1Regulating navigators, assisters <-and insurance producers in the
2education and promotion of health insurance exchanges.

3The General Assembly of the Commonwealth of Pennsylvania
4hereby enacts as follows:

5Section 1.  Short title.

6This act shall be known and may be cited as the Navigator
7Accessibility and Regulation Act.

8Section 2.  Definitions.

9The following words and phrases when used in this act shall
10have the meanings given to them in this section unless the
11context clearly indicates otherwise:

12"Affiliate."  A person that directly or indirectly, through
13one or more intermediaries or controls, is controlled by or is
14under common control with a specified person.

<-15"Certificate."  A registration confirmation certificate
16issued by the Insurance Commissioner under section 5(b).

17"Commissioner."  The Insurance Commissioner of the

1Commonwealth.

2"Department."  The Insurance Department of the Commonwealth.

3"Exchange."  A health insurance exchange established or
4operating in this Commonwealth, including an exchange
5established or operated by the United States Department of
6Health and Human Services, under the Patient Protection and
7Affordable Care Act (Public Law 111-148, 124 Stat. 119).

8"Federal health care act."  The Patient Protection and
9Affordable Care Act (Public Law 111-148, 124 Stat. 119), as
10amended by the Health Care Education Reconciliation Act of 2010
11(Public Law 111-152, 124 Stat. 1029), and regulations or
12guidance issued under those acts.

13"Health insurance <-carrier" or "carrier carrier."  An entity,
14subject to the insurance laws of this Commonwealth or under the
15jurisdiction of the Insurance Commissioner, that contracts or
16offers to contract to provide, deliver, arrange for, pay for or
17reimburse any of the cost of a health care service. The term
18includes<-:

19(1)  A sickness and accident insurance company.

20(2)  A health maintenance organization.

21(3)  A nonprofit hospital and health service
22organization.

23(4)  An entity providing a plan of health insurance,
24health benefits or health services.

25(5)  A qualified health plan and multistate exchange
26where a navigator would be used.

27"Health insurance producer" or "producer."  An individual
28licensed to sell, solicit or negotiate the sale of a contract of
29insurance in this Commonwealth under Article VI-A of the act of
30May 17, 1921 (P.L.789, No.285), known as The Insurance

1Department Act of 1921. The term includes an individual
2enrolling or supervising the enrollment of an individual or
3small employer into an exchange.

4"Navigator."  An organization or individual certified by the
5Insurance Commissioner under the Federal health care act to
6provide public education or consumer assistance activities for
7or on behalf of an exchange to uninsured individuals and groups
8seeking health insurance coverage. The term shall include an
9individual performing navigator duties for an organization,
10association or business entity, if the organization, association
11or business entity is serving as a navigator.

12"Negotiate."  To confer directly with or offer advice
13directly to a purchaser or prospective purchaser of a contract
14of insurance with respect to the substantive benefits, terms or
15conditions of the contract, if the person engaged in the
16conference or offering sells insurance or obtains insurance from
17insurers, including insurers participating in the exchange, for
18purchasers.

19"Qualified employer" or "small employer."  An employer with
2050 or fewer full-time and part-time employees that elects to
21make its full-time employees and, at the employer's option, some
22or all of its part-time employees eligible for one or more
23qualified health plans offered through the Small Business Health
24Options Program Exchange.

25"Qualified health plan."  A health benefit plan that has in
26effect a certification that the plan meets the criteria for
27certification described in section 1311(c) of the Federal health
28care act.

29"Qualified individual."  An individual, including a minor,
30who:

1(1)  Seeks to enroll in a qualified health plan offered
2by an exchange as an individual or through the Small Business
3Health Options Program Exchange.

4(2)  Resides in this Commonwealth or is employed by a
5small employer whose principal place of business is in this
6Commonwealth.

7(3)  Is a citizen of the United States or an alien
8lawfully present in the United States.

9"Sell."  To receive compensation from a source for the
10enrollment of an individual or qualified employer into an
11exchange or the SHOP exchange.

12"SHOP exchange."  The Small Business Health Options Program
13described under section 1311(b)(1)(B) of the Federal health care
14act (42 U.S.C. § 18031(b)(1)(B)).

