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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 amend and reenact R.S. 44:4.1(B)(11) and to enact R.S. 22:821(B)(36) and 1566,2
relative to health insurance navigators; to provide for definitions; to provide with3
respect to licensing and regulation by the commissioner of insurance of individuals4
and entities as navigators for health benefit exchanges, including the authority of the5
commissioner to assess fees and impose penalties; to provide for an exemption from6
the Public Records Law; and to provide for related matters.7
Be it enacted by the Legislature of Louisiana:8
Section 1. R.S. 22:821(B)(36) and 1566 are hereby enacted to read as follows: 9
§821. Fees10
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B. The following fees and licenses shall be collected in advance by the12
commissioner of insurance: 13
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(36) Health insurance navigators15
(a) Initial license application.....................................$75.0016
(b) Renewal...............................................................$50.0017
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§1566. Health insurance navigators1
A. As used in this Section:2
(1) "Exchange" means any health benefit exchange established or operating3
in this state, including any exchange established or operated by the United States4
Department of Health and Human Services.5
(2) "Navigator" means any individual or entity, except for a licensed health6
insurance producer, unless the licensed health insurance producer has been certified7
or approved by an exchange or the United States Department of Health and Human8
Services as a navigator, who meets at least one of the following requirements:9
(a) Receives any funding, directly or indirectly, from an exchange, the state,10
or the federal government to perform any of the activities and duties identified in 4211
U.S.C. 18031(i).12
(b) Facilitates enrollment of individuals or employers in health benefit plans13
or public insurance programs offered through an exchange.14
(c) Conducts public education or consumer assistance activities for or on15
behalf of an exchange.16
(d) Is described or designated by an exchange, the state, or the United States17
Department of Health and Human Services, or could reasonably be described or18
designated as a navigator, in-person assister, enrollment assister, application assister,19
or application counselor.20
B.(1) The Louisiana Legislature finds that licensing and regulating21
navigators and navigator entities authorized under the federal Patient Protection and22
Affordable Care Act to ensure that they are properly trained and knowledgeable in23
the subject matter of individual and group health insurance benefit plans and24
insurance coverages is necessary to avoid substantial risk to the health, safety, and25
welfare of this state.26
(2) No individual or entity shall act as, offer to act as, or advertise any27
service as a navigator in this state unless licensed as a navigator by the commissioner28
of insurance under this Section.29 HLS 13RS-993 RE-REENGROSSED
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(3) Any individual or entity that is a navigator shall be subject to regulation1
by the commissioner of insurance as provided in this Section.2
C.(1) An individual applying for a navigator license shall make application3
to the commissioner of insurance on a form developed by the commissioner and4
declare under penalty of refusal, suspension, or revocation of the license that the5
statements made in the application are true, correct, and complete to the best of the6
individual's knowledge and belief. Before approving the application, the7
commissioner shall verify that the individual meets each of the following8
requirements:9
(a) Is at least eighteen years of age.10
(b) Intends to conduct business as a navigator in this state.11
(c) Is not disqualified for having committed any act that would be grounds12
for denial, suspension, or revocation of an insurance producer license under13
R.S. 22:1554.14
(d) Has not had a navigator license or an equivalent license or certification15
denied, suspended, or revoked in any state, province, district, or territory of the16
United States.17
(e) Has completed all required training and education prescribed by the18
United States Department of Health and Human Services or other appropriate entity19
or prescribed by the commissioner.20
(f) Has successfully passed the written examination and completed three21
hours of ethics continuing education as prescribed by the commissioner.22
(g) Has submitted a full set of fingerprints to the commissioner and23
successfully completed a criminal history and regulatory record check as further24
provided in Subsection D of this Section.25
(h) When applicable, has the written consent of the commissioner pursuant26
to 18 U.S.C. 1033, or any successor statute regulating crimes by or affecting persons27
engaged in the business of insurance whose activities affect interstate commerce.28
(i) Possesses the requisite character and integrity.29 HLS 13RS-993 RE-REENGROSSED
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(j) Has identified the entity with which he is affiliated and supervised.1
(k) Has paid the initial license application fee provided for in R.S.2
22:821(B)(36).3
(2) An entity that acts as a navigator, supervises or is responsible for the4
activities of individual navigators, or receives funding to perform such activities5
shall obtain a navigator entity license from the commissioner. An entity applying6
for a navigator entity license shall:7
