1Regulating navigators and assisters in the education and
2promotion 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 and 
7Exchange Assister Accessibility 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"Commissioner."  The Insurance Commissioner of the
13Commonwealth.

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

15"Exchange."  A health insurance exchange established or
16operating in this Commonwealth, including an exchange
17established or operated by the United States Department of

1Health and Human Services, under the Patient Protection and
2Affordable Care Act (Public Law 111-148, 124 Stat. 119).

3"Exchange assister." An individual or organization,
4including a navigator, navigator organization or certified
5application counselor, who provides public education or assists
6consumers for or on behalf of an exchange. This term does not
7include a licensed insurance producer. <-This term shall not 
8include an individual employed to provide insurance enrollment 
9or coverage assistance by a health care facility as defined in 
10section 103 of act of July 19, 1979 (P.L.130, No.48), known as 
11the Health Care Facilities Act.

12"Federal health care act."  The Patient Protection and
13Affordable Care Act (Public Law 111-148, 124 Stat. 119), as
14amended by the Health Care Education Reconciliation Act of 2010
15(Public Law 111-152, 124 Stat. 1029), and regulations or
16guidance issued under those acts.

17"Health insurance producer." An insurance producer with an 
18accident and health line of authority as defined in section 601-
19A of the act of May 17, 1921 (P.L.789, No.285), known as The 
20Insurance Department Act of 1921.

21"Insurance producer." Insurance producer has the meaning
22given it in section 601-A of the act of May 17, 1921 (P.L.789,
23No.285), known as The Insurance Department Act of 1921.

24"Navigator." An organization or individual under the Federal
25health care act that provides public education or consumer
26assistance activities for or on behalf of an exchange to
27uninsured individuals and groups seeking health insurance
28coverage. The term shall include an individual performing
29navigator duties for an organization, association or business
30entity, if the organization, association or business entity is

1serving as a navigator.

2"Negotiate." The term has the same meaning given it in
3section 601-A of the act of May 17, 1921 (P.L.789, No.285),
4known as The Insurance Department Act of 1921.

5"Registration." A registration certificate issued by the 
6department under section 3(c).

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"Solicit."  The term has the same meaning given it in section
13601-A of the act of May 17, 1921 (P.L.789, No.285), known as The 
14Insurance Department Act of 1921.

15Section 3. Registration.

16(a)  Prohibition.--An individual or organization may not
17advertise a service as a navigator or an exchange assister or
18operate in this Commonwealth as a navigator or an exchange 
19assister without first registering with the department.

20(b)  Registration application.--An individual or organization 
21shall register with the department as a navigator or exchange 
22assister, on a form approved by the department. The department
23shall review each application and may conduct an investigation
24of each applicant who applies for a registration in accordance
25with this act. The department shall issue a registration, as
26appropriate, to an applicant when the department determines that
27the applicant:

28(1)  Is at least 18 years of age.

29(2)  Resides in this Commonwealth or maintains a
30registered place of business in this Commonwealth.

1(3)  Is not disqualified for having committed an act that
2would be grounds for denial, suspension or revocation of a
3license as an insurance producer.

4(4)  Has not had a license as an insurance producer
5denied, suspended or revoked.

6(5)  Has submitted a completed application.

7(6)  Has submitted the applicant's fingerprints, for the
8department to receive national criminal history records
9information from the Criminal Justice Information Services
10Division of the Federal Bureau of Investigation.

11(7) Has paid the required registration fee and fees for
12obtaining national criminal history records information
13as prescribed by the department.

14(c)  Confirmation.--The department shall issue, in paper or
15electronic form, a nontransferable registration certification to 
16each registered navigator or exchange assister, which shall
17prominently list the expiration date of the registration and
18which must be shown upon request to potential enrollees.

19(d)  Term.--The term of registration shall be two years from
20the date of issue.

21(e) Searchable list.--The department shall maintain and make 
22available to the public a searchable list of all registrants on 
23its publicly accessible Internet website.

24Section 4.  Scope of activity.

25(a)  Registration required.--An individual or organization
26may not act or present itself to be a navigator or an exchange 
27assister unless the individual or organization is registered as
28a navigator or an exchange assister under this act.

29(b)  Limitations.--A navigator or an exchange assister may
30not engage in an activity for which licensure as a producer is

1required, except as explicitly permitted by Federal law or
2regulation, including any of the following:

3(1)  Sell, solicit or negotiate insurance.

4(2) Urge or advise a prospective purchaser to buy a
5particular policy or to insure with a particular company.

6(3) Initiate sales over the telephone or otherwise.

7(4) Collect premiums.

8(5) Make or propose to make an insurance contract.

9(6) Other than as necessary to inform a prospective
10purchaser of the availability of health insurance off the
11exchange, provide information or services related to health
12benefit plans or other products other than those offered in
13the health insurance marketplace, SHOP exchange, the
14Children's Health Insurance Program or product available
15through the Social Security Act (49 Stat. 620, 42 U.S.C. §301
16et seq.).

17(7) Initiate an inquiry as to the terms of existing
18coverage.

19(8) Recommend or initiate additions or deletions to an
20insured's policy.

21(9) Sign binders, endorsements and insurance policies.

22(10) Authorize the issuance or delivery of certificates
23of insurance, endorsements, binders or insurance policies on
24insurance identification cards.

25(11) Respond to a policyholder's request for advice or
26counsel regarding policy provisions or coverage.

27Section 5.  Enforcement by department.

28(a) Notice.--Upon evidence of a violation of this act or
29Article VI-A of the act of May 17, 1921 (P.L.789, No.285), known
30as The Insurance Department Act of 1921, the department shall

1notify the person of the alleged violation. The notice shall
2specify the nature of the alleged violation and fix a time and
3place, at least ten days thereafter, when a hearing on the
4matter shall be held.

5(b) Hearing.--The department shall conduct the hearing on
6the violation in accordance with 2 Pa.C.S. Ch. 5 Subch. A
7(relating to practice and procedure of Commonwealth agencies).

8(c) Evidence.--No person shall be excused from testifying or
9from producing any books, papers, contracts, agreements or
10documents at any hearing held by the commissioner on the ground
11that the testimony or evidence may tend to incriminate that
12person.

13(d)  Penalties.--After the hearing or upon failure of the
14person to appear at the hearing, if a violation is found, the
15commissioner may, in addition to any penalty which may be
16imposed by a court, do any combination of the following deemed
17appropriate:

18(1) Deny, suspend, refuse to renew or revoke the
19registration, if any, of the person.

20(2)  Impose a civil penalty of up to $5,000 for each
21violation of this act.

22(3) Impose an order to cease and desist.

23(4) Report violations of this act to the United States
24Department of Health and Human Services.

25(5) Refer potential violations of any laws of this
26Commonwealth relating to privacy of personal information to
27the Office of Attorney General.

28(6) Enforce other violations of The Insurance Department
29Act of 1921, as applicable.

30(7) Impose any other conditions the commissioner deems

1appropriate.

2(e)  Regulations and form.--The department may promulgate
3regulations and publish forms as necessary and appropriate to
4carry out this act.

5Section 6.  Effective date.

6This act shall take effect February 15, 2015, or the close of 
7the 2015 open enrollment period, whichever is later.