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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), to enact R.S. 22:1566, and to repeal R.S.2
22:753(H)(5), relative to health insurance navigators and similar individuals or3
entities; to provide for definitions; to provide with respect to regulation by the4
commissioner of insurance, including registration or licensing of individuals and5
entities acting as navigators or providing similar services; to authorize the6
commissioner to assess fees and impose penalties; to provide for an exemption from7
the Public Records Law; and to provide for related matters.8
Be it enacted by the Legislature of Louisiana:9
Section 1. R.S. 22:1566 is hereby enacted to read as follows: 10
§1566. Health insurance navigators; definitions11
A. As used in this Section:12
(1) "Commissioner" means the commissioner of insurance.13
(2) "Exchange" means any health benefit exchange established or operating14
in this state, including any exchange established or operated by the United States15
Department of Health and Human Services or any other federal office or agency.16
(3) "Navigator" means any individual or entity who meets at least one of the17
following requirements:18 HLS 14RS-1087 ENGROSSED
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(a) Receives any funding, directly or indirectly, from an exchange, the state,1
or the federal government to perform any of the activities and duties identified in 422
U.S.C. 18031(i).3
(b) Is described or designated by an exchange, the state, or any office or4
agency of the federal government, or who could be reasonably described or5
designated as a navigator.6
(c) Is employed by or is a volunteer on behalf of a navigator or navigator7
entity for the purposes of conducting consumer outreach or education, or for the8
purposes of facilitating enrollment in Qualified Health Plans.9
(4) "Non-navigator personnel" means any individual or entity that facilitates10
enrollment of individuals or employers in a health benefit plan or public insurance11
program offered through an Exchange and is certified, designated, or reasonably12
described as an in-person assister, enrollment assister, application counselor, or13
application assister.14
B.(1) The legislature finds that regulation of navigators and non-navigator15
personnel, including registration or licensure by the commissioner of insurance, to16
ensure that they are properly trained and knowledgeable in the subject matter of17
individual and group health insurance benefit plans and insurance coverages is18
necessary to avoid substantial risk to the health, safety, and welfare of the people of19
this state.20
(2) Navigators and non-navigator personnel shall be subject to regulation by21
the commissioner as provided in this Section.22
(a) No individual or entity shall act as, offer to act as, or market any service23
as a navigator in this state unless licensed as a navigator by the commissioner under24
this Section.25
(b) Individuals or entities conducting activities as non-navigator personnel,26
such as in-person assisters, enrollment assisters, application counselors, or27
application assisters, shall register with the commissioner in the manner and form28 HLS 14RS-1087 ENGROSSED
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prescribed by the commissioner. An entity conducting non-navigator activities may1
register its non-navigator personnel with the commissioner on their behalf.2
(3) The following individuals or entities are exempt from the provisions of3
this Section and shall not be considered navigators or non-navigator personnel:4
(a) Individuals who facilitate enrollment in a health benefit plan without5
receiving any form of direct or indirect compensation or who are employed by an6
employer who directly or indirectly benefits from enrollment in a health benefit plan,7
such as individuals assisting in the enrollment of family members, tutors acting for8
a minor child or acting as a continuing tutor, individuals with the authority to9
contract on behalf of interdicted persons, or a mandatary with the authority to10
contract on behalf of a principal.11
(b) Employees of an employer who facilitates enrollment in the health12
benefit plan of the employer.13
(c) A licensed insurance producer.14
(d) An attorney in good standing who is licensed or authorized to act as an15
attorney in this state.16
(e) An employee of a health insurance issuer, including a health maintenance17
organization.18
(f) Any individual or entity granted an exemption by the commissioner. For19
the purposes of granting exemptions from the provisions of this Section, the20
commissioner may grant exemptions in a manner and form determined by the21
commissioner.22
C.(1) An individual applying for registration as non-navigator personnel with23
the commissioner shall complete a registration form as prescribed by the24
commissioner.25
(2) Any individual applying for a navigator license shall make application26
to the commissioner on a form prescribed by the commissioner. Such individual27
shall meet each of the following requirements:28
(a) Be at least eighteen years of age.29 HLS 14RS-1087 ENGROSSED
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(b) Intends to conduct business as a navigator in this state.1
(c) Is not disqualified for having committed any act that would be grounds2
for denial or revocation of an insurance producer license under R.S. 22:1554.3
(d) Has completed all required training and education prescribed by any4
office or agency of the federal government or by an Exchange.5
(e) Has identified the entity licensed as a navigator with which he is6
affiliated and by which he is supervised, if applicable.7
(3) Each entity licensed as a navigator shall, in a manner and frequency8
prescribed by the commissioner, provide the commissioner with an accurate list of9
all licensed individual navigators that it employs, in addition to completing an10
application for a navigator license.11