(a) Make application for licensure on a form containing information8
prescribed by the commissioner and pay the initial license application fee provided9
for in R.S. 22:821(B)(36).10
(b) Designate an individual licensed as a navigator to be responsible for the11
entity's compliance with this Section.12
(3) The commissioner may require any documents deemed necessary to13
verify the information contained in an application submitted in accordance with this14
Subsection.15
(4) Each entity licensed as a navigator shall, in a manner prescribed by the16
commissioner, periodically provide the commissioner with a list of all individual17
navigators that it employs, supervises, or with whom it is affiliated.18
(5) Prior to any exchange becoming operational in this state, the19
commissioner shall prescribe pre-licensing training, continuing education, and20
written examination standards and requirements for navigators.21
(6) The commissioner may adopt, by rule or regulation promulgated and22
adopted pursuant to the Administrative Procedure Act, R.S. 49:950 et seq., any23
education, training, or examinations approved or administered by the exchange or24
the United States Department of Health and Human Services.25
D.(1) In order to make a determination of license eligibility, the26
commissioner shall require fingerprints of applicants and submit the fingerprints and27
the fees required to perform the criminal history record checks to the Louisiana28
Bureau of Criminal Identification and Information for state and national criminal29 HLS 13RS-993 RE-REENGROSSED
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history record checks. The commissioner shall require a criminal history record1
check on each applicant in accordance with this Subsection. The commissioner shall2
require each applicant to submit a full set of fingerprints in order for the3
commissioner to obtain and receive National Criminal History Records from the4
Criminal Justice Information Services Division of the Federal Bureau of5
Investigation.6
(2) The commissioner may contract for the collection, transmission, and7
resubmission of fingerprints required under this Subsection. If the commissioner8
does so, the fee for collecting and transmitting fingerprints and the fee for the9
criminal history record check shall be payable directly to the contractor by the10
applicant. The commissioner may agree to a reasonable fingerprinting fee to be11
charged by the contractor.12
(3) The commissioner shall treat and maintain an applicant's fingerprints and13
any criminal history record information obtained under this Section as confidential14
and shall apply security measures consistent with the Criminal Justice Information15
Services Division of the Federal Bureau of Investigation standards for the electronic16
storage of fingerprints and necessary identifying information and limit the use of17
records solely to the purposes authorized in this Section. The fingerprints and any18
criminal history record information shall be exempt from the Public Records Law,19
R.S. 44:1 et seq., shall not be subject to subpoena, other than a subpoena issued in20
a criminal proceeding or investigation, shall be confidential by law and privileged,21
and shall not be subject to discovery or admissible in evidence in any private civil22
action.23
E.(1) A navigator license shall be valid for one year.24
(2) A navigator shall file an application for renewal of a license in a method25
prescribed by the commissioner and pay the renewal fee provided for in R.S.26
22:821(B)(36). Any navigator who fails to file timely for license renewal shall be27
charged a late fee in an amount prescribed by the commissioner.28 HLS 13RS-993 RE-REENGROSSED
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(3) Prior to the filing date for application for renewal of a license, an1
individual licensee shall comply with at least sixteen hours of ongoing training and2
continuing education requirements, including three hours of ethics training3
prescribed by the commissioner. Such navigator shall file with the commissioner,4
by a method prescribed by the commissioner, satisfactory certification of completion5
of the continuing education requirements. Any failure to fulfill the ongoing training6
and continuing education requirements shall result in the expiration of the license.7
F.(1) A navigator shall not do any of the following:8
(a) Engage in any activities that would require a health and accident9
insurance producer license.10
(b) Provide advice concerning the benefits, terms, and features of a particular11
health benefit plan or offer advice about which health benefit plan is better or worse12
or suitable for a particular individual or employer.13
(c) Recommend or endorse a particular health benefit plan or advise14
consumers about which health benefit plan to choose.15
(d) Provide any services related to health benefit plans or other products not16
offered in the exchange.17
(e) Accept any compensation or consideration that is dependent on whether18
a person enrolls in or purchases a health benefit plan.19
(2) Only a person licensed as an insurance producer in this state may do any20
of the following:21
(a) Sell, solicit, or negotiate health insurance.22
(b) Provide advice concerning the benefits, terms, and features of a particular23
health benefit plan or offer advice about which health benefit plan is better or worse24
for a particular individual or employer.25
(c) Recommend a particular health benefit plan or advise consumers about26
which health benefit plan to choose.27
(3) Upon contact with a person who acknowledges having existing health28