15"Solicit."  To attempt to sell insurance or to ask or urge an
16individual or qualified employer to apply for a kind of
17insurance from a particular company. The term shall include any
18of the following:

19(1)  Presenting a specific comparison of a qualified
20health plan offered through an exchange.

21(2)  Offering to assist or assisting in the enrollment in
22a qualified health plan on an exchange or the SHOP exchange.

23Section 3.  Certification of navigators.

24(a)  Prohibition.--An individual may not advertise a service
25as a navigator or operate in this Commonwealth as a navigator
26without first registering with the department.

27(b)  Application.--An individual shall register as a
28navigator, on a form developed by the commissioner, and declare
29under penalty of perjury that the statements made in the
30application are true, correct and complete to the best of the

1individual's knowledge and belief. Prior to approving an
2application, the commissioner must determine that the applicants
3have met the following requirements:

4(1)  Is at least 18 years of age.

5(2)  Resides in this Commonwealth or maintains a
6principal place of business in this Commonwealth.

7(3)  Is not disqualified for having committed an act that
8would be grounds for denial, suspension or revocation of a
9license as a health insurance producer.

10(4)  Has not had a license as a health insurance producer
11denied, suspended or revoked.

12(5)  Has submitted a full set of fingerprints to the
13commissioner and successfully completed a criminal history
14and regulatory record check.

15(6)  Has provided evidence of liability coverage held by
16the individual or organization seeking to be registered.

17(7)  Has identified the entity with which the individual
18is affiliated.

19(8)  Has paid the fees prescribed by the commissioner.

20(9)  Does not have a conflict of interest.

21(c)  Term.--The term of registration shall be two years from
22the date of issue.

23(d)  Prohibited registration.--It is a conflict of interest
24for any entity which provides health care services, or affiliate
25thereof, to serve as a navigator in this Commonwealth.

26Section 4.  Navigator scope of activity.

27(a)  Registration required.--An individual or organization
28may not act or present itself to be a navigator or receive
29funding as a navigator unless the individual or organization is
30registered as a navigator under this act.

1(b)  Powers.--A navigator may do the following:

2(1)  Conduct public education activities designed to
3raise awareness of exchanges among underserved insurance
4populations and the potential availability of Federal tax
5subsidies in ways that are culturally and linguistically
6appropriate to an underserved insurance population.

7(2)  Distribute fair and impartial general information
8concerning enrollment in the exchange and the levels of
9insurance available in the exchange without specifically
10referencing or comparing the relative merits of a specific
11qualified health plan.

12(3)  Educate underserved insurance populations on the
13enrollment process without suggesting or facilitating
14enrollment in a particular qualified health plan.

15(4)  Require specific membership to an organization, if
16the organization is serving as a navigator. The following
17shall apply to an organization under this paragraph:

18(i)  the organization must provide at least one
19additional service, other than navigator services, to the
20members of its organization; and

21(ii)  no other fee may be charged for utilization of
22the navigator services.

23(5)  Receive funds from an insurance carrier which offers
24a qualified health plan in this Commonwealth if the funds are
25not associated with an individual who is enrolled through the
26exchange.

27(c)  Limitations.--A navigator may not do any of the
28following:

29(1)  Sell, solicit or negotiate insurance.

30(2)  Knowingly contact a person or business that is

1currently insured under an existing health benefit plan.

2(3)  Make a specific recommendation for a particular
3qualified health plan.

4(4)  Provide information or services related to health
5benefit plans or other products not offered in the exchange
6or SHOP exchange.

7(5)  Require that a potential enrollee in an exchange
8perform some action, including paying a separate fee to an
9organization, as a requirement for receiving navigator
10assistance.

11Section 5.  Powers of the commissioner.

12(a)  Approval.--The commissioner shall approve an application
13for navigator registration after review.

14(b)  Confirmation.--The commissioner shall issue a
15certificate and identification card to each navigator, which
16shall prominently list the expiration date of the registration
17and which must be shown upon request to potential enrollees.

