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Regular Session, 2013
HOUSE BILL NO. 614
BY REPRESENTATIVE HUVAL
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
INSURANCE/HEALTH: Provides for licensing and regulation of individuals and entities
as health insurance navigators for a health benefit exchange
AN ACT1
To enact R.S. 22:1566, relative to health insurance navigators; to provide for definitions; to2
provide with respect to licensing and regulation by the commissioner of insurance3
of individuals and entities as navigators for health benefit exchanges, including the4
authority of the commissioner to assess fees and impose penalties; and to provide for5
related matters.6
Be it enacted by the Legislature of Louisiana:7
Section 1. R.S. 22:1566 is hereby enacted to read as follows: 8
ยง1566. Health insurance navigators9
A. As used in this Section:10
(1) "Exchange" means any health benefit exchange established or operating11
in this state, including any exchange established or operated by the United States12
Department of Health and Human Services.13
(2) "Navigator" means any individual or entity, other than an insurance14
producer, who does at least one of the following:15
(a) Receives any funding, directly or indirectly, from an exchange, the state,16
or the federal government to perform any of the activities and duties identified in 4217
U.S.C. 18031(i).18
(b) Facilitates enrollment of individuals or employers in health benefit plans19
or public insurance programs offered through an exchange.20 HLS 13RS-993 ORIGINAL
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(c) Conducts public education or consumer assistance activities for or on1
behalf of an exchange.2
(d) Is described or designated by an exchange, the state, or the United States3
Department of Health and Human Services, or could reasonably be described or4
designated as a navigator, in-person assister, enrollment assister, application assister,5
or application counselor.6
B.(1) The Louisiana legislature finds that licensing and regulating navigators7
and navigator entities authorized under the federal Patient Protection and Affordable8
Care Act to ensure that they are properly trained and knowledgeable in the subject9
matter of individual and group health insurance benefit plans and insurance10
coverages is necessary to avoid substantial risk to the health, safety, and welfare of11
this state.12
(2) No individual or entity shall act as, offer to act as, or advertise any13
service as a navigator in this state unless licensed as a navigator by the commissioner14
of insurance under this Section.15
(3) Any individual or entity that is a navigator shall be subject to regulation16
by the commissioner of insurance as provided in this Section.17
C.(1) An individual applying for a navigator license shall make application18
to the commissioner of insurance on a form developed by the commissioner and19
declare under penalty of refusal, suspension, or revocation of the license that the20
statements made in the application are true, correct, and complete to the best of the21
individual's knowledge and belief. Before approving the application, the22
commissioner shall find that the individual meets each of the following23
requirements:24
(a) Is at least eighteen years of age.25
(b) Resides in this state or maintains his principal place of business in the26
state.27 HLS 13RS-993 ORIGINAL
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(c) Is not disqualified for having committed any act that would be grounds1
for denial, suspension, or revocation of an insurance producer license under R.S.2
22:1554.3
(d) Has not had an insurance producer license, a navigator license, or an4
equivalent license or certification denied, suspended, or revoked in any state,5
province, district, or territory.6
(e) Has completed at least sixteen hours of pre-licensing training prescribed7
by the commissioner.8
(f) Has successfully passed the written examination prescribed by the9
commissioner.10
(g) Has submitted a full set of fingerprints to the commissioner and11
successfully completed a criminal history and regulatory record check in a manner12
prescribed by the commissioner.13
(h) When applicable, has the written consent of the commissioner pursuant14
to 18 U.S.C. 1033, or any successor statute regulating crimes by or affecting persons15
engaged in the business of insurance whose activities affect interstate commerce.16
(i) Possesses the requisite character and integrity.17
(j) Has identified the entity with which he is affiliated and supervised.18
(k) Has paid the fees prescribed by the commissioner.19
(2) An entity that acts as a navigator, supervises or is responsible for the20
activities of individual navigators, or receives funding to perform such activities21
shall obtain a navigator entity license from the commissioner. An entity applying22
for a navigator entity license shall:23
(a) Make application for licensure on a form containing information24
prescribed by the commissioner.25
(b) Designate an individual licensed as a navigator to be responsible for the26
entity's compliance with this Section.27 HLS 13RS-993 ORIGINAL
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(3) The commissioner may require any documents deemed necessary to1
verify the information contained in an application submitted in accordance with this2
Subsection.3
(4) Entities licensed as navigators shall, in a manner prescribed by the4
commissioner, periodically provide the commissioner with a list of all individual5
navigators that it employs, supervises, or is affiliated with.6
(5) Prior to any exchange becoming operational in this state, the7
commissioner shall prescribe pre-licensing training, continuing education, and8
written examination standards and requirements for navigators.9
D.(1) A navigator license shall be valid for two years.10
(2) A navigator shall file an application for renewal of a license in a method11
prescribed by the commissioner and pay the renewal fee prescribed by the12
commissioner. Any navigator who fails to file timely for license renewal shall be13
charged a late fee in an amount prescribed by the commissioner.14
(3) Prior to the filing date for application for renewal of a license, an15
individual licensee shall comply with at least sixteen hours of ongoing training and16
continuing education requirements, including three hours of ethics training17
