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SS/SB 401 - This act provides that no individual or entity shall perform, offer to perform, or advertise any service as a navigator in Missouri or receive navigator funding from Missouri or a health insurance exchange unless licensed as a navigator by the Department of Insurance, Financial Institutions and Professional Registration. Under the act, navigators may provide fair and impartial information and services in connection with eligibility, enrollment, and program specifications of any health benefit exchange operating in this state, including information about the costs of coverage, advance payments of premium tax credits, and cost sharing reductions. In addition, navigators may facilitate the selection of a qualified health plan and initiate the enrollment process. Navigators may provide referrals to any applicable office of health insurance consumer assistance, ombudsman, or other agency for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or determination under the plan. Unless properly licensed as a health insurance producer in this state, a navigator shall not: (1) Sell, solicit, or negotiate health insurance; (2) Engage in any activity that would require an insurance producer license; (3) Provide advice concerning the benefits, terms, and features of a particular health plan or offer advice about which exchange health plan is better or worse for a particular individual or employer; (4) Recommend or endorse a particular health plan or advise consumers about which health plan to choose; or (5) Provide any information or services related to health benefit plans or other products not offered in the exchange. The act specifically exempts certain entities from being the licensure requirements. Specifically, health insurance producers, law firms, licensed attorneys, and certain health care providers are exempt from licensure. The act delineates the process for obtaining a navigator license, including the qualifications for obtaining such a license, the payment of licensing fees, the posting of surety bonds, and other ancillary matters. A navigation license is valid for 2 years. The act sets forth the process for renewing a navigator license. In order to renew a license, an individual licensee must comply with any training and continuing education requirements established by the director. Failure to satisfy training and continuing education requirements shall result in the expiration of the license. Under the act, any navigator who has contact with a person who acknowledges having existing health insurance coverage obtained through an insurance producer must advise the person to consult with a licensed insurance producer regarding coverage in the private market. The act establishes a procedure for suspending, revoking, or refusing to issue or renew a navigator license. The grounds for suspension or revocation are similar to the grounds for suspending an insurance producer license. A navigator license may also be suspended or revoked for engaging in unfair trade practices. The act allows the director to issue administrative orders and maintain civil actions against persons who are violating the navigator licensure provisions. Under the act, a violation of the navigator licensure provisions is a level 2 violation under the state insurance code. Under the terms of the act, each licensed navigator shall report to the director within 30 calendar days of the final disposition of the matter of any administrative action taken against him or her in another jurisdiction or by another governmental agency in this state. The act further requires, within 30 days of the initial pretrial hearing date, a navigator to report any criminal prosecution of the navigator in any jurisdiction. The provisions pertaining to navigator licensing are severable. The act authorizes the director to promulgate rules and regulations to implement the licensing provisions. This act provides that the Department of Insurance shall exercise its authority and responsibility over health insurance product form filings, consumer complaints, and investigations into compliance with state law, regardless as to how a health insurance product may be sold or marketed in this state or to residents of this state (Section 1). The act is subject to an emergency clause. Several provisions of this act are similar to the ones contained in SB 403 (2013). STEPHEN WITTE
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