Illinois General Assembly - Full Text of SB1194
Illinois General Assembly

Previous General Assemblies

Full Text of SB1194  98th General Assembly


Sen. William R. Haine

Filed: 4/22/2013





09800SB1194sam002LRB098 03986 RPM 44929 a


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    "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



09800SB1194sam002- 2 -LRB098 03986 RPM 44929 a

1receives grant funds from the United States Department of
2Health and Human Services, the State of Illinois, or an
3exchange or private funds to perform any of the activities and
4duties identified in 42 U.S.C. 18031(i), including, but not
5limited to, in-person assisters as defined by federal
6regulations or guidelines.
7    Section 10. Certificate required.
8    (a) No individual or entity shall perform, offer to
9perform, or advertise any service as a navigator in this State
10or receive navigator grant funding from the United States
11Department of Health and Human Services, the State of Illinois,
12or an exchange or private funds unless certified as a navigator
13by the Director under this Act.
14    (b) A navigator who complies with the requirements of this
15Act shall do the following:
16        (1) conduct public education activities to raise
17    awareness of the availability of qualified health plans;
18        (2) distribute fair and impartial information
19    concerning enrollment in qualified health plans offered
20    within the exchange and the availability of the premium tax
21    credits under Section 36B of the Internal Revenue Code of
22    1986, 26 U.S.C. 36B, and cost-sharing reductions under
23    Section 1402 of the federal Patient Protection and
24    Affordable Care Act;
25        (3) facilitate enrollment in qualified health plans;



09800SB1194sam002- 3 -LRB098 03986 RPM 44929 a

1        (4) provide referrals to appropriate federal and State
2    agencies for any enrollee with a grievance, complaint, or
3    question regarding their health plan or coverage or a
4    determination under such plan or coverage;
5        (5) provide information in a manner that is culturally
6    and linguistically appropriate to the needs of the
7    population being served by the exchange.
8    (c) A navigator may not:
9        (1) sell, solicit, or negotiate any of the classes of
10    insurance enumerated in Section 4 of the Illinois Insurance
11    Code;
12        (2) offer advice about which health plan is better or
13    worse 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 insurance products not
18    offered in the exchange; or
19        (5) accept any compensation or consideration directly
20    or indirectly from any issuer of accident and health
21    insurance or stop-loss insurance that is dependent, in
22    whole or in part, on whether a person enrolls in or
23    purchases a particular private health benefit plan.
24    (d) Items (1), (2), (3), (4), and (5) of subsection (c) of
25this Section do not apply to navigators when assisting
26individuals with the enrollment process in the State Medicaid



09800SB1194sam002- 4 -LRB098 03986 RPM 44929 a

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



09800SB1194sam002- 5 -LRB098 03986 RPM 44929 a

1    (b) An entity that acts as a navigator, supervises the
2activities of individual navigators, or receives funding to
3perform such activities shall obtain a navigator entity
4certificate. An entity applying for a navigator entity
5certificate shall make application on a form containing the
6information prescribed by the Director and shall list the
7individuals acting as navigators under the entity certificate.
8        (1) The entity shall designate a certified navigator
9    responsible for the navigator entity's compliance with the
10    laws of this State and the Exchange.
11        (2) The entity, under penalty of revocation,
12    suspension, or other discipline prescribed by the
13    Director, shall certify that each individual completes the
14    mandatory training required by item (4) of subsection (a)
15    of Section 15 of this Act.
16    (c) The Director may require any documents deemed necessary
17to verify the information contained in an application submitted
18in accordance with subsections (a) and (b) of this Section.
19    (d) Entities certified as navigators shall provide the
20Director with a list of all individual navigators that it
21employs, supervises, or is affiliated with at renewal.
22    (e) The Director may require, in a manner determined by the
23Director, that each entity that acts as a navigator demonstrate
24a level of financial responsibility capable of protecting all
25persons against the wrongful acts, misrepresentations, or
26negligence of the navigator.



09800SB1194sam002- 6 -LRB098 03986 RPM 44929 a

1    (f) Prior to any exchange becoming operational in this
2State, the Director, in coordination with the exchange, shall
3prescribe the initial training and continuing education
4requirements for navigators.
5    (g) Certificate holders must inform the Director, in
6writing, of a change of address within 30 days after the
8    (h) In order to assist in the performance of the Director's
9duties, the Director may contract with the National Association
10of Insurance Commissioners (NAIC), or any affiliates or
11subsidiaries that the NAIC oversees, to perform any ministerial
12functions, including the collection of fees, related to
13certification that the Director and the nongovernmental entity
14may deem appropriate.
15    Section 20. Certificate renewal.
16    (a) An individual navigator and entity certificate shall be
17valid for one year.
18    (b) A navigator may file an application for renewal of a
19certificate in a method prescribed by the Director. Any
20navigator who fails to timely file for certificate renewal
21shall be charged a late fee in an amount prescribed by the
23    (c) Prior to the filing date for application for renewal of
24a certificate, an individual navigator shall comply with
25ongoing training and continuing education requirements



09800SB1194sam002- 7 -LRB098 03986 RPM 44929 a

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



09800SB1194sam002- 8 -LRB098 03986 RPM 44929 a

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



09800SB1194sam002- 9 -LRB098 03986 RPM 44929 a

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



09800SB1194sam002- 10 -LRB098 03986 RPM 44929 a

1    (b) Within 30 days after the initial pretrial hearing date,
2a navigator shall report to the Director any criminal
3prosecution of the navigator of a matter that violates the
4provisions set forth in this Act taken in any jurisdiction. The
5report shall include a copy of the initial complaint filed, the
6order resulting from the hearing, and any other relevant legal
8    (c) An entity that acts as a navigator that terminates the
9employment, engagement, affiliation, or other relationship
10with an individual navigator shall notify the Director within
1130 days following the effective date of the termination, using
12a format prescribed by the Director, if the reason for
13termination is one of the reasons set forth in this Act or the
14entity has knowledge the navigator was found by a court or
15government body to have engaged in any of the activities
16prohibited by this Act. Upon the written request of the
17Director, the entity shall provide additional information,
18documents, records, or other data pertaining to the termination
19or activity of the individual.
20    Section 40. Certified application counselor.
21    (a) A certified application counselor may not:
22        (1) sell, solicit, or negotiate any of the classes of
23    insurance enumerated in Section 4 of the Illinois Insurance
24    Code;
25        (2) offer advice about which health plan is better or



09800SB1194sam002- 11 -LRB098 03986 RPM 44929 a

1    worse for a particular individual or employer;
2        (3) recommend or endorse a particular health plan or
3    advise consumers about which plan to choose;
4        (4) provide any information or services related to
5    health benefit plans or other insurance products not
6    offered in the exchange; or
7        (5) accept any compensation or consideration directly
8    or indirectly from any issuer of accident and health
9    insurance or stop-loss insurance that is dependent, in
10    whole or in part, on whether a person enrolls in or
11    purchases a particular health benefit plan.
12    (b) Items (1), (2), (3), (4) and (5) of subsection (a) of
13this Section do not apply to certified application counselors
14when assisting individuals with the enrollment process in the
15State Medicaid program or other public programs.
16    (c) The Director shall develop education and certification
17requirements for certified application counselors by rule.
18    Section 45. Other laws; rulemaking authority.
19    (a) The requirements of this Act shall not apply to any
20individual or entity licensed as an insurance producer in this
22    (b) Pursuant to the authority granted by this Act, the
23Director may adopt rules as may be necessary or appropriate for
24the administration and enforcement of this Act.



09800SB1194sam002- 12 -LRB098 03986 RPM 44929 a

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.".