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ACT No. 635
Regular Session, 2014
HOUSE BILL NO. 764
BY REPRESENTATIVE PEARSON
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
(a) Receives any funding, directly or indirectly, from an exchange, the state,19
or the federal government to perform any of the activities and duties identified in 4220
U.S.C. 18031(i).21
(b) Is described or designated by an exchange, the state, or any office or22
agency of the federal government, or who could be reasonably described or23
designated as a navigator.24 ENROLLED - CORRECTED COPYHB NO. 764
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(c) Is employed by or is a volunteer on behalf of a navigator or navigator1
entity for the purposes of conducting consumer outreach or education, or for the2
purposes of facilitating enrollment in qualified health plans.3
(4) "Non-navigator personnel" means any individual or entity that facilitates4
enrollment of individuals or employers in a health benefit plan or public insurance5
program offered through an exchange and is certified, designated, or reasonably6
described as an in-person assister, enrollment assister, application counselor, or7
application assister.8
B.(1) The legislature finds that regulation of navigators and non-navigator9
personnel, including registration or licensure by the commissioner, to ensure that10
they are properly trained and knowledgeable in the subject matter of individual and11
group health insurance benefit plans and insurance coverages is necessary to avoid12
substantial risk to the health, safety, and welfare of the people of this state.13
(2) Navigators and non-navigator personnel shall be subject to regulation by14
the commissioner as provided in this Section.15
(a) No individual or entity shall act as, offer to act as, or market any service16
as a navigator in this state unless licensed as a navigator by the commissioner17
pursuant to this Section.18
(b) Individuals or entities conducting activities as non-navigator personnel,19
such as in-person assisters, enrollment assisters, application counselors, or20
application assisters, shall register with the commissioner in the manner and form21
prescribed by the commissioner. An entity conducting non-navigator activities may22
register its non-navigator personnel with the commissioner on their behalf.23
(3) The following individuals or entities are exempt from the provisions of24
this Section and shall not be considered navigators or non-navigator personnel:25
(a) Individuals who facilitate enrollment in a health benefit plan without26
receiving any form of direct or indirect compensation or who are employed by an27
employer who directly or indirectly benefits from enrollment in a health benefit plan,28
such as individuals assisting in the enrollment of family members, tutors acting for29
a minor child or acting as a continuing tutor, individuals with the authority to30 ENROLLED - CORRECTED COPYHB NO. 764
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contract on behalf of interdicted persons, or a mandatary with the authority to1
contract on behalf of a principal.2
(b) Employees of an employer who facilitates enrollment in the health3
benefit plan of the employer.4
(c) A licensed insurance producer.5
(d) An attorney in good standing who is licensed or authorized to act as an6
attorney in this state.7
(e) An employee of a health insurance issuer, including a health maintenance8
organization.9
(f) Any individual or entity granted an exemption by the commissioner. For10
the purposes of granting exemptions from the provisions of this Section, the11
commissioner may grant exemptions in a manner and form determined by the12
commissioner.13
C.(1) An individual applying for registration as non-navigator personnel with14
the commissioner shall complete a registration form as prescribed by the15
commissioner.16
(2) Any individual applying for a navigator license shall make application17
to the commissioner on a form prescribed by the commissioner. Such individual18
shall meet each of the following requirements:19
(a) Be at least eighteen years of age.20
(b) Intends to conduct business as a navigator in this state.21
(c) Is not disqualified for having committed any act that would be grounds22
for denial or revocation of an insurance producer license pursuant to R.S. 22:1554.23
(d) Has completed all required training and education prescribed by any24
office or agency of the federal government or by an exchange.25
(e) Has identified the entity licensed as a navigator with which he is26
affiliated and by which he is supervised, if applicable.27
(3) Each entity licensed as a navigator shall, in a manner and frequency28
prescribed by the commissioner, provide the commissioner with an accurate list of29 ENROLLED - CORRECTED COPYHB NO. 764
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all licensed individual navigators that it employs, in addition to completing an1
application for a navigator license.2
(4) A navigator license shall be valid for a period of two years from the date3
the license is issued. The commissioner shall prescribe the form for an application4
for renewal of a license.5
(5) An individual applying for a navigator license shall submit any6
documents that the commissioner deems necessary to verify the information7
contained in a license application, shall submit a full set of fingerprints to the8
commissioner, and shall successfully complete a criminal history and regulatory9
background check as provided for pursuant to this Section.10
(6) For any individual applying for licensure as or licensed as a navigator,11
the commissioner may prescribe any education, training, or examinations in addition12
