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"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"Commissioner."  The Insurance Commissioner of the
16Commonwealth.

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

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

<-6"Exchange assister." An individual or organization,
7including a navigator, navigator organization or certified
8application counselor, who provides public education or assists
9consumers for or on behalf of an exchange. This term does not
10include a licensed insurance producer.

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

<-16"Health insurance carrier."  An entity, subject to the
17insurance laws of this Commonwealth or under the jurisdiction of
18the Insurance Commissioner, that contracts or offers to contract
19to provide, deliver, arrange for, pay for or reimburse any of
20the cost of a health care service. The term includes an entity
21organized under:

22(1) The act of May 17, 1921 (P.L.682, No.284), known as 
23The Insurance Company Law of 1921, including section 630 and 
24Article XXIV thereof.

25(2) The act of December 29, 1972 (P.L.1701, No.364),
26known as the Health Maintenance Organization Act.

27(3) 40 Pa.C.S. Chs. 61 (relating to hospital plan
28corporations) and 63 (relating to professional health
29services plan corporations).

30"Health insurance producer." An insurance producer with an

1accident and health line of authority as defined in section 601-
2A of the act of May 17, 1921 (P.L.789, No.285), known as The
3Insurance Department Act of 1921.

4"Insurance producer." Insurance producer has the meaning
5given it in section 601-A of the act of May 17, 1921 (P.L.789,
6No.285), known as The Insurance Department Act of 1921.

7"Navigator." An organization or individual under the Federal
8health care act that provides public education or consumer
9assistance activities for or on behalf of an exchange to
10uninsured individuals and groups seeking health insurance
11coverage. The term shall include an individual performing
12navigator duties for an organization, association or business
13entity, if the organization, association or business entity is
14serving as a navigator.

15"Negotiate." The term has the same meaning given it in
16section 601-A of the act of May 17, 1921 (P.L.789, No.285),
17known as The Insurance Department Act of 1921.

<-18"Qualified employer." The term has the same meaning given it
19in the Federal health care act.

20"Qualified health plan." The term has the same meaning given
21it in the Federal health care act.

22"Qualified individual." The term has the same meaning given
23it in the Federal health care act.

<-24"Registration." A registration certificate issued by the
25department under section 3(c).

26"Sell."  The term has the same meaning given it in section
27601-A of the act of May 17, 1921 (P.L.789, No.285), known as The 
28Insurance Department Act of 1921.

29"Shop exchange."  The term has the same meaning given it in
30the Federal health care act.

<-1"Small employer." An employer that purchasers accident and
2health insurance in the small group market, as defined in
3section 2791(e)(5) of the Public Health Service Act (110 Stat.
41972, 42 U.S.C. § 300gg-91(e)(5)), except that for plan years
5beginning prior to January 1, 2016, or other date as established
6in Federal law, 50 employees shall be required.

7"Solicit."  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.

10Section 3. Registration.

11(a)  Prohibition.--An individual or organization may not
12advertise a service as a navigator or an exchange assister or
13operate in this Commonwealth as a navigator or an exchange 
14assister without first registering with the department.

15(b)  Registration application.--An individual or organization 
16shall register with the department as a navigator or exchange 
17assister, on a form approved by the department. The department
18shall review each application and may conduct an investigation
19of each applicant who applies for a registration in accordance
20with this act. The department shall issue a registration, as
21appropriate, to an applicant when the department determines that
22the applicant:

23(1)  Is at least 18 years of age.

24(2)  Resides in this Commonwealth or maintains a
25registered place of business in this Commonwealth.

26(3)  Is not disqualified for having committed an act that
27would be grounds for denial, suspension or revocation of a
28license as an insurance producer.

29(4)  Has not had a license as an insurance producer
30denied, suspended or revoked.

1(5)  Has submitted a completed application.

2(6)  Has submitted the applicant's fingerprints, for the
3department to receive national criminal history records
4information from the Criminal Justice Information Services
5Division of the Federal Bureau of Investigation.

6(7) Has paid the required registration fee and fees for
7obtaining national criminal history records information
8as prescribed by the department.