prescribed by the commissioner. Such navigator shall file with the commissioner,18
by a method prescribed by the commissioner, satisfactory certification of completion19
of the continuing education requirements. Any failure to fulfill the ongoing training20
and continuing education requirements shall result in the expiration of the license.21
E.(1) A navigator shall not do any of the following:22
(a) Engage in any activities that would require an insurance producer license.23
(b) Provide advice concerning the benefits, terms, and features of a particular24
health benefit plan or offer advice about which health benefit plan is better or worse25
or suitable for a particular individual or employer.26
(c) Recommend or endorse a particular health benefit plan or advise27
consumers about which health benefit plan to choose.28 HLS 13RS-993 ORIGINAL
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(d) Provide any information or services related to health benefit plans or1
other products not offered in the exchange.2
(e) Accept any compensation or consideration that is dependent on whether3
a person enrolls in or purchases a health benefit plan.4
(2) Only a person licensed as an insurance producer in this state may do any5
of the following:6
(a) Sell, solicit, or negotiate health insurance.7
(b) Provide advice concerning the benefits, terms, and features of a particular8
health benefit plan or offer advice about which health benefit plan is better or worse9
for a particular individual or employer.10
(c) Recommend a particular health benefit plan or advise consumers about11
which health benefit plan to choose.12
(3) Upon contact with a person who acknowledges having existing health13
insurance coverage obtained through an insurance producer, a navigator shall refer14
the person back to that insurance producer for information, assistance, and any other15
services.16
F.(1) The commissioner may place on probation, suspend, revoke, or refuse17
to issue, renew, or reinstate a navigator license, or may levy a fine not to exceed five18
hundred dollars for each violation, or any combination of actions, for any one or19
more of the causes set forth in Paragraph (E)(1) of this Section or R.S. 22:1554, or20
for other good cause.21
(2) In addition to imposing the penalties authorized by this Subsection, the22
commissioner may require that restitution be made to any person who has suffered23
financial injury because of a violation of this Section.24
(3) The commissioner shall have power to examine and investigate the25
business affairs and records of any navigator to determine whether the individual or26
entity has engaged or is engaging in any violation of this Section.27
(4) A navigator entity license may be suspended or revoked, or renewal or28
reinstatement thereof may be refused, or a fine may be levied, with or without a29 HLS 13RS-993 ORIGINAL
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suspension, revocation, or refusal to renew a license, if the commissioner finds that1
an individual navigator licensee's violation was known or should have been known2
by the employing or supervising entity and the violation was not reported to the3
commissioner on a timely basis.4
(5) In the event that the commissioner suspends or revokes a license, refuses5
the renewal or reinstatement of a license, or levies a fine, with or without suspension,6
revocation, or refusal to renew a license, the commissioner, in accordance and7
compliance with R.S. 49:961, shall notify the licensee in writing of the8
determination. An aggrieved party affected by the commissioner's decision, act, or9
order may demand a hearing in accordance with Chapter 12 of this Title, R.S.10
22:2191 et seq.11
G.(1) Each licensed navigator shall report to the commissioner any12
administrative action taken by a governmental agency against him in any jurisdiction13
within thirty calendar days of the final disposition of the matter. This report shall14
include a copy of the order or other relevant legal documents.15
(2) Within thirty days of the initial pretrial hearing date, a navigator shall16
report to the commissioner of insurance any criminal prosecution of the navigator17
taken in any jurisdiction. The report shall include a copy of the initial complaint18
filed, the order resulting from the hearing, and any other relevant legal documents.19
(3) An entity that acts as a navigator that terminates the employment,20
engagement, affiliation, or other relationship with an individual navigator shall21
notify the commissioner of insurance within thirty days following the effective date22
of the termination, using a format prescribed by the commissioner, if the reason for23
termination is one of the reasons set forth in R.S. 22:1554 or the entity has24
knowledge that the navigator was found by a court or governmental agency to have25
engaged in any of the activities set forth in R.S. 22:1554. Upon the written request26
of the commissioner, the entity shall provide additional information, documents,27
records, or other data pertaining to the termination or activity of the individual.28 HLS 13RS-993 ORIGINAL
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H. The requirements of R.S. 22:1964, and any related rules, shall apply to1
navigators. The activities and duties of a navigator shall be deemed to constitute2
transacting the business of insurance.3
I. The requirements of this Section shall not apply to any individual or entity4
licensed as an insurance producer in this state.5
J. The commissioner may, pursuant to the Administrative Procedure Act,6
R.S. 49:950, adopt and promulgate such rules and regulations as may be necessary7
or appropriate for the administration and enforcement of this Section.8
Section 2. This Act shall become effective upon signature by the governor or, if not9
signed by the governor, upon expiration of the time for bills to become law without signature10
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If11
vetoed by the governor and subsequently approved by the legislature, this Act shall become12
effective on the day following such approval.13
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
Huval HB No. 614
Abstract: Provides with respect to licensing and regulation by the commissioner of
insurance of individuals and entities as navigators for a health benefit exchange
authorized under the federal Patient Protection and Affordable Care Act.
