HOUSE AMENDED
A01633
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
293
Session of
2015
INTRODUCED BY EICHELBERGER, FOLMER, GORDNER, HUTCHINSON, WAGNER,
BARTOLOTTA, VULAKOVICH, WHITE, SCARNATI, ALLOWAY, RAFFERTY,
VOGEL, ARGALL, McGARRIGLE, WARD, BROOKS, BROWNE AND MENSCH,
JANUARY 20, 2015
AS REPORTED FROM COMMITTEE ON INSURANCE, HOUSE OF
REPRESENTATIVES, AS AMENDED, MAY 11, 2015
AN ACT
Regulating navigators and assisters in the education and
promotion of health insurance exchanges.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Navigator and
Exchange Assister Accessibility and Regulation Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Commissioner." The Insurance Commissioner of the
Commonwealth.
"Department." The Insurance Department of the Commonwealth.
"Exchange." A health insurance exchange established or
operating in this Commonwealth, including an exchange
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established or operated by the United States Department of
Health and Human Services, under the Federal health care act.
"Exchange assister." An individual or organization,
including a navigator, navigator organization or certified
application counselor, who provides public education or assists
consumers for or on behalf of an exchange. This term does not
include a licensed insurance producer. This term does not
include an individual employed to provide insurance enrollment
or coverage assistance by a health care facility as defined in
section 103 of act of July 19, 1979 (P.L.130, No.48), known as
the Health Care Facilities Act.
"Federal health care act." The Patient Protection and
Affordable Care Act (Public Law 111-148, 124 Stat. 119), as
amended by the Health Care Education Reconciliation Act of 2010
(Public Law 111-152, 124 Stat. 1029), and regulations or
guidance issued under those acts.
"Insurance producer." Insurance producer has the meaning
given it in section 601-A of the act of May 17, 1921 (P.L.789,
No.285), known as The Insurance Department Act of 1921.
"Navigator." An organization or individual under the Federal
health care act that provides public education or consumer
assistance activities for or on behalf of an exchange to
uninsured individuals and groups seeking health insurance
coverage. The term shall include an individual performing
navigator duties for an organization, association or business
entity, if the organization, association or business entity is
serving as a navigator.
"Negotiate." The term has the same meaning given it in
section 601-A of the act of May 17, 1921 (P.L.789, No.285),
known as The Insurance Department Act of 1921.
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"Registration." A registration certificate issued by the
department under section 3(c).
"Sell." The term has the same meaning given it in section
601-A of the act of May 17, 1921 (P.L.789, No.285), known as The
Insurance Department Act of 1921.
"SHOP Exchange." The term has the same meaning given it in
the Federal health care act.
"Solicit." The term has the same meaning given it in section
601-A of the act of May 17, 1921 (P.L.789, No.285), known as The
Insurance Department Act of 1921.
Section 3. Registration.
(a) Prohibition.--An individual or organization may not
advertise a service as a navigator or an exchange assister or
operate in this Commonwealth as a navigator or an exchange
assister without first registering with the department.
(b) Registration application.--An individual or organization
shall register with the department as a navigator or exchange
assister, on a form approved by the department. The department
shall review each application and may conduct an investigation
of each applicant who applies for a registration in accordance
with this act. The department shall issue a registration, as
appropriate, to an applicant when the department determines that
the applicant:
(1) Is at least 18 years of age.
(2) Resides in this Commonwealth or maintains a
registered place of business in this Commonwealth.
(3) Is not disqualified for having committed an act that
would be grounds for denial, suspension or revocation of a
license as an insurance producer.
(4) Has not had a license as an insurance producer
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denied, suspended or revoked.
(5) Has submitted a completed application.
(6) Has submitted the applicant's fingerprints, for the
department to receive national criminal history records
information from the Criminal Justice Information Services
Division of the Federal Bureau of Investigation.
(7) Has paid the required registration fee and fees for
obtaining national criminal history records information
as prescribed by the department.
