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) Defines a navigator as any individual or entity, except for a licensed health insurance
producer, unless the licensed health insurance producer has been certified or approved by
an exchange or the U. S. Department of Health and Human Services (HHS) as a
navigator, who does at least one of the following:
(a)Receives any funding, directly or indirectly, from an exchange, the state, or the
federal government to perform any of the activities and duties identified in
PPACA.
(b)Facilitates enrollment of individuals or employers in health benefit plans or public
insurance programs offered through an exchange.
(c)Conducts public education or consumer assistance activities for or on behalf of an
exchange.
(d)Is described or designated by an exchange, the state, or HHS, or could reasonably
be described or designated as a navigator, in-person assister, enrollment assister,
application assister, or application counselor.
(2)Requires that an applicant for an individual navigator license meet certain qualifications,
including passage of an examination, completion of three hours of ethics continuing
education, and payment of an initial license application fee of $75.
(3)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, pay a $75 initial license application fee, and designate an individual licensed as
a navigator to be responsible for its compliance with proposed law. (4)Prior to any exchange becoming operational in this state, requires the commissioner to
prescribe pre-licensing training, continuing education, and written examination standards
and requirements for navigators. Further authorizes the commissioner to adopt any
education, training, or examinations approved or administered by the exchange or HHS.
(5)Authorizes the commissioner, in order to make a determination of license eligibility, to
require fingerprints and a criminal history record check on each applicant. Specifies that
such fingerprints and information shall be exempt from the public records law, shall not
be subject to subpoena, other than a subpoena issued in a criminal proceeding or
investigation, shall be confidential by law and privileged, and shall not be subject to
discovery or admissible in evidence in any private civil action.
(6)Provides that a navigator license shall be valid for one year. Further provides relative to
the application for license renewal and sets the renewal fee at $50. Requires individual
licensees to comply with certain ongoing training and continuing education requirements
prior to renewal.
(7)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.
(8)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. 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.
(9)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.
(10)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.
(11)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.
(Amends R.S. 44:4.1(B)(11); Adds R.S. 22:821(B)(36) and 1566)
Summary of Amendments Adopted by House
Committee Amendments Proposed by House Committee on Insurance to the original bill.
1. Changed definition of "navigator" to include a licensed health insurance producer
who has been certified or approved by an exchange or HHS as a navigator. Also
deleted provisions making proposed law inapplicable to licensed insurance producers.
2. Changed training requirements for individuals applying for a navigator license from at
least 16 hours of pre-licensing training to all required training and education
prescribed by HHS or other appropriate entity or prescribed by the commissioner, in
addition to three hours of ethics continuing education.
3. Added authorization for the commissioner to adopt any education, training, or
examinations approved or administered by the exchange or HHS.
4. Set license application and renewal fees for navigators at $75 and $50, respectively,
rather than allowing the commissioner to set them. Also shortened term of the license
from two years to one year.
5. Added more detailed provisions relative to the commissioner requiring fingerprints
and criminal background checks of navigators, including a public records exemption
for such information.
6. Deleted authorization for the commissioner to require that restitution be made to any
person who has suffered financial injury because of a violation of proposed law.