to education, training, or examinations required by any office or agency of the13
federal government or by an exchange; however, such additional education, training,14
or examinations shall not exceed thirty hours for initial education, training, or15
examinations and fifteen hours per year for continuing educational purposes when16
combined with education, training, or examinations required by any office or agency17
of the federal government or by an exchange.18
D.(1) In order to make a determination of license eligibility for individuals19
applying for a navigator license, the commissioner shall require fingerprints of20
applicants and submit the fingerprints and the fees required to perform the criminal21
history record checks to the Louisiana Bureau of Criminal Identification and22
Information for state and national criminal history record checks. The commissioner23
shall require a criminal history record check on each applicant in accordance with24
this Subsection. The commissioner shall require each applicant to submit a full set25
of fingerprints in order for the commissioner to obtain and receive national criminal26
history records from the Criminal Justice Information Services Division of the27
Federal Bureau of Investigation.28
(2) The commissioner may contract for the collection, transmission, and29
resubmission of fingerprints required under this Subsection. If the commissioner30 ENROLLED - CORRECTED COPYHB NO. 764
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does so, the fee for collecting and transmitting fingerprints and the fee for the1
criminal history record check shall be payable directly to the contractor by the2
applicant. The commissioner may agree to a reasonable fingerprinting fee to be3
charged by the contractor.4
(3) The commissioner shall treat and maintain an applicant's fingerprints and5
any criminal history record information obtained pursuant to this Section as6
confidential, shall apply security measures consistent with the Criminal Justice7
Information Services Division of the Federal Bureau of Investigation standards for8
the electronic storage of fingerprints and necessary identifying information, and shall9
limit the use of records solely to the purposes authorized in this Section. The10
fingerprints and any criminal history record information shall be exempt from the11
Public Records Law, R.S. 44:1 et seq., shall not be subject to subpoena, other than12
a subpoena issued in a criminal proceeding or investigation, shall be confidential by13
law and privileged, and shall not be subject to discovery or admissible in evidence14
in any private civil action.15
E.(1) A navigator may:16
(a) Provide fair and impartial information and services in connection with17
eligibility, enrollment, and program specifications of any health benefit plan issued18
or issued for delivery in this state, including information about the costs of coverage,19
advanced payment of premium tax credits, and cost sharing reductions.20
(b) Facilitate the selection of a health benefit plan offered for sale on an21
exchange.22
(c) Initiate the enrollment process for a health benefit plan offered for sale23
on an exchange.24
(d) Provide referrals to the Department of Insurance or other local, state, or25
federal offices or agencies for any grievance, complaint, or inquiry in connection26
with a health benefit plan or health insurance issuer, including a health maintenance27
organization.28
(e) Carry out any activities required or authorized pursuant to 42 U.S.C.29
18031(i).30 ENROLLED - CORRECTED COPYHB NO. 764
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(2) Non-navigator personnel may carry out the functions and duties1
authorized for non-navigator personnel under 45 CFR Part 155 and shall:2
(a) Disclose all conflicts of interest that the non-navigator personnel may3
have with health insurance issuers to enrollees and potential enrollees in a health4
benefit plan.5
(b) Not receive any form of compensation, whether direct or indirect, from6
a health insurance issuer or an issuer of health stop loss insurance if prohibited by7
federal law.8
(c) Not disclose any information obtained in the course of non-navigator9
personnel activities where such information is confidential or protected from10
disclosure by law.11
F. Unless an individual navigator or non-navigator personnel possesses an12
accident and health insurance producer license, no navigator or non-navigator13
personnel shall:14
(1) Sell, solicit, or negotiate a health benefit plan or any form of accident and15
health insurance.16
(2) Engage in any activity that would exclusively require an insurance17
producer license.18
(3) Provide partial advice concerning the benefits, terms, and features of19
health benefit plans or offer advice about which health benefit plan, health insurance20
issuer, or health maintenance organization is better or worse for a particular21
individual or employer.22
(4) Recommend or endorse a particular health benefit plan or health23
insurance issuer or health maintenance organization.24
(5) Provide any plan specific or product specific information or services25
related to any health benefit plan issued or issued for delivery in this state if such26
health benefit plan is not offered for sale on an exchange.27
(6) Disclose any information obtained in the course of navigator activities28
where such information is confidential or protected from disclosure by law.29 ENROLLED - CORRECTED COPYHB NO. 764
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(7) Violate any of the provisions of 45 CFR 155.260 or other state or federal1
laws or regulations.2
G.(1) The commissioner may place on probation, suspend, revoke, or refuse3
to issue, renew, or reinstate a navigator license, levy a fine not to exceed five4
