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, 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
22this Section do not apply to navigators when assisting
23individuals with the enrollment process in the State Medicaid
24program or other public programs.
25    Section 15. Application for certificate.



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1    (a) An entity or individual applying for a navigator
2certificate shall make application to the Director on a form
3developed by the Director and declare under penalty of refusal,
4suspension, or revocation of the certificate that the
5statements made in the application are true, correct, and
6complete to the best of the individual's or entity's knowledge
7and belief. Before approving the application, the Director
8shall 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
25activities of individual navigators, or receives funding to
26perform such activities shall obtain a navigator entity



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1certificate. An entity applying for a navigator entity
2certificate shall make application on a form containing the
3information prescribed by the Director and shall list the
4individuals 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
14to verify the information contained in an application submitted
15in accordance with subsections (a) and (b) of this Section.
16    (d) Entities certified as navigators shall provide the
17Director with a list of all individual navigators that it
18employs, supervises, or is affiliated with at renewal.
19    (e) The Director may require, in a manner determined by the
20Director, that each entity that acts as a navigator demonstrate
21a level of financial responsibility capable of protecting all
22persons against the wrongful acts, misrepresentations, or
23negligence of the navigator.
24    (f) Prior to any exchange becoming operational in this
25State, the Director, in coordination with the exchange, shall
26prescribe the initial training and continuing education



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1requirements for navigators.
2    (g) Certificate holders must inform the Director, in
3writing, of a change of address within 30 days after the
5    (h) In order to assist in the performance of the Director's
6duties, the Director may contract with the National Association
7of Insurance Commissioners (NAIC), or any affiliates or
8subsidiaries that the NAIC oversees, to perform any ministerial
9functions, including the collection of fees, related to
10certification that the Director and the nongovernmental entity
11may deem appropriate.
12    Section 20. Certificate renewal.
13    (a) An individual navigator entity certificate shall be
14valid for one year.
15    (b) A navigator may file an application for renewal of a
16certificate in a method prescribed by the Director. Any
17navigator who fails to timely file for certificate renewal
18shall be charged a late fee in an amount prescribed by the
20    (c) Prior to the filing date for application for renewal of
21a certificate, an individual navigator shall comply with
22ongoing training and continuing education requirements
23established by the Director. The navigator shall file with the
24Director, by a method prescribed by the Director, satisfactory
25certification of completion of the continuing education



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1requirements. Any failure to fulfill the ongoing training and
2continuing education requirements shall result in the
3expiration of the certificate.
4    Section 25. Navigator referrals. On contact with a person
5who acknowledges having existing health insurance coverage
6obtained through an insurance producer, a navigator shall refer
7the person back to that insurance producer for information,
8assistance, 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,
18or refuse to issue or renew a navigator's certificate or may
19levy a civil penalty as established by rule.
20    (b) If an action by the Director is to nonrenew, suspend,
21or revoke a certificate or to deny an application for a
22certificate, then the Director shall notify the applicant or
23certificate holder and advise, in writing, the applicant or
24certificate holder of the reason for the suspension,



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



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



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1provisions set forth in this Act taken in any jurisdiction. The
2report shall include a copy of the initial complaint filed, the
3order resulting from the hearing, and any other relevant legal
5    (c) An entity that acts as a navigator that terminates the
6employment, engagement, affiliation, or other relationship
7with an individual navigator shall notify the Director within
830 days following the effective date of the termination, using
9a format prescribed by the Director, if the reason for
10termination is one of the reasons set forth in this Act or the
11entity has knowledge the navigator was found by a court or
12government body to have engaged in any of the activities
13prohibited by this Act. Upon the written request of the
14Director, the entity shall provide additional information,
15documents, records, or other data pertaining to the termination
16or 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
14this Section do not apply to certified application counselors
15when assisting individuals with the enrollment process in the
16State Medicaid program or other public programs.
17    (c) The Director shall develop education and certification
18requirements 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
21individual or entity licensed as an insurance producer in this
23    (b) Pursuant to the authority granted by this Act, the
24Director may adopt rules as may be necessary or appropriate for
25the administration and enforcement of this Act.



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1    Section 97. Severability. The provisions of this Act are
2severable under Section 1.31 of the Statute on Statutes.
3    Section 99. Effective date. This Act takes effect upon
4becoming law.