(4) A navigator license shall be valid for a period of two years from the date12
the license is issued. The commissioner shall prescribe the form for an application13
for renewal of a license.14
(5) An individual applying for a navigator license shall submit any15
documents that the commissioner deems necessary to verify the information16
contained in a license application, shall submit a full set of fingerprints to the17
commissioner, and shall successfully complete a criminal history and regulatory18
background check as provided for under this Section.19
(6) For any individual applying for licensure as or licensed as a navigator,20
the commissioner may prescribe any education, training, or examinations in addition21
to education, training, or examinations required by any office or agency of the22
federal government or by an Exchange; however, such additional education, training,23
or examinations shall not exceed thirty hours for initial education, training, or24
examinations and fifteen hours per year for continuing educational purposes when25
combined with education, training, or examinations required by any office or agency26
of the federal government or by an Exchange.27 HLS 14RS-1087 ENGROSSED
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D.(1) In order to make a determination of license eligibility for individuals1
applying for a navigator license, the commissioner shall require fingerprints of2
applicants and submit the fingerprints and the fees required to perform the criminal3
history record checks to the Louisiana Bureau of Criminal Identification and4
Information for state and national criminal history record checks. The commissioner5
shall require a criminal history record check on each applicant in accordance with6
this Subsection. The commissioner shall require each applicant to submit a full set7
of fingerprints in order for the commissioner to obtain and receive National Criminal8
History Records from the Criminal Justice Information Services Division of the9
Federal Bureau of Investigation.10
(2) The commissioner may contract for the collection, transmission, and11
resubmission of fingerprints required under this Subsection. If the commissioner12
does so, the fee for collecting and transmitting fingerprints and the fee for the13
criminal history record check shall be payable directly to the contractor by the14
applicant. The commissioner may agree to a reasonable fingerprinting fee to be15
charged by the contractor.16
(3) The commissioner shall treat and maintain an applicant's fingerprints and17
any criminal history record information obtained pursuant to this Section as18
confidential, shall apply security measures consistent with the Criminal Justice19
Information Services Division of the Federal Bureau of Investigation standards for20
the electronic storage of fingerprints and necessary identifying information, and shall21
limit the use of records solely to the purposes authorized in this Section. The22
fingerprints and any criminal history record information shall be exempt from the23
Public Records Law, R.S. 44:1 et seq., shall not be subject to subpoena, other than24
a subpoena issued in a criminal proceeding or investigation, shall be confidential by25
law and privileged, and shall not be subject to discovery or admissible in evidence26
in any private civil action.27 HLS 14RS-1087 ENGROSSED
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E.(1) A navigator may:1
(a) Provide fair and impartial information and services in connection with2
eligibility, enrollment, and program specifications of any health benefit plan issued3
or issued for delivery in this state, including information about the costs of coverage,4
advanced payment of premium tax credits, and cost sharing reductions.5
(b) Facilitate the selection of a health benefit plan offered for sale on an6
Exchange.7
(c) Initiate the enrollment process for a health benefit plan offered for sale8
on an Exchange.9
(d) Provide referrals to the Department of Insurance or other local, state, or10
federal offices or agencies for any grievance, complaint, or inquiry in connection11
with a health benefit plan or health insurance issuer, including a health maintenance12
organization.13
(e) Carry out any activities required or authorized pursuant to 42 U.S.C.14
18031(i).15
(2) Non-navigator personnel may carry out the functions and duties16
authorized for non-navigator personnel under 45 CFR Part 155 and shall:17
(a) Disclose all conflicts of interest that the non-navigator personnel may18
have with health insurance issuers to enrollees and potential enrollees in a health19
benefit plan.20
(b) Not receive any form of compensation, whether direct or indirect, from21
a health insurance issuer or an issuer of health stop loss insurance if prohibited by22
federal law.23
(c) Not disclose any information obtained in the course of non-navigator24
personnel activities where such information is confidential or protected from25
disclosure by law.26
F.(1) Unless an individual navigator or non-navigator personnel possesses27
an accident and health insurance producer license, no navigator or non-navigator28
personnel shall:29 HLS 14RS-1087 ENGROSSED
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(a) Sell, solicit, or negotiate a health benefit plan or any form of accident and1
health insurance.2
(b) Engage in any activity that would exclusively require an insurance3
producer license.4
(c) Provide partial advice concerning the benefits, terms, and features of5
health benefit plans or offer advice about which health benefit plan, health insurance6
issuer, or health maintenance organization is better or worse for a particular7
individual or employer.8
(d) Recommend or endorse a particular health benefit plan or health9
insurance issuer or health maintenance organization.10
(e) Provide any plan specific or product specific information or services11
related to any health benefit plan issued or issued for delivery in this state if such12
