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Senate of Pennsylvania
Session of 2013 - 2014 Regular Session


Posted: December 3, 2013 03:27 PM
From: Senator John H. Eichelberger, Jr.
To: All Senate members
Subject: Health Exchange "Navigators"
I plan to introduce legislation to address consumer protection concerns resulting from the implementation of the Affordable Care Act. The Act, in large part, depends upon individuals, known as “navigators,” to educate and enroll millions of uninsured Americans in either Medicaid or a private insurance plan. Although in many respects these navigators act like insurance agents, they have almost no qualifications or restrictions placed upon them.

The introduction of these “navigators” into the health insurance market raises numerous consumer protection issues. First, it is essential for navigators to provide reliable information to consumers. Erroneous information could lead a consumer to choose a plan without understanding provider network limitations, cost-sharing, or benefits. Further, if a navigator does not correctly explain income reporting requirements, a consumer may get the wrong premium tax credit amount and have to repay some or all of the excess received in a later tax return. Just as importantly, it is critical that navigators preserve the privacy of the extremely sensitive information they will be given by consumers.

My legislation would require “navigators” to apply and obtain certification from the Department of Insurance, and to pass a criminal background check. Additionally, the bill would require training on the specific differences between the appropriate responsibilities of navigators, as opposed to persons licensed to sell and advise on insurance. Further, training would have to include education on Pennsylvania’s privacy laws in addition to HIPAA.

Introduced as SB1268