 25. Navigator referrals. On contact with a person
14who acknowledges having existing health insurance coverage
15obtained through an insurance producer, a navigator shall refer
16the person back to that insurance producer for information,
17assistance, and any other services unless:
18        (1) the individual is eligible for but has not obtained
19    a federal premium subsidy and cost-sharing assistance
20    available only through an exchange;
21        (2) the insurance producer is not authorized to sell
22    health plans in an individual exchange; or
23        (3) the individual would prefer not to seek further
24    assistance from the individual's insurance producer.



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1    Section 30. License denial, nonrenewal, or revocation.
2    (a) The Director may place on probation, suspend, revoke,
3or refuse to issue or renew a marketplace navigator's
4certificate or may levy civil penalty as established by
5emergency rule.
6    (b) If an action by the Director is to nonrenew, suspend,
7or revoke a certificate or to deny an application for a
8certificate, then the Director shall notify the applicant or
9certificate holder and advise, in writing, the applicant or
10certificate holder of the reason for the suspension,
11revocation, or denial or nonrenewal of the applicant's or
12certificate holder's certificate. The applicant or certificate
13holder may make written demand upon the Director within 30 days
14after the date of mailing for a hearing before the Director to
15determine the reasonableness of the Director's action. The
16hearing must be held within not fewer than 20 days nor more
17than 30 days after the mailing of the notice of hearing and
18shall be held pursuant to Part 2402 of Title 50 of the Illinois
19Administrative Code.
20    (c) A marketplace entity license may be suspended, revoked,
21or refused or information turned over to the U.S. Department of
22Health and Human Services and applicable state agencies if the
23Director finds, after hearing, that an individual licensee's
24violation was known or should have been known by one or more of
25the partners, officers, or managers acting on behalf of the



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1marketplace navigator entity.
2    (d) In addition to or instead of any applicable denial,
3suspension, or revocation of a certificate, a person may, after
4hearing, be subject to a civil penalty in accordance with
5emergency rules issued by the Director.
6    (e) The Director has the authority to enforce the
7provisions of and impose any penalty or remedy authorized by
8this Act against any person who is under investigation of or
9charged with a violation of this Act or rules even if the
10person's certificate has been surrendered or has lapsed by
11operation of law.
12    (f) Upon the suspension, denial, or revocation of a
13certificate, the certificate holder or other person having
14possession or custody of the certificate shall promptly deliver
15it to the Director in person or by mail. The Director shall
16publish all suspensions, denials, or revocations after the
17suspensions, denials, or revocations become final in a manner
18designed to notify the public.
19    (g) A person whose certificate is revoked or whose
20application is denied pursuant to this Section is ineligible to
21apply for any license for 3 years after the revocation or
22denial. A person whose certificate as a marketplace navigator
23has been revoked, suspended, or denied may not be employed,
24contracted, or engaged in an Exchange-related capacity during
25the time the revocation, suspension, or denial is in effect.



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1    Section 35. Reporting to the Director.
2    (a) Each navigator shall report to the Director within 30
3calendar days after the final disposition of a matter that
4violates the provisions set forth in this Act that results in
5any administrative action taken against him in another
6jurisdiction or by another governmental agency in this State.
7The report shall include a copy of the order, consent to order,
8or other relevant legal documents.
9    (b) Within 30 days after the initial pretrial hearing date,
10a navigator shall report to the Director any criminal
11prosecution of the navigator of a matter that violates the
12provisions set forth in this Act taken in any jurisdiction. The
13report shall include a copy of the initial complaint filed, the
14order resulting from the hearing, and any other relevant legal
16    (c) An entity that acts as a navigator that terminates the
17employment, engagement, affiliation, or other relationship
18with an individual navigator shall notify the Director within
1930 days following the effective date of the termination, using
20a format prescribed by the Director, if the reason for
21termination is one of the reasons set forth in this Act or the
22entity has knowledge the navigator was found by a court or
23government body to have engaged in any of the activities
24prohibited by this Act. Upon the written request of the
25Director, the entity shall provide additional information,
26documents, records, or other data pertaining to the termination



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1or activity of the individual.
2    Section 40. Hospitals; hospital affiliates; All Kids
3Application Agents.
4    (a) The requirements of this Act shall not apply to
5hospitals or hospital affiliates or any entity or medical
6provider enrolled with the Department of Healthcare and Family
7Services as an All Kids Application Agent (AKAA), that do not
8actively recruit enrollees in the Illinois Health Benefits
9Exchange, with regard to assisting uninsured individuals
10seeking medical care in understanding the process for enrolling
11in the Illinois Healthcare Marketplace.
12    (b) The Director may by rule establish registration and
13training requirements applicable to hospitals or hospital
14affiliates or any AKAA that desire to assist uninsured
15individuals that seek medical care to understand the process
16for enrolling in the Illinois Health Benefits Exchange.
17    (c) No hospitals or hospital affiliates or any AKAA that
18assists uninsured individuals that seek medical care may:
19        (1) sell, solicit, or negotiate health insurance;
20        (2) provide advice concerning the substantive
21    benefits, terms, and conditions of a particular health plan
22    or offer advice about which health plan is better or worse
23    for a particular individual or employer;
24        (3) recommend or endorse a particular health plan or
25    advise consumers about which health plan to choose; or



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1        (4) provide any information or services to uninsured
2    individuals related to the purchase of health benefit plans
3    or other products not offered in the exchange.
4    (d) Nothing in this Section shall prohibit hospitals or
5hospital affiliates or any AKAA from informing patients in
6non-emergency situations about the provider's participation in
7particular networks or plans in order to ensure that patients
8can understand their payment responsibilities relating to
9copayments, coinsurance, or deductibles.
10    (e) Nothing in this Section shall prohibit hospitals or
11hospital affiliates or any AKAA, otherwise authorized by the
12Department of Healthcare and Family Services to enroll
13individuals into Medicaid, from continuing that practice in the
14absence of rules required by this Section.
15    (f) Nothing in this Section authorizes the Director to make
16determinations or adopt rules relating to the ability for
17hospitals or hospital affiliates or any AKAA to enroll
18individuals in Medicaid if those entities have otherwise been
19authorized by the Department of Healthcare and Family Services
20to enroll individuals into Medicaid.
21    Section 45. Other laws; rulemaking authority.
22    (a) The requirements of this Act shall not apply to any
23individual or entity licensed as an insurance producer in this
25    (b) Pursuant to the authority granted by this Act, the



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1Director may adopt rules as may be necessary or appropriate for
2the administration and enforcement of this Act.
3    Section 97. Severability. The provisions of this Act are
4severable under Section 1.31 of the Statute on Statutes.
5    Section 99. Effective date. This Act takes effect upon
6becoming law.".