health benefit plan is not offered for sale on an Exchange.13
(f) Disclose any information obtained in the course of navigator activities14
where such information is confidential or protected from disclosure by law.15
(g) Violate any of the provisions of 45 CFR 155.260 or other state or federal16
laws or regulations.17
G.(1) The commissioner may place on probation, suspend, revoke, or refuse18
to issue, renew, or reinstate a navigator license, levy a fine not to exceed five19
hundred dollars for each violation, or take any combination of actions for any one20
or more violations of this Section or R.S. 22:1554 or for other good cause.21
(2) The commissioner may examine and investigate the business affairs and22
records of any navigator to determine whether the individual or entity has engaged23
or is engaging in any violation of this Section.24
(3) A navigator entity license may be suspended or revoked, or renewal or25
reinstatement thereof may be refused, or a fine may be levied, with or without a26
suspension, revocation, or refusal to renew a license, if the commissioner finds that27
an individual navigator licensee's violation was known or should have been known28 HLS 14RS-1087 ENGROSSED
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by the employing or supervising entity and the violation was not reported to the1
commissioner on a timely basis.2
(4) In the event that the commissioner suspends or revokes a navigator3
license, refuses the renewal or reinstatement of a license, or levies a fine, with or4
without suspension, revocation, or refusal to renew a license, the commissioner, in5
accordance and compliance with R.S. 49:961, shall notify the licensee in writing of6
the determination. An aggrieved party affected by the commissioner's decision, act,7
or order may demand a hearing in accordance with Chapter 12 of this Title, R.S.8
22:2191 et seq.9
H.(1) An individual navigator shall report to the commissioner any10
administrative action taken by a governmental agency against him in any jurisdiction11
within thirty calendar days of the final disposition of the matter. This report shall12
include a copy of the order or other relevant legal documents.13
(2) Within thirty days of the initial pretrial hearing date, an individual14
navigator shall report to the commissioner any criminal prosecution of the navigator15
instituted in any jurisdiction. The report shall include a copy of the initial complaint16
filed, the order resulting from the hearing, and any other relevant legal documents.17
(3) An entity that acts as a navigator that terminates the employment,18
engagement, affiliation, or other relationship with an individual navigator shall19
notify the commissioner within thirty days following the effective date of the20
termination, using a format prescribed by the commissioner, if the reason for21
termination is one of the reasons set forth in R.S. 22:1554 or the entity has22
knowledge that the individual navigator was found by a court or governmental23
agency to have engaged in any of the activities set forth in R.S. 22:1554. Upon the24
written request of the commissioner, the entity shall provide additional information,25
documents, records, or other data pertaining to the termination or activity of the26
individual navigator.27 HLS 14RS-1087 ENGROSSED
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I. The provisions of R.S. 22:1964 and any related rules or regulations shall1
apply to navigators. The activities and duties of navigators shall be deemed to2
constitute transacting the business of insurance.3
J. A navigator that is required to file annual and quarterly progress reports4
or annual financial reports with the Centers for Medicare and Medicaid Services5
shall also file such reports with the commissioner within fifteen days of filing with6
the appropriate federal office or agency.7
K. The commissioner may promulgate such rules and regulations as may be8
necessary or proper to carry out the provisions of this Section. Such rules and9
regulations shall be promulgated and adopted in accordance with the Administrative10
Procedure Act, R.S. 49:950 et seq.11
L. Upon this Section acquiring the force of law, the commissioner may, in12
addition to his enforcement discretion, establish an enforcement moratorium for the13
provisions of this Section relating to the license requirement for navigators, the14
registration process for non-navigator personnel, and any prescribed training,15
education, or examinations for the purposes of properly effectuating the provisions16
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
* * *20
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
* * *26 HLS 14RS-1087 ENGROSSED
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(11) R.S. 22.2, 14, 42.1, 88, 244, 461, 572, 572.1, 574, 618, 732, 752, 771,1
1203, 1460, 1466, 1546, 1566(D), 1644, 1656, 1723, 1927, 1929, 1983, 1984, 2036,2
23033
* * *4
Section 3. R.S. 22:753(H)(5) is hereby repealed in its entirety.5
Section 4. If any provision or provisions of this Act or its application to a particular6
circumstance is held to be invalid by a court of competent jurisdiction, the invalidity does7
not affect the other provisions or applications of this Act. A court of competent jurisdiction8
shall properly sever provisions that are held to be invalid, and the valid portions, provisions,9
or applications shall retain full force and effect.10
Section 5. This Act shall become effective upon signature by the governor or, if not11
signed by the governor, upon expiration of the time for bills to become law without signature12
of the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If13
vetoed by the governor, and subsequently approved by the Legislature, this Act shall become14
effective on the day following such approval.15
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 of health insurance navigators and registration of non-
navigator personnel by the commissioner of insurance.