<-9(b) <-(c)  Confirmation.--The department shall issue, in paper
10or electronic form, a nontransferable registration certification 
<-11to each registered navigator or exchange assister, which shall
12prominently list the expiration date of the registration and
13which must be shown upon request to potential enrollees.

<-14(c) <-(d)  Term.--The term of registration shall be two years
15from the date of issue.

<-16(d) <-(e) Searchable list.--The department shall maintain and 
17make available to the public a searchable list of all 
18registrants on its publicly accessible Internet website.

19Section 4.  Scope of activity.

20(a)  Registration required.--An individual or organization
21may not act or present itself to be a navigator or an exchange 
22assister unless the individual or organization is registered as
23a navigator or an exchange assister under this act.

24(b)  Limitations.--A navigator or an exchange assister may
25not engage in an activity for which licensure as a producer is
26required, except as explicitly permitted by Federal law or
27regulation, including any of the following:

28(1)  Sell, solicit or negotiate insurance.

<-29(2) Discuss the effect of age, health or other risk-
30related conditions of the prospective policyholders.

1(3) <-(2) Urge or advise a prospective purchaser to buy a
2particular policy or to insure with a particular company.

<-3(4) <-(3) Initiate sales over the telephone or otherwise.

<-4(5) <-(4) Collect premiums.

<-5(6) <-(5) Make or propose to make an insurance contract.

<-6(7) <-(6) Other than as necessary to inform a prospective
7purchaser of the availability of health insurance off the
8exchange, provide information or services related to health
9benefit plans or other products other than those offered in
10the health insurance marketplace, SHOP exchange, the
11Children's Health Insurance Program or product available
12through the Social Security Act (49 Stat. 620, 42 U.S.C. §301
13et seq.).

<-14(8) <-(7) Initiate an inquiry as to the terms of existing
15coverage.

<-16(9) Discuss or describe the specific coverages or terms
17of a proposed contract of insurance with a prospective
18policyholder, including counseling as to which coverages to
19buy.

20(10) <-(8) Recommend or initiate additions or deletions to
21an insured's policy.

<-22(11) <-(9) Sign binders, endorsements and insurance
23policies.

<-24(12) <-(10) Authorize the issuance or delivery of
25certificates of insurance, endorsements, binders or insurance
26policies on insurance identification cards.

<-27(13) <-(11) Respond to a policyholder's request for advice
28or counsel regarding policy provisions or coverage.

29Section 5.  Enforcement by department.

30(a) Notice.--Upon evidence of a violation of this act or

1Article VI-A of the act of May 17, 1921 (P.L.789, No.285), known
2as The Insurance Department Act of 1921, the department shall
3notify the person of the alleged violation. The notice shall
4specify the nature of the alleged violation and fix a time and
5place, at least ten days thereafter, when a hearing on the
6matter shall be held.

7(b) Hearing.--The department shall conduct the hearing on
8the violation in accordance with 2 Pa.C.S. Ch. 5 Subch. A
9(relating to practice and procedure of Commonwealth agencies).

10(c) Evidence.--No person shall be excused from testifying or
11from producing any books, papers, contracts, agreements or
12documents at any hearing held by the commissioner on the ground
13that the testimony or evidence may tend to incriminate that
14person.

15(d)  Penalties.--After the hearing or upon failure of the
16person to appear at the hearing, if a violation is found, the
17commissioner may, in addition to any penalty which may be
18imposed by a court, do any combination of the following deemed
19appropriate:

20(1) Deny, suspend, refuse to renew or revoke the
21registration, if any, of the person.

22(2)  Impose a civil penalty of up to $5,000 for each
23violation of this act.

24(3) Impose an order to cease and desist.

25(4) Report violations of this act to the United States
26Department of Health and Human Services.

27(5) Refer potential violations of any laws of this
28Commonwealth relating to privacy of personal information to
29the Office of Attorney General.

30(6) Enforce other violations of The Insurance Department

1Act of 1921, as applicable.

2(7) Impose any other conditions the commissioner deems
3appropriate.

4(e)  Regulations and form.--The department may promulgate
5regulations and publish forms as necessary and appropriate to
6carry out this act.

7Section 6.  Effective date.

8This act shall take effect February 15, 2015, or the close of 
9the 2015 open enrollment period, whichever is later.