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Regular Session, 2014
HOUSE BILL NO. 764
BY REPRESENTATIVE PEARSON
INSURANCE/HEALTH: Provides for the licensing and regulation of health insurance
navigators and similar individuals and entities
AN ACT1
To amend and reenact R.S. 44:4.1(B)(11) and to enact R.S. 22:1566, relative to health2
insurance navigators and similar individuals or entities; to provide for definitions;3
to provide with respect to licensing and regulation by the commissioner of insurance4
of individuals and entities acting as navigators or providing similar services; to5
authorize the commissioner to assess fees and impose penalties; to provide for an6
exemption from the Public Records Law; and to provide for related matters.7
Be it enacted by the Legislature of Louisiana:8
Section 1. R.S. 22:1566 is hereby enacted to read as follows: 9
§1566. Health insurance navigators; definitions10
A. As used in this Section:11
(1) "Commissioner" means the commissioner of insurance.12
(2) "Exchange" means any health benefit exchange established or operating13
in this state, including any exchange established or operated by the United States14
Department of Health and Human Services or any other federal office or agency.15
(3) "Navigator" means any individual or entity who meets at least one of the16
following requirements:17
(a) Receives any funding, directly or indirectly, from an exchange, the state,18
or the federal government to perform any of the activities and duties identified in 4219
U.S.C. 18031(i).20 HLS 14RS-1087 ORIGINAL
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(b) Is described or designated by an exchange, the state, or any office or1
agency of the federal government, or who could be reasonably described or2
designated as a navigator.3
(c) Is employed by or is a volunteer on behalf of a navigator or navigator4
entity for the purposes of conducting consumer outreach or education, or for the5
purposes of facilitating enrollment in Qualified Health Plans.6
(4) "Non-navigator personnel" means any individual or entity that facilitates7
enrollment of individuals or employers in a health benefit plan or public insurance8
program offered through an exchange and is certified, designated, or reasonably9
described as an in-person assister, enrollment assister, application counselor, or10
application assister.11
B.(1) The legislature finds that licensing and regulating navigators and12
similar persons or entities to ensure that they are properly trained, knowledgeable in13
the subject matter of individual and group health insurance benefit plans and14
insurance coverages is necessary to avoid substantial risk to the health, safety, and15
welfare of the people of this state.16
(2) No individual or entity shall act as, offer to act as, or market any service17
as a navigator in this state unless licensed as a navigator by the commissioner under18
this Section.19
(3) Any individuals or entities that are navigators or non-navigator personnel20
shall be subject to regulation by the commissioner as provided for in this Section.21
(4) Individuals or entities conducting activities as non-navigator entities or22
non-navigator personnel, such as in-person assisters, enrollment assisters, application23
counselors, or application assisters, shall register with the commissioner in the24
manner and form prescribed by the commissioner. An entity conducting25
non-navigator activities may register its non-navigator personnel with the26
commissioner on their behalf.27
(5) The following individuals or entities are exempt from the provisions of28
this Section, and shall not be considered navigators or non-navigator personnel:29 HLS 14RS-1087 ORIGINAL
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(a) Individuals who facilitate enrollment in a health benefit plan without1
receiving any form of direct or indirect compensation, or being employed by an2
employer who directly or indirectly benefits from enrollment in a health benefit plan,3
such as individuals assisting in the enrollment of family members, tutors acting for4
a minor child or acting as a continuing tutor, individuals with the authority to5
contract on behalf of interdicted persons, or a mandatary with the authority to6
contract on behalf of a principal.7
(b) Employees of an employer who facilitate enrollment in the health benefit8
plan of the employer.9
(c) A licensed insurance producer.10
(d) An attorney in good standing who is licensed or authorized to act as an11
attorney in this state.12
(e) An employee of a health insurance issuer, which includes a health13
maintenance organization.14
(f) Any individual or entity granted an exemption by the commissioner. For15
the purposes of granting exemptions from the provisions of this Section, the16
commissioner may grant exemptions in a manner and form determined by the17
commissioner.18
C.(1) An individual applying for a navigator license or registering with the19
commissioner as non-navigator personnel shall make an application for a license or20
shall complete a registration form as prescribed by the commissioner. Any21
individual submitting a navigator license shall meet each of the following22
requirements:23
(a) Be at least eighteen years of age.24
(b) Intend to conduct business as a navigator or non-navigator personnel in25
this state.26
(c) Is not disqualified for having committed any act that would be grounds27