18(c)  Certification.--The commissioner may suspend, revoke or
19refuse to issue or renew the certification of a navigator for
20conduct which would prohibit an individual from being certified
21under section 3 or a violation of this act or Article VI-A of
22the act of May 17, 1921 (P.L.789, No.285), known as The
23Insurance Department Act of 1921.

24(d)  Penalties.--The commissioner may do any of the
25following:

26(1)  Impose a civil penalty of up to $1,000 for each
27violation of this act or of section 611-A of The Insurance
28Department Act of 1921.

29(2)  Place a navigator under supervision.

30(e)  Rules.--The commissioner may promulgate rules necessary

1to carry out this act.

2Section 6.  Effective date.

3This act shall take effect immediately <-an entity organized
4under:

5(1) The act of May 17, 1921 (P.L.682, No.284), known as 
6The Insurance Company Law of 1921, including section 630 and 
7Article XXIV thereof.

8(2) The act of December 29, 1972 (P.L.1701, No.364),
9known as the Health Maintenance Organization Act.

10(3) 40 Pa.C.S. Chs. 61 (relating to hospital plan
11corporations) and 63 (relating to professional health
12services plan corporations).

13"Health insurance producer." An insurance producer with an
14accident and health line of authority as defined in section 601-
15A of the act of May 17, 1921 (P.L.789, No.285), known as The
16Insurance Department Act of 1921.

17"Insurance producer." Insurance producer has the meaning
18given it in section 601-A of the act of May 17, 1921 (P.L.789,
19No.285), known as The Insurance Department Act of 1921.

20"Navigator." An organization or individual under the Federal
21health care act that provides public education or consumer
22assistance activities for or on behalf of an exchange to
23uninsured individuals and groups seeking health insurance
24coverage. The term shall include an individual performing
25navigator duties for an organization, association or business
26entity, if the organization, association or business entity is
27serving as a navigator.

28"Negotiate." The term has the same meaning given it in
29section 601-A of the act of May 17, 1921 (P.L.789, No.285),
30known as The Insurance Department Act of 1921.

1"Qualified employer." The term has the same meaning given it 
2in the Federal health care act.

3"Qualified health plan." The term has the same meaning given
4it in the Federal health care act.

5"Qualified individual." The term has the same meaning given
6it in the Federal health care act.

7"Sell."  The term has the same meaning given it in section
8601-A of the act of May 17, 1921 (P.L.789, No.285), known as The 
9Insurance Department Act of 1921.

10"Shop exchange."  The term has the same meaning given it in
11the Federal health care act.

12"Small employer." An employer that purchasers accident and
13health insurance in the small group market, as defined in
14section 2791(e)(5) of the Public Health Service Act (110 Stat.
151972, 42 U.S.C. § 300gg-91(e)(5)), except that for plan years
16beginning prior to January 1, 2016, or other date as established
17in Federal law, 50 employees shall be required.

18"Solicit."  The term has the same meaning given it in section
19601-A of the act of May 17, 1921 (P.L.789, No.285), known as The 
20Insurance Department Act of 1921.

21Section 3. Registration.

22(a)  Prohibition.--An individual or organization may not
23advertise a service as a navigator or an exchange assister or
24operate in this Commonwealth as a navigator or an exchange 
25assister without first registering with the department.

26(b)  Registration application.--An individual or organization 
27shall register with the department as a navigator or exchange 
28assister, on a form approved by the department. The department
29shall review each application and may conduct an investigation
30of each applicant who applies for a registration in accordance

1with this act. The department shall issue a registration, as
2appropriate, to an applicant when the department determines that
3the applicant:

4(1)  Is at least 18 years of age.

5(2)  Resides in this Commonwealth or maintains a
6registered place of business in this Commonwealth.

7(3)  Is not disqualified for having committed an act that
8would be grounds for denial, suspension or revocation of a
9license as an insurance producer.

10(4)  Has not had a license as an insurance producer
11denied, suspended or revoked.

12(5)  Has submitted a completed application.

13(6)  Has submitted the applicant's fingerprints, for the
14department to receive national criminal history records
15information from the Criminal Justice Information Services
16Division of the Federal Bureau of Investigation.

