SB1194 98TH GENERAL ASSEMBLY

LRB098 03986 RPM 37333 b

98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
SB1194

Introduced 1/30/2013, by Sen. William R. Haine

SYNOPSIS AS INTRODUCED:

New Act

Creates the Insurance Navigator Licensing Act. Provides that no individual or entity shall perform, offer to perform, or advertise any service as a navigator in this State or receive navigator funding from the State or an exchange unless licensed as a navigator by the Director of Insurance under the Act. Sets forth provisions concerning prohibited activities; applications for licensure; license renewal; referrals; probation, the refusal to issue or renew a license, and the revocation or suspension of a license; reporting requirements; and the Act's relationship to other laws and rulemaking authority. Contains a severability clause. Effective immediately

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning insurance.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the Insurance Navigator Licensing Act.

Section 5. Definitions. As used in this Act:

"Director" means the Director of Insurance.

"Exchange" means any health benefit exchange established or operating in this State, including any exchange established or operated by the United States Department of Health and Human Services.

"Navigator" means a person selected to perform the activities and duties identified in 42 U.S.C. 18031(i) in this State. "Navigator" includes any person who receives grant funds from the United States Department of Health and Human Services to perform any of the activities and duties identified in 42 U.S.C. 18031(i), including, but not limited to, in-person assisters and application counselors.

Section 10. License required.

(a) No individual or entity shall perform, offer to perform, or advertise any service as a navigator in this State or receive navigator funding from the State or an exchange unless licensed as a navigator by the Director under this Act.

(b) A navigator may not:

(1) engage in any activities that would require an insurance producer license;

(2) provide advice concerning the benefits, terms, and features of a particular health plan or offer advice about which health plan is better or worse for a particular individual or employer;

(3) recommend or endorse a particular health plan or advise consumers about which health plan to choose; or

(4) provide any information or services related to health benefit plans or other products not offered in the exchange.

(c) Only a person licensed as an insurance producer in this State may:

(1) sell, solicit, or negotiate health insurance;

(2) provide advice concerning the benefits, terms, and features of a particular health plan or offer advice about which health plan is better or worse for a particular individual or employer; or

(3) recommend a particular health plan or advise consumers about which health plan to choose.

Section 15. Application for license.

(a) An individual applying for a navigator license shall make application to the Director on a form developed by the Director and declare under penalty of refusal, suspension, or revocation of the license that the statements made in the application are true, correct, and complete to the best of the individual's knowledge and belief. Before approving the application, the Director shall find that the individual:

(1) is at least 18 years of age;

(2) resides in this State or maintains his or her principal place of business in this State;

(3) is not disqualified due to having committed any act that would be grounds for denial, suspension, or revocation of an insurance producer license under the Illinois Insurance Code;

(4) has completed the pre-licensing training and course of study prescribed by the Director;

(5) has successfully passed the written examination prescribed by the Director;

(6) when applicable, has the written consent of the Director pursuant to 18 U.S.C. 1033, or any successor statute regulating crimes by or affecting persons engaged in the business of insurance whose activities affect interstate commerce;

(7) possesses the requisite character and integrity;

(8) has identified the entity with which it is affiliated and by which it is supervised; and

(9) has paid the fees prescribed by the Director.

(b) An entity that acts as a navigator, supervises the activities of individual navigators, or receives funding to perform such activities shall obtain a navigator license. An entity applying for a navigator license shall make application on a form containing the information prescribed by the Director.

(c) The Director may require any documents deemed necessary to verify the information contained in an application submitted in accordance with subsections (a) and (b) of this Section.

(d) Entities licensed as navigators shall, in a manner prescribed by the Director, periodically provide the Director with a list of all individual navigators that it employs, supervises, or is affiliated with.

(e) The Director shall require that each navigator obtain a surety bond in an amount acceptable to the Director or otherwise demonstrate a level of financial responsibility capable of protecting all persons against the wrongful acts, misrepresentations, or negligence of the navigator. The Director may ask for a copy of the bond or other evidence of financial responsibility at any time.

(f) Prior to any exchange becoming operational in this State, the Director shall prescribe initial training, continuing education, and written examination standards and requirements for navigators.

Section 20. License renewal.

(a) A navigator license shall be valid for 2 years.

(b) A navigator may file an application for renewal of a license in a method prescribed by the Director and pay the renewal fee prescribed by the Director. Any navigator who fails to timely file for license renewal shall be charged a late fee in an amount prescribed by the Director.

(c) Prior to the filing date for application for renewal of a license, an individual licensee shall comply with ongoing training and continuing education requirements established by the Director. The navigator shall file with the Director, by a method prescribed by the Director, satisfactory certification of completion of the continuing education requirements. Any failure to fulfill the ongoing training and continuing education requirements shall result in the expiration of the license.

Section 25. Navigator referrals. On contact with a person who acknowledges having existing health insurance coverage obtained through an insurance producer, a navigator shall refer the person back to that insurance producer for information, assistance, and any other services.

Section 30. Grounds for placing on probation; refusal to issue or renew a license; revocation or suspension of a license.

(a) The Director may place on probation, suspend, revoke, or refuse to issue, renew, or reinstate a navigator license, or may levy a fine for each violation, or any combination of actions, for any one or more of the causes set forth in this Act or for other good cause.

(b) In addition to imposing the penalties authorized by subsection (a) of this Section, the Director may require that restitution be made to any person who has suffered financial injury because of a violation of this Act.

(c) The Director shall have power 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 this Act.

(d) The navigator license held by an entity may be suspended or revoked, or the renewal or reinstatement thereof may be refused, or a fine may be levied with or without a suspension, revocation, or refusal to renew a license, if the Director finds that an individual licensee's violation was known or should have been known by the employing or supervising entity and the violation was not reported to the Director and no corrective action was undertaken on a timely basis.

Section 35. Reporting to the Director.

(a) Each licensed navigator shall report to the Director within 30 calendar days after the final disposition of the matter any administrative action taken against him in another jurisdiction or by another governmental agency in this State. The report shall include a copy of the order, consent to order, or other relevant legal documents.

(b) Within 30 days after the initial pretrial hearing date, a navigator shall report to the Director any criminal prosecution of the navigator taken in any jurisdiction. The report shall include a copy of the initial complaint filed, the order resulting from the hearing, and any other relevant legal documents.

(c) An entity that acts as a navigator that terminates the employment, engagement, affiliation, or other relationship with an individual navigator shall notify the Director within 30 days following the effective date of the termination, using a format prescribed by the Director, if the reason for termination is one of the reasons set forth in this Act or the entity has knowledge the navigator was found by a court or government body to have engaged in any of the activities prohibited by this Act. Upon the written request of the Director, the entity shall provide additional information, documents, records, or other data pertaining to the termination or activity of the individual.

Section 40. Other laws; rulemaking authority.

(a) The requirements of the Illinois Insurance Code, and any related rules, shall apply to navigators. The activities and duties of a navigator shall be deemed to constitute transacting the business of insurance.

(b) The requirements of this Act shall not apply to any individual or entity licensed as an insurance producer in this State.

(c) Pursuant to the authority granted by this Act, the Director may adopt rules as may be necessary or appropriate for the administration and enforcement of this Act.

Section 97. Severability. The provisions of this Act are severable under Section 1.31 of the Statute on Statutes.

Section 99. Effective date. This Act takes effect upon becoming law.