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, 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 6(b).

17"Commissioner." The Insurance Commissioner of the
18Commonwealth.

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

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

7"Federal act." The Patient Protection and Affordable Care
8Act (Public Law 111-148, 124 Stat. 119), as amended by the
9Health Care Education Reconciliation Act of 2010 (Public Law
10111-152, 124 Stat. 1029), and regulations or guidance issued
11under those acts.

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

18(1) A sickness and accident insurance company.

19(2) A health maintenance organization.

20(3) A nonprofit hospital and health service
21organization.

22(4) An entity providing a plan of health insurance,
23health benefits or health services.

24(5) A qualified health plan and multistate exchange
25where a navigator would be used.

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

1enrolling or supervising the enrollment of an individual or
2small employer into an exchange.

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

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

18"Qualified employer" or "small employer." An employer with
1950 or fewer full-time and part-time employees that elects to
20make its full-time employees and, at the employer's option, some
21or all of its part-time employees eligible for one or more
22qualified health plans offered through the Small Business Health
23Options Program Exchange.

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

27"Qualified individual." An individual, including a minor,
28who:

29(1) Seeks to enroll in a qualified health plan offered
30by an exchange as an individual or through the Small Business

1Health Options Program.

2(2) Resides in this Commonwealth or is employed by a
3small employer whose principal place of business is in this
4Commonwealth.

5(3) Is a citizen of the United States or an alien
6lawfully present in the United States.

7"Sell." To receive compensation from a source for the
8enrollment of an individual or qualified employer into an
9exchange or the SHOP exchange.

10"SHOP Exchange." The Small Business Health Options Program
11described under section 1311(b)(1)(B) of the Federal act (42 
12U.S.C. § 18031(b)(1)(B)).

13"Solicit." To attempt to sell insurance or to ask or urge an
14individual or qualified employer to apply for a kind of
15insurance from a particular company. The term shall include any
16of the following:

17(1) Presenting a specific comparison of a qualified
18health plan offered through an exchange.

19(2) Offering to assist or assisting in the enrollment in
20a qualified health plan on an exchange or the SHOP exchange.

21Section 3. Certification of navigators.

22(a) Prohibition.--An individual may not advertise a service
23as a navigator or operate in this Commonwealth as a navigator
24without first obtaining a certificate.

25(b) Application.--An individual shall apply for a
26certificate, on a form developed by the commissioner, and
27declare under penalty of perjury that the statements made in the
28application are true, correct and complete to the best of the
29individual's knowledge and belief. Prior to approving an
30application, the commissioner must determine that the applicants

1have met the following requirements:

2(1) Is at least 18 years of age.

3(2) Resides in this Commonwealth or maintains a
4principal place of business in this Commonwealth.

5(3) Is not disqualified for having committed an act that
6would be grounds for denial, suspension or revocation of a
7license as a health insurance producer.

8(4) Has not had a license as a health insurance producer
9denied, suspended or revoked.

10(5) Has completed the precertification training required
11under section 4.

12(6) Has submitted a full set of fingerprints to the
13commissioner and successfully completed a criminal history
14and regulatory record check.

15(7) Has provided evidence of liability coverage held by
16the individual or organization seeking to be registered.

17(8) Has identified the entity with which the individual
18is affiliated.

19(9) Has paid the fees prescribed by the commissioner.

20(10) Does not have a conflict of interest.

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

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

26Section 4. Training.

27(a) Approval.--The commissioner shall approve at least one
28training program which shall be offered by an approved
29continuing education provider using approved instructors under
30section 602-A(2) of the act of May 17, 1921 (P.L.789, No.285),

1known as The Insurance Department Act of 1921.

2(b) Continuing education credits.--The training under
3subsection (a) may be offered for continuing education credits
4for health insurance producers.

5(c) Contents.--The training under subsection (a) shall
6include, but not be limited to:

7(1) Training on provisions of the Federal act relating
8to exchanges.

9(2) Levels of coverage in an exchange or SHOP exchange.

10(3) Eligibility requirements for individuals and
11qualified employers to purchase insurance through an exchange
12or SHOP exchange.