17(7) Has paid the required registration fee and fees for
18obtaining national criminal history records information
19as prescribed by the department.

20(b)  Confirmation.--The department shall issue, in paper or
21electronic form, a nontransferable registration certification,
22which shall prominently list the expiration date of the
23registration and which must be shown upon request to potential
24enrollees.

25(c)  Term.--The term of registration shall be two years from
26the date of issue.

27(d) Searchable list.--The department shall maintain and make 
28available to the public a searchable list of all registrants on 
29its publicly accessible Internet website.

30Section 4.  Scope of activity.

1(a)  Registration required.--An individual or organization
2may not act or present itself to be a navigator or an exchange 
3assister unless the individual or organization is registered as
4a navigator or an exchange assister under this act.

5(b)  Limitations.--A navigator or an exchange assister may
6not engage in an activity for which licensure as a producer is
7required, except as explicitly permitted by Federal law or
8regulation, including any of the following:

9(1)  Sell, solicit or negotiate insurance.

10(2) Discuss the effect of age, health or other risk-
11related conditions of the prospective policyholders.

12(3) Urge or advise a prospective purchaser to buy a
13particular policy or to insure with a particular company.

14(4) Initiate sales over the telephone or otherwise.

15(5) Collect premiums.

16(6) Make or propose to make an insurance contract.

17(7) Other than as necessary to inform a prospective
18purchaser of the availability of health insurance off the
19exchange, provide information or services related to health
20benefit plans or other products other than those offered in
21the health insurance marketplace, SHOP exchange, the
22Children's Health Insurance Program or product available
23through the Social Security Act (49 Stat. 620, 42 U.S.C. §301
24et seq.).

25(8) Initiate an inquiry as to the terms of existing
26coverage.

27(9) Discuss or describe the specific coverages or terms
28of a proposed contract of insurance with a prospective
29policyholder, including counseling as to which coverages to
30buy.

1(10) Recommend or initiate additions or deletions to an
2insured's policy.

3(11) Sign binders, endorsements and insurance policies.

4(12) Authorize the issuance or delivery of certificates
5of insurance, endorsements, binders or insurance policies on
6insurance identification cards.

7(13) Respond to a policyholder's request for advice or
8counsel regarding policy provisions or coverage.

9Section 5.  Enforcement by department.

10(a) Notice.--Upon evidence of a violation of this act or
11Article VI-A of the act of May 17, 1921 (P.L.789, No.285), known
12as The Insurance Department Act of 1921, the department shall
13notify the person of the alleged violation. The notice shall
14specify the nature of the alleged violation and fix a time and
15place, at least ten days thereafter, when a hearing on the
16matter shall be held.

17(b) Hearing.--The department shall conduct the hearing on
18the violation in accordance with 2 Pa.C.S. Ch. 5 Subch. A
19(relating to practice and procedure of Commonwealth agencies).

20(c) Evidence.--No person shall be excused from testifying or
21from producing any books, papers, contracts, agreements or
22documents at any hearing held by the commissioner on the ground
23that the testimony or evidence may tend to incriminate that
24person.

25(d)  Penalties.--After the hearing or upon failure of the
26person to appear at the hearing, if a violation is found, the
27commissioner may, in addition to any penalty which may be
28imposed by a court, do any combination of the following deemed
29appropriate:

30(1) Deny, suspend, refuse to renew or revoke the

1registration, if any, of the person.

2(2)  Impose a civil penalty of up to $5,000 for each
3violation of this act.

4(3) Impose an order to cease and desist.

5(4) Report violations of this act to the United States
6Department of Health and Human Services.

7(5) Refer potential violations of any laws of this
8Commonwealth relating to privacy of personal information to
9the Office of Attorney General.

10(6) Enforce other violations of The Insurance Department
11Act of 1921, as applicable.

12(7) Impose any other conditions the commissioner deems
13appropriate.

14(e)  Regulations and form.--The department may promulgate
15regulations and publish forms as necessary and appropriate to
16carry out this act.

17Section 6.  Effective date.

18This act shall take effect February 15, 2015, or the close of 
19the 2015 open enrollment period, whichever is later.