Public Act 098-0524
 
SB1194 EnrolledLRB098 03986 RPM 37333 b

    AN ACT concerning insurance.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 1. Short title. This Act may be cited as the
Navigator Certification Act.
 
    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.
 
    Section 10. Certificate required.
    (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.
    (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.
 
    Section 15. Application for certificate.
    (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
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
requirements for navigators.
    (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.
 
    Section 20. Certificate renewal.
    (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
requirements. Any failure to fulfill the ongoing training and
continuing education requirements shall result in the
expiration of the certificate.
 
    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.
 
    Section 30. Certificate denial, nonrenewal, or revocation.
    (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,
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.
    (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.
 
    Section 35. Reporting to the Director.
    (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
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.
 
    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
    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.
 
    Section 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.
 
    Section 97. Severability. The provisions of this Act are
severable under Section 1.31 of the Statute on Statutes.
 
    Section 99. Effective date. This Act takes effect upon
becoming law.