(c) Confirmation.--The department shall issue, in paper or
electronic form, a nontransferable registration certification to
each registered navigator or exchange assister, which shall
prominently list the expiration date of the registration and
which must be shown upon request to potential enrollees.
(d) Term.--The term of registration shall be two years from
the date of issue.
(e) Searchable list.--The department shall maintain and make
available to the public a searchable list of all registrants on
its publicly accessible Internet website.
Section 4. Scope of activity.
(a) Registration required.--An individual or organization
may not act or present itself to be a navigator or an exchange
assister unless the individual or organization is registered as
a navigator or an exchange assister under this act.
(b) Authority.--A navigator or an exchange assister may:
(1) Refer an individual to an insurance producer.
(2) Provide information or services related to health
benefit plans or other products other than those offered in
the health insurance marketplace, SHOP Exchange, the
Children's Health Insurance Program or product available
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through the Social Security Act (49 Stat. 620, 42 U.S.C. §
301 et seq.). The navigator or exchange assister shall fairly
provide information under this paragraph about the health
benefit plan or other product in accordance with Federal law
or regulation.
(b) (c) Limitations.--A navigator or an exchange assister
may not engage in an activity for which licensure as a producer
is required, except as explicitly permitted by Federal law or
regulation, including any of the following:
(1) Sell, solicit or negotiate insurance.
(2) Urge or advise a prospective purchaser to buy a
particular policy or to insure with a particular company.
(3) Initiate sales over the telephone or otherwise.
(4) Collect premiums.
(5) Make or propose to make an insurance contract.
(6) Other than as necessary to inform a prospective
purchaser of the availability of health insurance off the
exchange, provide information or services related to health
benefit plans or other products other than those offered in
the health insurance marketplace, SHOP Exchange, the
Children's Health Insurance Program or product available
through the Social Security Act (49 Stat. 620, 42 U.S.C. §
301 et seq.).
(7) Initiate an inquiry as to the terms of existing
coverage.
(8) (7) (6) Recommend or initiate additions or deletions
to an insured's policy.
(9) (8) (7) Sign binders, endorsements and insurance
policies.
(10) (9) Authorize the issuance or delivery of (8)
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Issue or deliver certificates of insurance, endorsements,
binders or insurance policies on insurance identification
cards.
(11) Respond to a policyholder's request for advice or
counsel regarding policy provisions or coverage.
Section 5. Enforcement by department.
(a) Notice.--Upon evidence of a violation of this act or
Article VI-A of the act of May 17, 1921 (P.L.789, No.285), known
as The Insurance Department Act of 1921, the department shall
notify the person of the alleged violation. The notice shall
specify the nature of the alleged violation and fix a time and
place, at least 10 days thereafter, when a hearing on the matter
shall be held.
(b) Hearing.--The department shall conduct the hearing on
the violation in accordance with 2 Pa.C.S. Ch. 5 Subch. A
(relating to practice and procedure of Commonwealth agencies).
(c) Evidence.--A person may not be excused from testifying
or from producing any books, papers, contracts, agreements or
documents at any hearing held by the commissioner on the ground
that the testimony or evidence may tend to incriminate that
person.
(d) Penalties.--After the hearing or upon failure of the
person to appear at the hearing, if a violation is found, the
commissioner may, in addition to any penalty which may be
imposed by a court, do any combination of the following deemed
appropriate:
(1) Deny, suspend, refuse to renew or revoke the
registration, if any, of the person.
(2) Impose a civil penalty of up to $5,000 for each
violation of this act.
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(3) Impose an order to cease and desist.
(4) Report violations of this act to the United States
Department of Health and Human Services.
(5) Refer potential violations of any laws of this
Commonwealth relating to privacy of personal information to
the Office of Attorney General.
(6) Enforce other violations of The Insurance Department
Act of 1921, as applicable.
(7) Impose any other conditions the commissioner deems
appropriate.
(e) Regulations and form.--The department may promulgate
regulations and publish forms as necessary and appropriate to
carry out this act.
Section 6. Effective date.
This act shall take effect February 15, 2016, or the close of
the 2016 open enrollment period, whichever is later.
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