Proposed law for licensing and regulation by the commissioner of insurance of individuals
and entities as navigators for a health benefit exchange authorized under the federal Patient
Protection and Affordable Care Act (PPACA), as follows:
(1)Requires that an individual navigator affiliated with such an exchange meet certain
qualifications, including completion of 16 hours of pre-licensing training, passage
of an examination, licensure by the commissioner of insurance, and payment of fees
prescribed by the commissioner.
(2)Requires that an entity that acts as a navigator, supervises or is responsible for the
activities of individual navigators, or receives funding to perform such activities
shall obtain a navigator entity license. Further requires that such an entity make
application for licensure and designate an individual licensed as a navigator to be
responsible for its compliance with proposed law.
(3)Provides that a navigator license shall be valid for two years. Further provides
relative to the application for license renewal as well as renewal fees and late fees.
Requires individual licensees to comply with certain ongoing training and continuing
education requirements. HLS 13RS-993 ORIGINAL
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(4)Prohibits certain acts by navigators and specifies that only an insurance producer
(agent) may: (a) sell, solicit, or negotiate health insurance; (b) provide advice
concerning the terms, of a particular health benefit plan or offer advice about which
health benefit plan is better or worse for a particular individual or employer; or (c)
recommend a particular health benefit plan or advise consumers about which health
benefit plan to choose. Further requires that a navigator, upon contact with a person
who acknowledges having existing health insurance coverage obtained through an
insurance producer, refer the person back to that insurance producer for information,
assistance, and any other services.
(5)Authorizes the commissioner to place on probation, suspend, revoke, or refuse to
issue, renew, or reinstate a navigator license, or to levy a fine not to exceed $500 for
each violation, or any combination of actions, for any cause set forth in present law
relative to grounds for denial, nonrenewal, or revocation of a producer license, or
for other good cause. Also authorizes the commissioner to require that restitution
be made to any person who has suffered financial injury because of a violation of
proposed law. Additionally, gives the commissioner the authority to examine and
investigate the business affairs and records of any navigator to determine whether
the individual or entity has engaged or is engaging in any violation of proposed law.
Specifies that a navigator entity license may be suspended or revoked, renewal or
reinstatement thereof may be refused, or a fine may be levied if the commissioner
finds that an individual navigator licensee's violation was known or should have been
known by such entity and that the violation was not reported to the commissioner on
a timely basis. Provides for notice to an applicant or licensee of any such action by
the commissioner and provides for an opportunity to be heard pursuant to present
law.
(6)Requires that each navigator report to the commissioner any administrative action
taken by a governmental agency against him or any criminal prosecution of him
taken in any jurisdiction. Specifies that an entity acting as a navigator that terminates
its relationship with an individual navigator shall notify the commissioner if the
reason for termination is one of the reasons set forth in present law relative to
grounds for denial, nonrenewal, or revocation of a producer license or if the entity
has knowledge that the navigator was found by a court or governmental agency to
have engaged in any activities that constitute such grounds.
(7)Provides that present law relative to unfair trade practices in the business of
insurance shall apply to navigators. Further provides that the activities of a navigator
shall be deemed to constitute transacting the business of insurance.
(8)Provides that proposed law shall not apply to any individual or entity licensed as an
insurance producer in this state.
(9)Authorizes the commissioner to adopt and promulgate rules necessary for the
administration and enforcement of proposed law.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Adds R.S. 22:1566)