Texas Adopts Rules for Health Insurance Exchange Navigators

January 22, 2014

The Texas Department of Insurance (TDI) issued final rules that it says will strengthen protections for consumers who seek assistance from federal health benefit exchange navigators.

The department says the rules address insufficiencies in federal standards, as required by Senate Bill (SB) 1795.

The rules do not apply to licensed insurance agents.

“These rules will help ensure Texans have confidence that anyone registered as a navigator has passed appropriate background checks and received the training they need to safeguard a consumer’s most sensitive and personal information,” Commissioner of Insurance Julia Rathgeber said in an announcement released by TDI.

For individual navigators who provide enrollment assistance in a health benefit exchange, the rules require background checks, training, and proof of identity.

Entities that perform or oversee an individual’s performance of enrollment assistance in a health benefit exchange must provide evidence of financial responsibility.

Entities and individuals providing enrollment assistance are required to register with TDI. There is no fee to register.

Navigators have until March 1, 2014, to register with TDI and until May 1, 2014, to complete the required 20 hours of preregistration education courses that consist of TDI-certified, Texas-specific training on the following topics:

  • Texas-specific Medicaid and Children’s Health Insurance Program provisions (five hours),
  • Applicable privacy requirements (five hours),
  • Ethics (five hours),
  • Basic insurance terminology and how insurance works (two hours),
  • Exam preparation (two hours), and
  • Completion of a final examination (one hour)

The rules prohibit navigators while providing navigator services from the following:

  • Charging consumers for providing information about health coverage
  • Selling, soliciting, or negotiating health insurance coverage
  • Recommending a specific health benefit plan, and
  • Engaging in electioneering activities, or otherwise supporting the candidacy of an individual for government positions

The final rules apply to both federal grant recipients and other entities and individuals that may wish to provide federal benefit exchange enrollment assistance.

Under the rules, Texas Insurance Code provisions related to privacy and protection of personal information would also apply to navigators.

The final rules have been submitted to the Texas Register for publication on Feb. 7, 2014. The final rules, are available for viewing on TDI’s website.

Source: Texas Department of Insurance

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