for denial or revocation of an insurance producer license under R.S. 22:1554.28 HLS 14RS-1087 ORIGINAL
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(d) Has completed all required training and education prescribed by any1
office or agency of the federal government or by an exchange.2
(e) Has identified the entity to which he is affiliated and by which he is3
supervised, if applicable.4
(2) Each entity licensed as a navigator shall, in a manner and frequency5
prescribed by the commissioner, provide the commissioner with an accurate list of6
all licensed navigators that it employs, in addition to completing an application for7
a navigator license.8
(3) A navigator license shall be valid for a period of two years from the date9
the license is issued. The commissioner shall prescribe the form for an application10
for renewal of a license.11
(4) An individual applying for a navigator license shall submit any12
documents that the commissioner deems necessary to verify the information13
contained in a license application, and shall submit a full set of fingerprints to the14
commissioner and successfully complete a criminal history and regulatory15
background check as provided for under this Section.16
(5) The commissioner may prescribe any education, training, or examination17
in addition to education, training, or examinations required by any office or agency18
of the federal government or by an exchange, provided that such additional19
education, training or examinations shall not exceed thirty hours for initial training20
education or examinations, or fifteen hours per year for continuing educational21
purposes when combined with education, training, or examinations required by any22
office or agency of the federal government or by an exchange.23
(6) The commissioner may examine any navigator or non-navigator for the24
purposes of determining whether such navigator or non-navigator personnel are in25
compliance with this Section.26
D.(1) In order to make a determination of license eligibility the27
commissioner shall require fingerprints of applicants and submit the fingerprints and28
the fees required to perform the criminal history record checks to the Louisiana29 HLS 14RS-1087 ORIGINAL
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Bureau of Criminal Identification and Information for state and national criminal1
history record checks. The commissioner shall require a criminal history record2
check on each applicant in accordance with this Subsection. The commissioner shall3
require each applicant to submit a full set of fingerprints in order for the4
commissioner to obtain and receive National Criminal History Records from the5
Criminal Justice Information Services Division of the Federal Bureau of6
Investigation.7
(2) The commissioner may contract for the collection, transmission, and8
resubmission of fingerprints required under this Subsection. If the commissioner9
does so, the fee for collecting and transmitting fingerprints and the fee for the10
criminal history record check shall be payable directly to the contractor by the11
applicant. The commissioner may agree to a reasonable fingerprinting fee to be12
charged by the contractor.13
(3) The commissioner shall treat and maintain an applicant’s fingerprints and14
any criminal history record information obtained pursuant to this Section as15
confidential and shall apply security measures consistent with the Criminal Justice16
Information Services Division of the Federal Bureau of Investigation standards for17
the electronic storage of fingerprints and necessary identifying information and limit18
the use of records solely to the purposes authorized in this Section. The fingerprints19
and any criminal history record information shall be exempt from the Public Records20
Law, R.S. 44:1 et seq., shall not be subject to subpoena, other than a subpoena21
issued in a criminal proceeding or investigation, shall be confidential by law and22
privileged, and shall not be subject to discovery or admissible in evidence in any23
private civil action.24
E.(1) A navigator may:25
(a) Provide fair and impartial information and services in connection with26
eligibility, enrollment, and program specifications of any health benefit plan issued27
or issued for delivery in this state, including information about the costs of coverage,28
advanced payment of premium tax credits, and cost sharing reductions.29 HLS 14RS-1087 ORIGINAL
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(b) Facilitate the selection of a health benefit plan offered for sale on an1
Exchange.2
(c) Initiate the enrollment process for a health benefit plan offered for sale3
on an Exchange.4
(d) Provide referrals to the Department of Insurance or other local, state, or5
federal offices or agencies for any grievance, complaint, or inquiry in connection6
with a health benefit plan or health insurance issuer or health maintenance7
organization.8
(e) Carry out any activities required or authorized pursuant to 42 U.S.C.9
18031(i).10
(2) Non-navigator personnel:11
(a) May carry out the functions and duties authorized for non-navigator12
personnel under 45 CFR Part 155.13
(b) Shall disclose all conflicts of interest that the non-navigator personnel14
may have with health insurance issuers to enrollees and potential enrollees in a15
health benefit plan.16
(c) Shall not receive any form of compensation, whether direct or indirect,17