13(4) Individual eligibility requirements for Federal tax
14subsidies, if applicable.

15(5) Individual eligibility requirements for Medicaid.

16(6) The use of enrollment forms in the exchange and SHOP
17exchange.

18(7) The distinction between navigators and insurance
19producers.

20(8) Limitations on services which can be provided by a
21navigator.

22(9) Privacy requirements for documents and other
23information that must be safeguarded by department
24regulations.

25(d) Proof.--Each individual completing the training under
26subsection (a) shall be provided with written proof of
27completion.

28(e) Requirement.--The training under subsection (a) must be
29completed before an applicant can be initially certified as a
30navigator and prior to the start of each subsequent two-year

1term of certification.

2Section 5. Navigator scope of activity.

3(a) Certification required.--An individual or organization
4may not act or present itself to be a navigator or receive
5funding as a navigator unless the individual or organization is
6certified as a navigator under this act.

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

8(1) Conduct public education activities designed to
9raise awareness of exchanges among underserved insurance
10populations and the potential availability of Federal tax
11subsidies in ways that are culturally and linguistically
12appropriate to an underserved insurance population.

13(2) Distribute fair and impartial general information
14concerning enrollment in the exchange and the levels of
15insurance available in the exchange without specifically
16referencing or comparing the relative merits of a specific
17qualified health plan.

18(3) Educate underserved insurance populations on the
19enrollment process without suggesting or facilitating
20enrollment in a particular qualified health plan.

21(4) Require specific membership to an organization, if
22the organization is serving as a navigator. The following
23shall apply to an organization under this paragraph:

24(i) the organization must provide at least one
25additional service, other than navigator services, to the
26members of its organization; and

27(ii) no other fee may be charged for utilization of
28the navigator services.

29(5) Receive funds from an insurance carrier which offers
30a qualified health plan in this Commonwealth if the funds are

1not associated with an individual who is enrolled through the
2exchange.

3(c) Limitations.--A navigator may not do any of the
4following:

5(1) Sell, solicit or negotiate insurance.

6(2) Knowingly contact a person or business that is
7currently insured under an existing health benefit plan.

8(3) Make a specific recommendation for a particular
9qualified health plan.

10(4) Provide information or services related to health
11benefit plans or other products not offered in the exchange
12or SHOP exchange.

13(5) Require that a potential enrollee in an exchange
14perform some action, including paying a separate fee to an
15organization, as a requirement for receiving navigator
16assistance.

17Section 6. Powers of the commissioner.

18(a) Approval.--The commissioner shall approve an application
19for navigator registration after review.

20(b) Confirmation.--The commissioner shall issue a
21certificate and identification card to each navigator, which
22shall prominently list the expiration date of the registration
23and must be shown upon request to potential enrollees.

24(c) Certification.--The commissioner may suspend, revoke or
25refuse to issue or renew the certification of a navigator for
26conduct which would prohibit an individual from being certified
27under section 3 or a violation of this act or Article VI-A of
28the act of May 17, 1921 (P.L.789, No.285), known as The
29Insurance Department Act of 1921.

30(d) Penalties.--The commissioner may do any of the

1following:

2(1) Impose a civil penalty of up to $1,000 for each
3violation of this act or section 611-A of The Insurance
4Department Act of 1921.

5(2) Place a navigator under supervision.

6(e) Examination.--The commissioner may examine and
7investigate business affairs and records of a navigator which
8relate to the navigator function being carried out.

9(f) Locator.--The commissioner shall post a navigator
10locator function on its publicly accessible Internet website
11which shall assist consumers in locating navigator services. The
12locator function shall include navigators' addresses, telephone
13numbers and e-mail addresses and must be accessible through a
14geographic search.

15(g) Rules.--The commissioner may promulgate rules necessary
16to carry out this act.

17(h) Report.--The commissioner shall provide an annual report
18to the General Assembly and to the United States Department of
19Health and Human Services which lists all navigators and any
20enforcement action taken against a navigator.

21Section 40. Effective date.

22This act shall take effect immediately.