760 IAC 4-3-1 - Certification and registration requirement

Authority: IC 27-19-1-4; IC 27-19-4-1; IC 27-19-4-11

Affected: IC 27-1-15.6; IC 27-1-15.7; IC 27-19-4-11

Sec. 1.

(a) A person shall not assist individuals with application for and enrollment in a QHP through a health benefit exchange or in a public health insurance program or otherwise function as a navigator or application organization unless the individual is certified as a navigator or the entity is registered as an application organization under this rule.

(b) A person that is a navigator described in Section 1311(i) of PPACA (42 U.S.C. 18031(i)), a certified application counselor described in 45 CFR 155.225 issued pursuant to PPACA, or any other federal assistance personnel under PPACA, shall:

(1) continue to carry out all duties and functions under PPACA while applying to be certified as a navigator or registered as an application organization under this rule;

(2) obtain certification as a navigator or registration as an application organization in a timely manner as determined by the commissioner in consultation with the secretary; and

(3) continue to carry out all duties and functions under PPACA while acting as a certified navigator or registered application organization.

(c) An individual applying for navigator certification shall meet the following:

(1) Be at least eighteen (18) years of age.

(2) Not have committed any violation under IC 27-19-4 or this article that would be grounds for denial, suspension, or revocation of certification.

(3) Complete and submit the navigator application pursuant to section 2 of this rule.

(4) Submit the nonrefundable application fee in accordance with section 3 of this rule.

(5) Complete navigator precertification education under section 4 of this rule.

(6) Pass the certification examination pursuant to section 5 of this rule.

(7) Not have a conflict of interest, as defined in 760 IAC 4-5, that prohibits the individual from:

(A) providing fair, accurate, and impartial information and assistance regarding application for and enrollment in a QHP through a health benefit exchange or in a public health insurance program; or

(B) acting in the best interests of individuals the individual is assisting.

(d) An entity applying for registration as an application organization shall meet the following:

(1) Be in good standing with the Indiana secretary of state.

(2) Not have committed or have an owner, partner, officer, director, member, or manager who has committed any violation under IC 27-19-4 or this article that would be grounds for denial, suspension, or revocation of registration.

(3) Complete and submit the application organization application pursuant to section 2 of this rule.

(4) Submit the nonrefundable application fee in accordance with section 3 of this rule.

(5) Designate at least one (1) certified navigator to ensure the entity's compliance with IC 27-19-4 and this article.

(6) Not have a conflict of interest, as defined in 760 IAC 4-5, that prohibits the entity from:

(A) providing fair, accurate, and impartial information and assistance regarding application for and enrollment in a QHP through a health benefit exchange or in a public health insurance program; or

(B) acting in the best interests of individuals the entity is assisting.

(e) Neither a navigator nor application organization is subject to the licensing requirements of IC 27-1-15.6 unless such navigator or application organization is also acting within the capacity of an insurance producer or consultant as defined under IC 27-1-15.6.

(f) A licensed insurance producer or consultant acting solely within the capacity of a licensed insurance producer or consultant under IC 27-1-15.6 is not subject to the navigator certification or application organization registration requirements under IC 27-19-4 and this rule.

(g) If a licensed insurance producer or consultant, who does not currently receive consideration directly or indirectly from a health insurance issuer in connection with the enrollment of an individual in a health plan, wants to perform the functions of a certified navigator under IC 27-19-4 and this rule, the licensed insurance producer or consultant shall request designation and approval from the commissioner by:

(1) submitting to the department such request for designation and approval on a form provided by the department in a manner specified by the commissioner in consultation with the secretary; and

(2) completing navigator precertification education as described in section 4 of this rule.

The precertification education hours shall be in addition to the insurance producer or consultant continuing education requirements under IC 27-1-15.7 and shall not be credited toward such requirements.

(h) If a licensed producer or consultant receives approval from the department and is designated as a certified navigator, the licensed producer or consultant shall be subject to regulation and enforcement by the department under IC 27-19-4 and this article and shall do the following to maintain such designation:

(1) Complete annually at least two (2) hours of navigator continuing education as described in section 6 of this rule. Such hours shall not be in addition to the insurance producer or consultant continuing education requirements under IC 27-1-15.7 and shall be credited toward such requirements.

(2) Follow the conflicts of interest and privacy and security requirements under 760 IAC 4-5.

(3) Submit to the department an annual request for renewal of designation and approval on a form provided by the department in a manner specified by the commissioner in consultation with the secretary.

Notes

760 IAC 4-3-1

Filed 6/10/2016, 1:21 p.m.: 20160706-IR-760150033FRA Readopted filed 11/30/2022, 11:39 a.m.: 20221228-IR-760220302RFA