from a health insurance issuer or issuer of health stop loss insurance.18
(d) Shall not disclose any information obtained in the course of19
non-navigator personnel activities where such information is confidential or20
protected from disclosure by law.21
F.(1) Unless a navigator or non-navigator personnel possesses an accident22
and health insurance producer license, no navigator shall:23
(a) Sell, solicit, or negotiate a health benefit plan or any form of accident and24
health insurance.25
(b) Engage in any activity that would exclusively require an insurance26
producer license.27
(c) Provide partial advice concerning the benefits, terms, and features of28
health benefit plans or offer advice about which health benefit plan, health insurance29 HLS 14RS-1087 ORIGINAL
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issuer, or health maintenance organization is better or worse for a particular1
individual or employer.2
(d) Recommend or endorse a particular health benefit plan or health3
insurance issuer or health maintenance organization.4
(e) Provide any plan specific or product specific information or services5
related to any health benefit plan issued or issued for delivery in this state if such6
health benefit plan is not offered for sale on an Exchange.7
(f) Disclose any information obtained in the course of navigator activities8
where such information is confidential or protected from disclosure by law.9
(g) Violate any of the provisions of 45 CFR 155.260, or other state or federal10
laws or regulations.11
G.(1) The commissioner may place on probation, suspend, revoke, or refuse12
to issue, renew, or reinstate a navigator license, or may levy a fine not to exceed five13
hundred dollars for each violation, or any combination of actions, for any one or14
more violations of this Section or R.S. 22:1554, or for other good cause.15
(2) The commissioner may examine and investigate the business affairs and16
records of any navigator to determine whether the individual or entity has engaged17
or is engaging in any violation of this Section.18
(3) A navigator entity license may be suspended or revoked, or renewal or19
reinstatement thereof may be refused, or a fine may be levied, with or without a20
suspension, revocation, or refusal to renew a license, if the commissioner finds that21
an individual navigator licensee’s violation was known or should have been known22
by the employing or supervising entity and the violation was not reported to the23
commissioner on a timely basis.24
(4) In the event that the commissioner suspends or revokes a license, refuses25
the renewal or reinstatement of a license, or levies a fine, with or without suspension,26
revocation, or refusal to renew a license, the commissioner, in accordance and27
compliance with R.S. 49:961, shall notify the licensee in writing of the28
determination. An aggrieved party affected by the commissioner’s decision, act, or29 HLS 14RS-1087 ORIGINAL
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order may demand a hearing in accordance with Chapter 12 of this Title, R.S.1
22:2191 et seq.2
H.(1) Each licensed navigator shall report to the commissioner any3
administrative action taken by a governmental agency against him in any jurisdiction4
within thirty calendar days of the final disposition of the matter. This report shall5
include a copy of the order or other relevant legal documents.6
(2) Within thirty days of the initial pretrial hearing date, a navigator shall7
report to the commissioner any criminal prosecution of the navigator instituted in8
any jurisdiction. The report shall include a copy of the initial complaint filed, the9
order resulting from the hearing, and any other relevant legal documents.10
(3) An entity that acts as a navigator that terminates the employment,11
engagement, affiliation, or other relationship with an individual navigator shall12
notify the commissioner within thirty days following the effective date of the13
termination, using a format prescribed by the commissioner, if the reason for14
termination is one of the reasons set forth in R.S. 22:1554 or the entity has15
knowledge that the navigator was found by a court or governmental agency to have16
engaged in any of the activities set forth in R.S. 22:1554. Upon the written request17
of the commissioner, the entity shall provide additional information, documents18
records, or other data pertaining to the termination or activity of the individual.19
I. The provisions of R.S. 22:1964, and any related rules or regulations, shall20
apply to navigators. The activities and duties of navigators shall be deemed to21
constitute transacting the business of insurance.22
J. A navigator that is required to file annual and quarterly progress reports23
or annual financial reports with the Centers for Medicare and Medicaid Services24
shall also file such reports with the commissioner within fifteen days of filing with25
the appropriate federal office or agency.26
K. The commissioner may promulgate such rules and regulations as may be27
necessary or proper to carry out the provisions of this Section. Such rules and28 HLS 14RS-1087 ORIGINAL
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regulations shall be promulgated and adopted in accordance with the Administrative1
Procedure Act, R.S. 49:950 et seq.2
L. Upon this Section acquiring the force of law, the commissioner may, in3
