Regulators begin work on “navigator” licensing framework
Federal guidance due out soon
State and federal regulators have begun developing a framework for licensing Health Insurance Exchange “navigators.” Starting shortly before the exchanges go live in 2014, navigators will be responsible for helping to educate or enroll individuals or small businesses in exchange plans. A navigator is intended to serve as a neutral advisor who will help consumers, including people who have never used any kind of public or private health insurance, determine how to use the new exchange system and make decisions about their coverage.
The Producer Licensing Task Force, a part of the National Association of Insurance Commissioners, is seeking public comments on a "discussion framework," or an outline of ideas about navigator oversight. The task force draft lays out recommendations for application information requirements, training and continuing education, and mechanisms for addressing consumer complaints.1 Federal guidance on navigators is tentatively set to be released in January 2013.
Under the health care law, a navigator’s purpose is to:
- Conduct public education activities to raise awareness about Qualified Health Plans
- Distribute fair and impartial information concerning enrollment in Qualified Health Plans and the availability of premium tax credits and cost-sharing reductions
- Facilitate enrollment in Qualified Health Plans
- Provide referrals to appropriate agencies for enrollees with grievances, complaints or questions
- Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the exchange
Federal guidance from August 2012 calls for oversight to make sure navigators are properly trained to:2
- Provide sound consumer guidance
- Avoid any conflict of interest
- Protect the privacy and security of consumers
Each Health Insurance Exchange is required to institute a program that will award grants to help establish navigator resources. The money for these grants will come from the exchange’s operational funds, not from the federal funds that states can receive to establish their exchanges. The NAIC task force suggests that states can wait to find out which navigator regulations HHS will implement — or they can proceed, basing their navigator standards on those already applied to agents and brokers who sell Medicare supplement plans and other health insurance plans to seniors. Navigators need to be ready to help consumers use exchanges by October 1, 2013.
What you need to know now
- Impact on employers – Employers will need to follow the progress of the exchanges in their states and understand the options available to their company and workers. They will also need to understand the navigator role and how navigators can help their business and workers (if applicable) access health coverage on the exchanges.
- Impact on brokers – Brokers will need to continue to stay informed about the evolving role of the navigator, so they can continue to serve as trusted advisors on key employer questions. Brokers will need to understand how to operate alongside navigators. Be watching for guidance/information on what exchanges the navigators will support. As it stands currently, navigators may only support the individual exchanges, with brokers then supporting the small business (or SHOP) exchanges.
Qualified Health Plan
A Qualified Health plan must:
- Meet certain criteria for certification issued or recognized by each exchange through which the plan is offered
- Provide the "Essential Benefits" package
- Be offered by an approved health insurer