M ARYLAND H EALTH B ENEFIT E XCHANGE Navigator Program Advisory Committee Second Meeting July 30, 2012 11:00 am - 2:00pm Maryland Department of Transportation
Definitions Overview
Definitions Overview -Authorized by the Individual Exchange -Engages Individual Exchange Navigators to carry out all or some Individual Exchange Navigator Navigator functions Entity -May not be a health insurance issuer or receive compensation for the sale of health plans 1 -Authorized by the Individual Exchange -Engages Individual Exchange Health Insurance Issuer Navigators to carry out all or some Navigator functions -May provide customer assistance Local DSSs, LHDs, and other through current funding streams Non-Navigator Customer -May not assist individuals with the sale, solicitation, or negotiation of Assistance Entities plans in or outside the Exchange 1 Navigator Entities may receive compensation from issuers for services unrelated to the sale of health plans - 2 -
Definitions Overview -Employed by Individual Exchange Navigator Entity -Certified by Health Insurance Commissioner Individual -Compensated by the Exchange Exchange -May only provide assistance regarding health and dental Navigator plans in the Individual Exchange -May not be an insurance producer -Employed by unknown -Licensed by Health Insurance Commissioner -Compensated by the Exchange SHOP Exchange -May only provide assistance regarding health and dental Navigator plans in the SHOP Exchange -May not be an insurance producer -Employed by Health Insurance Issuer -Licensed by Health Insurance Commissioner -Compensated by Health Insurance Issuer Health Insurance -May provide assistance regarding health and dental plans in Producer or out of the Individual and SHOP Exchange, provided additional training and licensure by the Commissioner - 3 -
Definitions Overview Employee of a Navigator Entity or outside entity; may Assister not assist with the sale, solicitation, or negotiation of plans in or outside the Exchange Uncompensated individual; may not assist with the sale, solicitation, or negotiation of plans in or outside Consumer Rep the Exchange - 4 -
Representa- Consumer Exchange Navigator Exchange Insurance Individual Navigator Producer Assister SHOP tive Who can provide customer assistance services in the Exchange? Who can be compensated for their services? Who can be compensated by the Exchange? Who can be compensated by Issuers? Who can assist with the sale, solicitation, or negotiation of plans in the Exchange? Who can provide customer assistance services outside the Exchange? Who can assist with the sale, solicitation, or negotiation of plans outside the Exchange? - 5 -
Operational Models Overview and Request for Information Discussion
Draft Regulations Discussion
Regulation Promulgation Process - 8 -
Individual Exchange Navigator Certification Topic MHBE Act of 2012 Language Proposed Regulation Recommendation Eligibility To qualify for an Individual Exchange To be eligible to apply for initial Individual Requirements Navigator Certification, an applicant Exchange Navigator Certification, an shall: applicant must: • Be of good character • Be at least 18 yrs old • Be of good character • Complete and comply with any • Be at least 18 yrs old ongoing requirements of the training • Complete and comply with any program and applicable requirements ongoing requirements of the training of DHMH program and applicable requirements of DHMH An Individual Exchange Navigator: • Be employed or engaged by a shall be employed or engaged by an Navigator Entity Individual Exchange navigator entity - 9 -
Insurance Producer Authorization Topic MHBE Act of 2012 Language (Paraphrased) Proposed Regulation Recommendation Eligibility Under the authorization program/process, the To be eligible to apply for Requirements SHOP/Individual Exchange shall provide an initial Insurance Producer authorization to sell qualified plans to: Authorization, an applicant • a licensed producer must: • who registers and applies for an authorization from • Be a licensed insurance the SHOP/Individual Exchange, producer in good • completes and complies with any ongoing standing under the requirements of the SHOP/Individual Exchange Insurance Article of the Insurance Producer Authorization training program, state • (for SHOP) and in providing assistance to a small employer, informs the small employer of all qualified health plans available in the SHOP Exchange • (for Individual Exchange) refer individual seeking insurance who may qualify for Medicaid or MCHP to the Navigator Program for the Individual Exchange An insurance producer may not be compensated by the SHOP or Individual Exchange for the sale of a qualified plan and shall be compensated directly by a carrier. - 10 -
Individual Exchange Navigator Certification Topic MHBE Act of Proposed Regulation Recommendation 2012 Language Application N/A In order to obtain an Individual Exchange Navigator Certification, Procedures the applicant shall submit: • An application on the form provided by the Exchange • Pay to the Exchange an application fee of $75 • Submit evidence that the applicant has successfully completed the Individual Exchange Navigator Certification training, including, as appropriate, the annual Exchange Consumer Assistance Training • Submit evidence of employment or engagement by a Navigator Entity The Exchange may not consider an application as complete until it has received all required materials. If the application is not completed with all required materials within 45 days after the Exchange receives the signed application form, the Exchange may deny the application. - 11 -
Insurance Producer Authorization Topic MHBE Act of Proposed Regulation Recommendation 2012 Language Application N/A In order to obtain an Insurance Producer Authorization, the Procedures applicant shall submit to the Exchange: • An application on the form provided by the Exchange • Pay to the Exchange the application fee of $75 • Submit evidence that the applicant is a licensed insurance producer in good standing under the Insurance Article of the state • Submit evidence that the applicant has successfully completed, as appropriate, the SHOP Exchange Insurance Producer Authorization training or the Individual Exchange Producer Authorization training, including the annual Exchange Consumer Assistance Training The Exchange may not consider an application as complete until it has received all required materials. If the application is not completed with all required materials within 45 days after the Exchange receives the signed application form, the Exchange may deny the application. - 12 -
Individual Exchange Navigator Certification Topic MHBE Act of 2012 Language Proposed Regulation (Paraphrased) Recommendation Training Standards: The training program shall: Scope of the Training: The • Scope, Conduct, Provide Individual Exchange Navigators training shall include, as and Type of with the full range of skills, knowledge, appropriate to the Individual Training and expertise necessary to meet the Exchange Navigator functions: • consumer assistance , eligibility, Consumer assistance and enrollment, renewal, and disenrollment protection expertise • needs of individuals who are eligible for Quality assurance standards Medicaid or CHIP or seeking qualified plans in the Individual Exchange; Conduct: The exchange shall • Enable the Navigator Program for the conduct the training in several, Individual Exchange to provide robust geographically diverse locations protection of consumers and adherence across the state. The training must to high quality standards; and be conducted in facilities equipped • Enable the Individual Exchange to to provide access in accordance ensure that, with respect to Individual with the American with Disabilities Exchange Navigators who offer any Act (ADA) of 1990. form of assistance to individuals regarding Medicaid or CHIP, the Type: The training shall include a Individual Exchange Navigator final examination. The examination Certification program shall comply with will be multiple choice. all DHMH requirements - 13 -
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