insurance coverage obtained through an insurance producer, a navigator shall refer29 HLS 13RS-993 RE-REENGROSSED
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the person back to that insurance producer for information, assistance, and any other1
services.2
G.(1) The commissioner may place on probation, suspend, revoke, or refuse3
to issue, renew, or reinstate a navigator license, or may levy a fine not to exceed five4
hundred dollars for each violation, or any combination of actions, for any one or5
more of the causes set forth in Paragraph (F)(1) of this Section or R.S. 22:1554, or6
for other good cause.7
(2) The commissioner may examine and investigate the business affairs and8
records of any navigator to determine whether the individual or entity has engaged9
or is engaging in any violation of this Section.10
(3) A navigator entity license may be suspended or revoked, or renewal or11
reinstatement thereof may be refused, or a fine may be levied, with or without a12
suspension, revocation, or refusal to renew a license, if the commissioner finds that13
an individual navigator licensee's violation was known or should have been known14
by the employing or supervising entity and the violation was not reported to the15
commissioner on a timely basis.16
(4) In the event that the commissioner suspends or revokes a license, refuses17
the renewal or reinstatement of a license, or levies a fine, with or without suspension,18
revocation, or refusal to renew a license, the commissioner, in accordance and19
compliance with R.S. 49:961, shall notify the licensee in writing of the20
determination. An aggrieved party affected by the commissioner's decision, act, or21
order may demand a hearing in accordance with Chapter 12 of this Title, R.S.22
22:2191 et seq.23
H.(1) Each licensed navigator shall report to the commissioner any24
administrative action taken by a governmental agency against him in any jurisdiction25
within thirty calendar days of the final disposition of the matter. This report shall26
include a copy of the order or other relevant legal documents.27
(2) Within thirty days of the initial pretrial hearing date, a navigator shall28
report to the commissioner of insurance any criminal prosecution of the navigator29 HLS 13RS-993 RE-REENGROSSED
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instituted in any jurisdiction. The report shall include a copy of the initial complaint1
filed, the order resulting from the hearing, and any other relevant legal documents.2
(3) An entity that acts as a navigator that terminates the employment,3
engagement, affiliation, or other relationship with an individual navigator shall4
notify the commissioner of insurance within thirty days following the effective date5
of the termination, using a format prescribed by the commissioner, if the reason for6
termination is one of the reasons set forth in R.S. 22:1554 or the entity has7
knowledge that the navigator was found by a court or governmental agency to have8
engaged in any of the activities set forth in R.S. 22:1554. Upon the written request9
of the commissioner, the entity shall provide additional information, documents,10
records, or other data pertaining to the termination or activity of the individual.11
I. The provisions of R.S. 22:1964, and any related rules, shall apply to12
navigators. The activities and duties of a navigator shall be deemed to constitute13
transacting the business of insurance.14
J. The commissioner may, pursuant to the Administrative Procedure Act,15
R.S. 49:950 et seq., adopt and promulgate such rules and regulations as may be16
necessary or appropriate for the administration and enforcement of this Section.17
Section 2. R.S. 44:4.1(B)(11) is hereby amended and reenacted to read as follows:18
§4.1. Exceptions19
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B. The legislature further recognizes that there exist exceptions, exemptions,21
and limitations to the laws pertaining to public records throughout the revised22
statutes and codes of this state. Therefore, the following exceptions, exemptions, and23
limitations are hereby continued in effect by incorporation into this Chapter by24
citation:25
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(11) R.S. 22:2, 14, 42.1, 88, 244, 461, 572, 572.1, 574, 618, 706, 732, 752,1
771, 1203, 1460, 1466, 1546, 1566(D), 1644, 1656, 1723, 1927, 1929, 1983, 1984,2
2036, 23033
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Section 3. This Act shall become effective upon signature by the governor or, if not5
signed by the governor, upon expiration of the time for bills to become law without signature6
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If7
vetoed by the governor and subsequently approved by the legislature, this Act shall become8
effective on the day following such approval.9
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. HLS 13RS-993 RE-REENGROSSED
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(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
instituted 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. HLS 13RS-993 RE-REENGROSSED
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(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.
House Floor Amendments to the reengrossed bill.
1. Deleted requirement that the navigator reside in this state or maintain his
principal place of business in this state. Instead required that the navigator intend
to conduct business as a navigator in this state.
2. Deleted prohibition against a navigator providing information related to health
benefit plans or other products not offered in the exchange.