hundred dollars for each violation, or take any combination of actions for any one5
or more violations of this Section or R.S. 22:1554 or for other good cause.6
(2) The commissioner may examine and investigate the business affairs and7
records of any navigator to determine whether the individual or entity has engaged8
or is engaging in any violation of the provisions of this Section.9
(3) A navigator entity license may be suspended or revoked, or renewal or10
reinstatement thereof may be refused, or a fine may be levied, with or without a11
suspension, revocation, or refusal to renew a license, if the commissioner finds that12
an individual navigator licensee's violation was known or should have been known13
by the employing or supervising entity and the violation was not reported to the14
commissioner on a timely basis.15
(4) In the event that the commissioner suspends or revokes a navigator16
license, refuses the renewal or reinstatement of a license, or levies a fine, with or17
without suspension, revocation, or refusal to renew a license, the commissioner, in18
accordance and compliance with R.S. 49:961, shall notify the licensee in writing of19
the determination. An aggrieved party affected by the commissioner's decision, act,20
or order may demand a hearing in accordance with Chapter 12 of this Title, R.S.21
22:2191 et seq.22
H.(1) An individual navigator shall report to the commissioner any23
administrative action taken by a governmental agency against him in any jurisdiction24
within thirty calendar days of the final disposition of the matter. This report shall25
include a copy of the order or other relevant legal documents.26
(2) Within thirty days of the initial pretrial hearing date, an individual27
navigator shall report to the commissioner any criminal prosecution of the navigator28
instituted in any jurisdiction. The report shall include a copy of the initial complaint29
filed, the order resulting from the hearing, and any other relevant legal documents.30 ENROLLED - CORRECTED COPYHB NO. 764
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(3) An entity that acts as a navigator that terminates the employment,1
engagement, affiliation, or other relationship with an individual navigator shall2
notify the commissioner within thirty days following the effective date of the3
termination, using a format prescribed by the commissioner, if the reason for4
termination is one of the reasons set forth in R.S. 22:1554 or the entity has5
knowledge that the individual navigator was found by a court or governmental6
agency to have engaged in any of the activities set forth in R.S. 22:1554. Upon the7
written request of the commissioner, the entity shall provide additional information,8
documents, records, or other data pertaining to the termination or activity of the9
individual navigator.10
I. The provisions of R.S. 22:1964 and any related rules or regulations shall11
apply to navigators. The activities and duties of navigators shall be deemed to12
constitute transacting the business of insurance.13
J. A navigator that is required to file annual and quarterly progress reports14
or annual financial reports with the Centers for Medicare and Medicaid Services15
shall also file such reports with the commissioner within fifteen days of filing with16
the appropriate federal office or agency.17
K. The commissioner may promulgate such rules and regulations as may be18
necessary or proper to carry out the provisions of this Section. Such rules and19
regulations shall be promulgated and adopted in accordance with the Administrative20
Procedure Act, R.S. 49:950 et seq.21
L. The commissioner may, in addition to his enforcement discretion,22
establish an enforcement moratorium for the provisions of this Section relating to the23
license requirement for navigators, the registration process for non-navigator24
personnel, and any prescribed training, education, or examinations for the purposes25
of properly effectuating the provisions of this Section.26
Section 2. R.S. 44:4.1(B)(11) is hereby amended and reenacted to read as follows:27
§4.1. Exceptions28
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B. The legislature further recognizes that there exist exceptions, exemptions,1
and limitations to the laws pertaining to public records throughout the revised2
statutes and codes of this state. Therefore, the following exceptions, exemptions, and3
limitations are hereby continued in effect by incorporation into this Chapter by4
citation:5
* * *6
(11) R.S. 22:2, 14, 31(B), 42.1, 88, 244, 461, 572, 572.1, 574, 618, 732, 752,7
753, 771, 1019.2(B)(5)(a), 1203, 1460, 1466, 1546, 1566(D), 1644, 1656, 1723,8
1927, 1929, 1983, 1984, 2036, 23039
* * *10
Section 3. R.S. 22:753(H)(5) is hereby repealed in its entirety.11
Section 4. If any provision or provisions of this Act or its application to a particular12
circumstance is held to be invalid by a court of competent jurisdiction, the invalidity does13
not affect the other provisions or applications of this Act. A court of competent jurisdiction14
shall properly sever provisions that are held to be invalid, and the valid portions, provisions,15
or applications shall retain full force and effect.16
Section 5. This Act shall become effective upon signature by the governor or, if not17
signed by the governor, upon expiration of the time for bills to become law without signature18
of the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If19
vetoed by the governor, and subsequently approved by the Legislature, this Act shall become20
effective on the day following such approval.21
SPEAKER OF THE HOUSE OF REPRESENTATI VES
PRESIDENT OF THE SENATE
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED: