"Certification" means the issuance by the Director of a license
or authorization pursuant to this Part.
"Certified Application Counselor" means any employee or
volunteer of a Certified Application Counselor Organization that enters into an
agreement with the Marketplace to have its employees or volunteers provide
information to individuals and employees about insurance affordability programs
and qualified health plan coverage options; assist individuals and employees to
apply for coverage in a qualified health plan through the Marketplace and for
insurance affordability programs; and help to facilitate enrollment of eligible
individuals in qualified health plans and insurance affordability
programs.
"Certified Application Counselor Organization" means any
organization designated by the Marketplace to certify its staff members or
volunteers to act as certified application counselors and includes those
organizations described in
45 CFR
155.225.
"Code" means the Illinois Insurance Code [ 215 ILCS 5 ].
"Course" means any course of study certified to the Director
that meets the requirements of this Part, including but not limited to seminar,
classroom, and self-study formats.
"Department" means the Illinois Department of Insurance.
"Director" means the Director of the Illinois Department of
Insurance or anyone to whom the Director's responsibilities and authority are
lawfully delegated.
"In-Person Counselor" means any individual or entity who
receives grant funds from the State of Illinois to perform the activities and
duties identified in
45 CFR
155.205 or is described or designated by a
Marketplace, the State, or the United States Department of Health and Human
Services, or could reasonably be described or designated as "non-Navigator
assistance personnel" as described in
45
CFR 155.215. An In-Person Counselor would
engage in the activities and meet the standards described in
45
CFR 155.215, including, but not limited
to:
conduct public education activities to raise awareness of the
availability of qualified health plans;
distribute fair and impartial information concerning enrollment
in qualified health plans, and the availability of premium tax credits under
26 USC
36B and cost-sharing reductions under
42
USC 18071;
facilitate enrollment in qualified health plans;
provide referrals to any applicable office of health insurance
consumer assistance or health insurance ombudsman established under section
2793 of the Public Health Services Act (
42 USC
300gg-93 ), or any other appropriate State
agency or agencies, for any enrollee with a grievance, complaint, or question
regarding his or her health plan, coverage, or a determination under a plan or
coverage; and
provide information in a manner that is culturally and
linguistically appropriate to the needs of the population being served by the
Marketplace.
"Marketplace" means any health benefit exchange authorized
under the federal Patient Protection and Affordable Care Act and established or
operating in this State, including any exchange established or operated by the
United States Department of Health and Human Services.
"Navigator" means any individual or entity who is certified as
a "Navigator" under the federal Patient Protection and Affordable Care Act, and
means any individual or entity, other than an insurance producer licensed by
the Department, 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 USC
18031(i)(3) or is described
or designated by a Marketplace, the State, or the United States Department of
Health and Human Services, or could reasonably be described or designated, as
Navigators, as described in
45 CFR
155.210. A Navigator would engage in the
activities and meet the standards described in
45 CFR
155.210 and 45 CFR 155.215, including, but
not limited to:
conduct public education activities to raise awareness of the
availability of qualified health plans;
distribute fair and impartial information concerning enrollment
in qualified health plans, and the availability of premium tax credits under
26 USC
36B and cost-sharing reductions under
42
USC 18071;
facilitate enrollment in qualified health plans;
provide referrals to any applicable office of health insurance
consumer assistance or health insurance ombudsman established under section
2793 of the Public Health Services Act (
42 USC
300gg-93 ), or any other appropriate State
agency or agencies, for any enrollee with a grievance, complaint, or question
regarding his or her health plan, coverage, or a determination under a plan or
coverage; and
provide information in a manner that is culturally and
linguistically appropriate to the needs of the population being served by the
Marketplace.
"Qualified health plan" has the meaning given that term in
42 USC
18021(a).
