WASHINGTON, D.C., March 11, 2013 — The Independent Insurance Agents & Brokers of America (IIABA or the Big “I”) applauds the National Conference of Insurance Legislators (NCOIL) for adopting a resolution urging local policymakers to establish state-based regulatory frameworks for navigators and in-person assisters during NCOIL’s spring meeting.

 

The Patient Protection and Affordable Care Act (PPACA) requires the establishment of health insurance exchanges in every state by Oct. 1, 2013, and the law requires every exchange – whether state-based or federally-operated – to have a navigator program. Navigators must comply with any licensing, certification or other standards required by states, and the ‘Resolution Regarding  Health Benefit Exchange Navigator Programs’ urges states to utilize their authority to ensure that navigators are subject to the jurisdiction and oversight of state officials. 

 

“The Big ‘I’ welcomes NCOIL’s recommendations concerning navigators and strongly agrees that states are best suited to oversee this new category of entity and protect consumers,” says Wes Bissett, Big “I” outside senior counsel, government affairs. “Ensuring that there is proper scrutiny over navigator qualifications and behavior is good public policy.”

 

In the resolution, NCOIL noted that “[t]he failure of a state to establish an appropriate licensing and oversight structure for navigators and similar assisters will result in a regulatory vacuum that leaves these individuals and entities outside of the jurisdiction of state officials and the state insurance code and makes consumers vulnerable.”

 

The document also urges states to enact a licensing framework and regulatory regime for navigators that includes the following elements:

 

•          Defines the permitted scope of a navigator and assister's activities and prohibits them from recommending particular health plans, offering advice about which health plan to choose, and engaging in similar activities;

 

•          Includes appropriate and meaningful training, continuing education and examination requirements;

 

•          Ensures that navigators are subject to the jurisdiction of state officials and the state insurance code, including privacy, market conduct and unfair trade practices acts;

 

•          Enables regulators to take enforcement action - such as assessing fines or suspending or revoking a license - when navigators engage in improper conduct, commit fraud, or violate state marketplace and consumer protection requirements;

 

•          Requires prospective navigators and similar assisters to undergo criminal and regulatory background screening;

 

•          Makes navigators and similar assisters responsible and legally liable for their actions and establishes financial responsibility requirements to ensure that consumers are made whole whenever wrongful or negligent acts are committed;

 

•          Establishes any other appropriate and relevant consumer protection and market conduct standards;

 

•          Ensures that navigators and similar assisters receive the due process protections afforded to other insurance licensees; and

 

•          Encourages the use of veterans for navigator positions.

 

Addressing and improving the navigator program has been a Big “I” priority since the enactment of the PPACA.

 

“The Big ‘I’ supports NCOIL’s resolution and the individual efforts of numerous states to improve the navigator program and ensure that consumers are protected,” says Charles Symington, Big “I” senior vice president of external and government affairs. “This is a perfect example of the many challenges presented by the PPACA and NCOIL’s constructive efforts to improve the law’s implementation are appreciated.”