addition to his enforcement discretion, establish an enforcement moratorium for the4
provisions of this Section relating to the license requirement for navigators, the5
registration process for non-navigator personnel, and any prescribed training,6
education or examinations for the purposes of properly effectuating the provisions7
of this Section.8
Section 2. R.S. 44:4.1(B)(11) is hereby amended and reenacted to read as follows:9
§4.1. Exceptions10
* * *11
B. The legislature further recognizes that there exist exceptions, exemptions,12
and limitations to the laws pertaining to public records throughout the revised13
statutes and codes of this state. Therefore, the following exceptions, exemptions, and14
limitations are hereby continued in effect by incorporation into this Chapter by15
citation:16
* * *17
(11) R.S. 22.2, 14, 42.1, 88, 244, 461, 572, 572.1, 574, 618, 732, 752, 771,18
1203, 1460, 1466, 1546, 1566(D), 1644, 1656, 1723, 1927, 1929, 1983, 1984, 2036,19
230320
* * *21
Section 3. If any provision or provisions of this Act or its application to a particular22
circumstance is held to be invalid by a court of competent jurisdiction, the invalidity does23
not affect the other provisions or applications of this Act. A court of competent jurisdiction24
shall properly sever provisions that are held to be invalid, and the valid portions, provisions,25
or applications shall retain full force and effect.26
Section 4. This Act shall become effective upon signature by the governor or, if not27
signed by the governor, upon expiration of the time for bills to become law without signature28
of the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If29 HLS 14RS-1087 ORIGINAL
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vetoed by the governor, and subsequently approved by the Legislature, this Act shall become1
effective on the day following such approval.2
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)]
Pearson HB No. 764
Abstract: Provides for licensing and regulation of health insurance navigators and
registration of non-navigator personnel by the commissioner of insurance.
Proposed law requires that health insurance navigators be licensed by the commissioner of
insurance. Also requires non-navigator personnel to register with the commissioner.
Proposed law requires that navigators be at least 18 year old and not be disqualified for any
act that would be grounds for denial or revocation of an insurance producer license under
present law. Proposed law requires that navigators complete all training and education
required by the federal government or an exchange.
Proposed law requires that navigators identify any entities affiliated with and any
supervisors.
Proposed law requires that entities licensed as a navigator provide the commissioner with
a list of licensed navigators employed by the entity.
Proposed law provides that a navigator license is valid for two years from the date issued.
Proposed law requires all applicants for a navigator license to submit a full set of fingerprints
to the commissioner and successfully complete a criminal history and regulatory background
check conducted by the commissioner. Proposed law requires that the commissioner submit
the fingerprints of every navigator license applicant to the Louisiana Bureau of Criminal
Identification and Information for state and national criminal history checks. Proposed law
requires that the applicant's fingerprints and any criminal history record information received
be treated as confidential and are exempt from the Public Records Law.
Proposed law provides that the commissioner may require education and training in addition
to that required by the federal government or exchange. Such training will not exceed 30
hours for initial training and education, or 15 hours for continuing education.
Proposed law specifies the activities that navigators and non-navigator personnel may
perform and may not perform.
Proposed law provides penalties that the commissioner may impose for violations, including
a fine up to $500.00 per violation, probation, suspension of license, revocation of license,
or refusal to issue, renew, or reinstate a navigator license, and provides for appeal of the
commissioner's decision to impose a penalty.
Proposed law requires navigators to report to the commissioner any administrative action
taken against him by a governmental agency in any jurisdiction within 30 days of the final
disposition of the matter.
Proposed law requires navigators to report to the commissioner any criminal prosecution
instituted in any jurisdiction within 30 days of the initial pretrial hearing date. HLS 14RS-1087 ORIGINAL
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Proposed law requires an entity acting as a navigator that terminates the employment or
other association with an individual navigator to notify the commissioner within 30 days
following the effective date of the termination, the reason for the termination if the reason
is one set forth in R.S. 22:1554.
Proposed law requires navigators to file with the commissioner the annual and quarterly
progress reports or annual financial reports the navigators file with the Centers for Medicare
and Medicaid Services.
Proposed law provides for the commissioner to establish an enforcement moratorium for the
provisions of this section to allow the drafting of regulations to implement the provisions of
this section.
(Amends R.S. 44:4.1(B)(11); Adds R.S. 22:1566)