Proposed law provides for regulation of health insurance navigators and registration of non-
navigator personnel by the commissioner of insurance, as follows:
(1)Provides for definitions, including defining "health insurance navigators" and "non-
navigator personnel" as individuals or entities which meet specific requirements.
(2)Requires that health insurance navigators be licensed by the commissioner of
insurance. Also requires non-navigator personnel to register with the commissioner.
However, provides for exemptions from proposed law for certain individuals or
entities and authorizes the commissioner to grant additional exemptions.
(3)Requires that individual navigators be at least 18 years old and not be disqualified
for any act that would be grounds for denial or revocation of an insurance producer
license under present law. Additionally requires that any such navigator complete
all training and education required by the federal government or an Exchange. HLS 14RS-1087 ENGROSSED
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Further provides that any such navigator shall identify any navigator entity with
which he is affiliated and by which he is supervised.
(4)Requires that each entity licensed as a navigator provide the commissioner with a list
of licensed individual navigators employed by the entity.
(5)Provides that a navigator license is valid for two years from the date issued and that
the commissioner prescribe the form for an application for license renewal.
(6)Requires that any applicant for an individual navigator license submit a full set of
fingerprints to the commissioner and successfully complete a criminal history and
regulatory background check conducted by the commissioner. Further requires that
the commissioner submit the fingerprints of each such navigator license applicant to
the Louisiana Bureau of Criminal Identification and Information for state and
national criminal history checks. Makes applicants' fingerprints and any criminal
history record information exempt from the Public Records Law, confidential and
privileged, and not subject to discovery or admissible in evidence in any private civil
action.
(7)Authorizes the commissioner to require education and training for individual
navigators in addition to that required by the federal government or an Exchange.
Limits such education and training to not more than 30 hours for initial education
and not more than 15 hours per year for continuing education when combined with
education or training required by any office or agency of the federal government or
by an Exchange.
(8)Specifies the activities that navigators and non-navigator personnel may perform and
may not perform.
(9)Provides penalties that the commissioner may impose on navigators for violations
of proposed law, including a fine up to $500 per violation, probation, suspension, or
revocation of a navigator license, or refusal to issue, renew, or reinstate a navigator
license, and provides for appeal of the commissioner's decision to impose a penalty.
(10)Requires an individual navigator to report to the commissioner any administrative
action taken against him by a governmental agency or any criminal prosecution
instituted against him in any jurisdiction within 30 days of the final disposition of
the matter. Also requires an individual navigator to report to the commissioner any
criminal prosecution instituted against him in any jurisdiction within 30 days of the
initial pretrial hearing date.
(11)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 if the reason for the termination is one
set forth in present law relative to prohibited activities by producers.
(12)Requires navigators to file with the commissioner the annual and quarterly progress
reports or annual financial reports required to be filed with the Centers for Medicare
and Medicaid Services.
(13)Authorizes the commissioner to promulgate rules and regulations to carry out the
provisions of proposed law in accordance with present law, the Administrative
Procedure Act.
(14)Authorizes the commissioner to establish an enforcement moratorium for the
provisions of proposed law relative to licensing and training of education of
navigators and registration of non-navigator personnel for the purposes of
effectuating the provisions of proposed law. HLS 14RS-1087 ENGROSSED
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(15) Deletes provisions contained in present law relative to life insurance which
authorized the commissioner to promulgate rules relative to navigators and required
the House and Senate insurance committees to review such rules.
`
(Amends R.S. 44:4.1(B)(11); Adds R.S. 22:1566; Repeals R.S. 22:753(H)(5))
Summary of Amendments Adopted by House
Committee Amendments Proposed by House Committee on Insurance to the original
bill.
1. Clarified which provisions of proposed law apply to individual navigators,
navigator entities, and/or non-navigator personnel.
2. Specified that the provision of proposed law prohibiting non-navigator personnel
from receiving any direct or indirect compensation from a health insurance
issuer or an issuer of health stop loss insurance is only applicable if prohibited
by federal law.
3. Deleted provisions contained in present law relative to life insurance which
authorized the commissioner to promulgate rules relative to navigators and
required the House and Senate insurance committees to review such rules, as
such provisions are superceded by proposed law.